Evolution of Information Infrastructures in Healthcare as Convergence of Digital Trajectories

In information infrastructures at hospitals, various stakeholders are responsible for specific information and communications technology (ICT) portfolios. Each portfolio represents a unique digital trajectory with a past, present, and future. This study investigated how stakeholders (in this study, software developers, ICT operations organizations, and users) collaborate to facilitate the convergence of different digital trajectories, thus contributing to the successful evolution of information infrastructures. Empirically, we focused on the preparatory work involved in implementing an app that would enable nurses to register and calculate National Early Warning Scores at Nordland Hospital in northern Norway. Specifically, we examined the collaboration between three stakeholders to align their respective ICT portfolios and prepare for the new solution. These stakeholders were the Finnish software developer Medanets, the Norwegian Electronic Health Record developer DIPS ASA, and the Northern Norway Regional Health Authority, which governed the regional health ICT infrastructure. These stakeholders governed three distinct portfolios that had been developed over many years and, in this sense, represented digital trajectories with a past, a present, and a possible future. This study is positioned within the computer-supported cooperative work field, and the analysis draws upon the theoretical concepts of information infrastructure and trajectories.