Medication, integrations and practice

To ensure quality in medication management, the electronic medication management system (EMMS) must communicate and collaborate with other IT systems in the hospital, particularly the electronic patient record (EPR). To achieve those integrations is not purely a technical task, and the aim of our paper is to contribute to the development of a socio-technical understanding of integration in health care, and to to conceptualize infrastructures with the help of boundary work and translations. Empirically, we have studied the implementation of a new EMMS in the Northern Norway Regional Health Authority. Our case shows that the integrations are affected by the existing IT systems in the region. Work tasks that had originally been planned for inclusion in the EMMS were shifted to the EPR due to existing functionality. In addition, differences in the contracts with the two vendors of the systems played a role. Most of the patient pathways and treatment plans extend across both the EMMS and the EPR and the boundaries between the two systems are sometimes blurred. To achieve integration based on this is hard. In addition, some integrations lead to additional work for clinicians, because data from one system to another must be translated between the different contexts, and the clinicians have to approve each translation. Integrations include crossing boundaries, which implies translation and negotiation. These concepts thus need to be considered to achieve successful integrations in health care.