The Slight Surprise of Integration

Western hospitals of some size are characterized by a proliferation of nonintegrated information systems, resulting in considerable frustration both among users and information technology personnel. Consequently there have been many integration efforts. Such efforts typically include some or all of the four principle classes of hospital-based systems: electronic patient records, laboratory systems, radiology systems and patient administrative systems. In this study, we trace the implementation process during most of 2004 at the University Hospital of North Norway, where these systems were part of a larger replacement project. We analyze the images and visions of order and perfection serving as a foundation for the decision to replace the existing IT portfolio. Furthermore, we analyze the manner and form in which unintended consequences of the integrated solutions appear and, finally, how the very act of integration may indeed produce rather than curb disorder. As a result, a lack of integration of any reasonably complex information system is an immanent feature.