Skip to main content
Log in

Transforming healthcare: policy discourses of IT and patient-centred care

  • Empirical Research
  • Published:
European Journal of Information Systems

Abstract

Information Technology (IT) is increasingly seen in policy and academic literature as key to the modernization of healthcare provision and to making healthcare patient-centred. However, the concept of Patient-Centred Care (PCC) and the role of IT in the transformation of healthcare are not straightforward. Their meanings need unpacking in order to reveal assumptions behind different visions and their implications for IT-enabled healthcare transformation. To this end, this paper reviews literature on PCC and IT and analyses England’s health policy between 1989 and 2013. English policy has set out to transform healthcare from organization-centric to patient-centred and has placed IT as central to this process. This policy vision is based on contested conceptualizations of PCC. IT implementation is problematic and this is at least partly because of the underpinning goals and visions of healthcare policy. If this misalignment is not addressed then producing technologically superior systems, or better IT implementation strategies, is unlikely to result in widespread and substantial changes to the way healthcare is delivered and experienced. For IT to support a healthcare service that is truly patient-centred, patients’ needs and wants need to be identified and designed into IT-enabled services rather than simply added on afterwards.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2

Similar content being viewed by others

References

  • Aanestad M and Jensen TB (2011) Building nation-wide information infrastructures in healthcare through modular implementation strategies. The Journal of Strategic Information Systems 20 (2), 161–176.

    Article  Google Scholar 

  • Aarts J and Berg M (2006) Same systems, different outcomes – comparing the implementation of computerized physician order entry in two Dutch hospitals. Methods of Information in Medicine 45 (1), 53–61.

    Google Scholar 

  • Adams S and Bont AD (2007) Information Rx: prescribing good consumerism and responsible citizenship. Health Care Anal 15 (4), 273–290.

    Article  Google Scholar 

  • Agarwal R, Gao G, Desroches C and Jha AK (2010) The digital transformation of healthcare: current status and the road ahead. Information Systems Research 21 (4), 796–809.

    Article  Google Scholar 

  • Ashburner DL, Ferlie DE and Fitzgerald DL (1996) Organizational transformation and top-down change: the case of the NHS. British Journal of Management 7 (1), 1–16.

    Article  Google Scholar 

  • Atkinson CJ and Peel VJ (1998) Transforming a hospital through growing, not building, an electronic patient record system. Methods Archive 37 (3), 285–293.

    Google Scholar 

  • Barley SR (1986) Technology as an occasion for structuring: evidence from observations of CT scanners and the social order of radiology departments. Administrative Science Quarterly 31 (1), 78–108.

    Article  Google Scholar 

  • Barrett M, Oborn E, Orlikowski WJ and Yates J (2012) Reconfiguring boundary relations: robotic innovations in pharmacy work. Organization Science 23 (5), 1448–1466.

    Article  Google Scholar 

  • Berg M, Aarts J and Van Der LEI J (2003) ICT in healthcare: sociotechnical approaches. Methods of Information in Medicine 42 (4), 297–301.

    Google Scholar 

  • Black A et al (2011) The impact of eHealth on the quality and safety of healthcare: a systematic overview. PLoS Med 8 (1:e100387).

  • Bloomfield BP and Hayes N (2009) Power and organizational transformation through technology: hybrids of electronic government. Organization Studies 30 (5), 461–487.

    Article  Google Scholar 

  • Blumenthal D (2011a) Wiring the health system – origins and provisions of a new federal program. New England Journal of Medicine 365 (24), 2323–2329.

    Article  Google Scholar 

  • Blumenthal D (2011b) Implementation of the federal health information technology initiative. New England Journal of Medicine 365 (25), 2426–2431.

    Article  Google Scholar 

  • Boland RJ (1987) The in-formation of information systems. In Critical Issues in Information Systems Research (Boland RJ and Hirschheim RA Eds), John Wiley & Sons, Chichester.

    Google Scholar 

  • Bowker G (1994) Information mythology: the world of/as information. In Information Acumen: The Understanding and Use of Knowledge in Modern Business (Bud-Frierman L, Ed), Routledge, London.

    Google Scholar 

  • Buntin MB, Burke MF, Hoaglin MC and Blumenthal D (2011) The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs 30 (3), 464–471.

    Article  Google Scholar 

  • Chalaby JK (1996) Beyond the prison-house of language: Discourse as a sociological concept. British Journal of Sociology 47 (4), 684–698.

    Article  Google Scholar 

  • Chen C, Garrido T, Chock D, Okawa G and Liang L (2009) The kaiser permanente electronic health record: transforming and streamlining modalities of care. Health Affairs 28 (2), 323–333.

