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Interpretation of the Concepts of Enterprise-wide and Best of Breed IT within the New Zealand eHealth Community
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
2013 (English)In: Health Care and Informatics Review Online, ISSN 1176-4201, Vol. 17, no 1, 11-17 p.Article in journal (Refereed) Published
Abstract [en]

Purpose The New Zealand eHealth landscape is diverse with hundreds of systems ‘wired together’ in a complex puzzle. The purpose of this paper is to explore the current debate about selecting and using Best of Breed (BoB) or Enterprise-wide (EW) eHealth systems.

Method Strategic eHealth documents were analysed and 14 senior IS executives from health and IT organisations were interviewed.

Findings There appears to be agreement about: (1) what the concepts mean; (2) the problems caused by the mix of BoB and EW, e.g., the strong influence of clinicians on IT decision making; and (3) a possible solution to the complex puzzle lies in changing the mix to emphasise patient-centric eHealth. However, when discussing to what degree IT systems should be customised and/or centralised disagreements become visible.

Discussion and conclusions There is a trend among decision-makers towards patients’ needs rather than the physical context in deciding system use and design, with an emphasis on what is considered to be ‘best practice’. In this process the preferred systems are EW, however it is important to remember that it is not the only option. There is a risk that if the IT system is too generic (centralised) it might be an unsupportive tool for clinicians and undermine its purpose. 

Place, publisher, year, edition, pages
2013. Vol. 17, no 1, 11-17 p.
Keyword [en]
eHealth, enterprise-wide systems, Best of Breed systems, procurement, development, system usage
National Category
Human Computer Interaction
Research subject
Medical Informatics; Human-Computer Interaction
URN: urn:nbn:se:uu:diva-196505OAI: oai:DiVA.org:uu-196505DiVA: diva2:610291
Available from: 2013-04-01 Created: 2013-03-10 Last updated: 2014-01-08Bibliographically approved
In thesis
1. Evolving Systems – Engaged Users: Key Principles for Improving Region-wide Health IT Adoption
Open this publication in new window or tab >>Evolving Systems – Engaged Users: Key Principles for Improving Region-wide Health IT Adoption
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many countries have formulated their eHealth visions and billions of dollars have been spent on supporting the eHealth development throughout the world. An important part of the development is the electronic patient record (EPR). To enable sharing and increase cooperation between care providers, most Swedish county councils have decided to use a region-wide EPR. The health professionals often experience numerous problems and consider the region-wide EPR to be too generic and require them to tailor their practices instead of the system evolving towards supporting their needs.

The aim of the PhD research is to gain knowledge of adoption when deploying and using region-wide health IT systems. This is accomplished by studying, analysing and reflecting upon what region-wide health IT systems are and how professionals use them in their practice. In the research a grounded theory method has been used, which means that the empirical data, not theories and hypotheses, have driven the research process. The data-gathering methods have been interviews, observations, participating in meetings, questionnaires, seminars and conducting literature reviews.

In order to be able to improve the adoption, a set of four key principles has been identified: (1) Evolving systems-Engaged users, (2) Treat IT deployment and usage as part of organisational development, (3) Identify, respect and support differences, and (4) Identify what must be customised and what can be centralised.

These four principles challenge the traditional way of developing enterprise-wide IT and emphasise the importance that users must engage in the development, procurement and deployment process to identify their similar and unique needs and procedures. It is crucial that both the similarities and uniqueness are respected and supported. The similarities can be supported by a centralised, standardised solution, while uniqueness requires a customised solution. In order to accomplish that, the IT deployment and usage needs to be treated as an important part of the on-going organisational development, and the IT systems must evolve, i.e., be continuously developed in order to engage the users to participate. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 85 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 1030
HCI, eHealth, EPR, sociotechnical systems, enterprise-wide systems, deployment, change management, usability, health care
National Category
Human Computer Interaction
Research subject
Computer Science with specialization in Human-Computer Interaction
urn:nbn:se:uu:diva-196510 (URN)978-91-554-8623-5 (ISBN)
Public defence
2013-05-24, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:30 (Swedish)
Available from: 2013-05-02 Created: 2013-03-11 Last updated: 2014-07-21Bibliographically approved

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