Unravelling Design Controversies in a Transnational Healthcare Information System: An Actor-Network Analysis

Healthcare insurance firms are experimenting with integrating self-managed healthcare elements into their product and service design and making these available through transnational healthcare information systems (THISs). The purpose of this article is to analyze this technology using a socio-technical theoretical lens. Drawing from a longitudinal case study, this paper unravels some of the design controversies presented by a self-managed nutrition technology, designed by a South African healthcare insurance firm for the local and UK market. Using key concepts (inscription, translation, enrollment, delegation, and displacement) from actor-network theory, this paper reveals why, in this context, the traditional face-to-face dietetic practice could not be completely entrusted to a THIS. The results demonstrate that firms are sometimes better off resorting to traditional channels for complex and high contact healthcare interventions. Practitioners need to be aware of potentially ‘tricky’ socio-technical entanglements when designing a novel THIS and future researchers must account for the increasing complexity involved in operating these technologies in different national healthcare contexts. Guidelines are offered for firms contemplating off-shoring self-managed healthcare technology developments. Unravelling Design Controversies in a Transnational Healthcare Information System: An Actor-Network Analysis