    Article  Google Scholar 

  • Cho S, Mathiassen L and Nilsson A (2008) Contextual dynamics during health information systems implementation: an event-based actor-network approach. European Journal of Information Systems 17 (6), 614–630.

    Article  Google Scholar 

  • Clegg C and Shepherd C (2007) The biggest computer programme in the world … ever!: time for a change in mindset? Journal of Information Technology 22 (3), 212–221.

    Article  Google Scholar 

  • Coakes E, Willis D and Lloyd-Jones R Eds (2000) The New Sociotech: Graffiti on the Longwall. Springer Verlag, London.

    Book  Google Scholar 

  • Cornford T and Klecun-Dabrowska E (2003) Images of health technology in national and local strategies. Methods of Information in Medicine 42 (4), 353–359.

    Google Scholar 

  • Currie W and Guah M (2007) Conflicting institutional logics: a national programme for IT in the organisational field of healthcare. Journal of Information Technology 22 (3), 235–247.

    Article  Google Scholar 

  • Currie WL (2012) Institutional isomorphism and change: thenational Programme for IT – 10 years on. Journal of Information Technology 27 (3), 236–248.

    Article  Google Scholar 

  • Currie WL and Finnegan DJ (2011) The policy-practice nexus of electronic health records adoption in the UK NHS: an institutional analysis. Journal of Enterprise Information Management 24 (2), 146–170.

    Article  Google Scholar 

  • Darking M et al (2014) Practice-centred evaluation and the privileging of care in health information technology evaluation. BMC Health Services Research 14 (1), 243.

    Article  Google Scholar 

  • Davidson E and Reardon J (2005) Organizing visions for IT healthcare: analysis of the discourse surrounding electronic health records. Academy of Management Conference. Honolulu.

  • Davidson EJ and Chismar WG (2007) The interaction of institutionally triggered and technology-triggered social structure change: an investigation of computerized physician order entry. MIS Quarterly 31 (4), 739–758.

    Google Scholar 

  • Davies SJ, Hayes C and Quintner JL (2011) System plasticity and integrated care: informed consumers guide clinical reorientation and system reorganization. Pain Medicine 12 (1), 4–8.

    Article  Google Scholar 

  • Davis K, Schoenbaum SD and Audet A (2005) A 2020 vision of patient-centred primary care. Journal of General Internal Medicine 20 (10), 953–957.

    Article  Google Scholar 

  • DOH (1989) Working for Patients. Department of Health. HMSO, London.

  • DOH (1992) The Health of the Nation. Department of Health. HMSO, London.

  • DOH (1997) The New NHS: Modern.Dependable. Department of Health. HMSO, London.

  • DOH (1998) Information For Health: An Information Strategy for the Modern NHS 1998–2005. Department of Health, NHS Executive, Leeds.

  • DOH (1999) Saving Lives: Our Healthier Nation. Department of Health. HMSO, London.

  • DOH (2000) The NHS Plan -The Command Paper 4818-1. Department of Health. HMSO, London.

  • DOH (2001) Building the Information Core – implementing The NHS Plan. Department of Health. HMSO, London.

  • DOH (2002) Delivering the 21st Century IT Support for the NHS: National Strategic Programme. Department of Health. HMSO, London.

  • DOH (2005) Creating a Patient-led NHS: Delivering the NHS Improvement Plan. Department of Health. HMSO, London.

  • DOH (2010) Equity and Excellence: Liberating the NHS. Department of Health. HMSO, London.

  • DOH (2012) Power of Information: Putting us All in Control of the Health and Social Care Information We Need. Department of Health. HMSO, London.

  • Doolin B (2003) Narratives of change: discourse, technology and organization. Organization 10 (4), 751–770.

    Article  Google Scholar 

  • Eason K (2007) Local sociotechnical system development in the NHS national programme for information technology. Journal of Information Technology 22 (3), 257–264.

    Article  Google Scholar 

  • Fairclough N and Wodak R (1997) Critical discourse analysis. In Discourse Studies: A Multidisciplinary Introduction (Dijk TV Ed) Sage, London.

    Google Scholar 

  • Fichman RG, Kohli R and Krishnan R (2011) The role of information systems in healthcare: current research and future trends. Information Systems Research 22 (3), 419–428.

    Article  Google Scholar 

  • Fotaki M (2010) Why do public policies fail so often? Exploring health policy-making as an imaginary and symbolic construction. Organization 17 (6), 703–720.

    Article  Google Scholar 

  • Gagnon S and Chartier L (2012) Health 3.0 – the patient-clinician ‘arabic spring’ in healthcare. Health 4 (2), 39–45.

    Article  Google Scholar 

  • Gianchandani EP (2011) Toward smarter health and well-being: an implicit role for networking and information technology. Journal of Information Technology 26 (2), 120–128.

    Article  Google Scholar 

  • Grant D and Hardy C (2004) Introduction: struggles with organizational discourse. Organization Studies 25 (1), 5–13.

    Article  Google Scholar 

  • Greenhalgh T, Potts HW W, Wong G, Bark P and Swinglehurst D (2009) Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. The Milbank Quarterly 87 (4), 729–788.

    Article  Google Scholar 

  • Greenhalgh T, Hinder S, Stramer K, Bratan T and Russell J (2010a) Adoption, non-adoption, and abandonment of a personal electronic health record: case study of healthspace. British Medical Journal 341 (c5814).

  • Greenhalgh T, Stramer K, Bratan T, Byrne E, Russell J and Potts H (2010b) Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study. British Medical Journal 340 (c3111).

  • Greenwood R, Suddaby R and Hinings C (2002) Theorizing change: the role of professional associations in the transformation of institutionalized fields. Academy of Management Journal 45 (1), 58–80.

    Article  Google Scholar 

  • Hall S (1997) Representation: Cultural Representations and Signifying Practices. Sage, Open University Press, London.

    Google Scholar 

  • Hanseth O and Aanestad M (2003) Design as bootstrapping. on the evolution of ICT networks in healthcare. Methods Archive 42 (4), 384–391.

    Google Scholar 

  • Hasselbladh H and Bejerot E (2007) Webs of knowledge and circuits of communication: constructing rationalized agency in swedish healthcare. Organization 14 (2), 175–200.

    Article  Google Scholar 

  • Hawn C (2009) Take two aspirin and tweet me in the morning: how twitter, facebook, and other social media are reshaping healthcare. Health Affairs 28 (2), 361–368.

    Article  Google Scholar 

  • Hayes G (2010) The NHS information technology (IT) and social care review 2009: a synopsis. Informatics in Primary Care 18 (2), 81–88.

    Google Scholar 

  • Henwood F, Wyatt S, Hart A and Smith J (2003) Ignorance is bliss sometimes: constraints on the emergence of the 'informed patient' in the changing landscapes of health information. Sociology of Health & Illness 25 (6), 589–607.

    Article  Google Scholar 

  • Hillestad R et al (2005) Can electronic medical record systems transform healthcare? Potential health benefits, savings, and costs. Health Affairs 24 (5), 1103–1117.

    Article  Google Scholar 

  • Hirji J (2004) Freedom or folly? Canadians and the consumption of online health information. Information, Communication and Society 7 (4), 445–465.

    Article  Google Scholar 

  • Hogarth M et al (2010) The communication and care plan: a novel approach to patient-centered clinical information systems. Journal of Biomedical Informatics 43 (5), S6–S8.

    Article  Google Scholar 

  • Iedema R (2007) On the multi-modality, materially and contingency of organization discourse. Organization Studies 28 (6), 931–946.

    Article  Google Scholar 

  • Jian G (2011) Articulating circumstance, identity and practice: toward a discursive framework of organizational changing. Organization 18 (1), 45–64, %R 10.1177/1350508410373672.

    Article  Google Scholar 

  • Jones SS, Heaton PS, Rudin RS and Schneider EC (2012) Unraveling the IT productivity paradox – lessons for healthcare. New England Journal of Medicine 366 (24), 2243–2245.

    Article  Google Scholar 

  • Kerr EA and Hayward RA (2013) Patient-centered performance management: enhancing value for patients and healthcare systems. JAMA 310 (2), 137–138.

    Article  Google Scholar 

  • Kitson A, Marshall A, Bassett K and Zeitz K (2013) What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing 69 (1), 4–15.

    Article  Google Scholar 

  • Klecun-Dabrowska E and Cornford T (2000) Telehealth acquires meanings: information and communication technologies within health policy. Information Systems Journal 10 (1), 41–63.

    Article  Google Scholar 

  • Klecun-Dabrowska E and Cornford T (2002) The organising vision of telehealth. In 10th European Conference on Information Systems (S. Wrycza, Ed). 6–8 June, Gdansk, Poland:Wydawnictwo Uniwersystetu Gdanskiego, pp 1206–1217.

  • Kling R (2000) Social informatics: a new perspective on social research about information and communication technologies. Prometheus 18 (3), 245–264.

    Article  Google Scholar 

  • Klöcker P, Bernnat R and veit D (2014) Implementation through force or measure? How institutional pressures shape national eHealth programs. European Conference on Information Systems (ECIS). Tel Aviv, Israel.

  • Krist AH and Woolf SH (2011) A vision for patient-centered health information systems. JAMA 305 (3), 300–301.

    Article  Google Scholar 

  • Lucas HCJ, Agarwal R, El Sawy OA and Weber B (2013) Impactful research on transformational information technology: an opportunity to inform new audiences. MIS Quarterly 37 (2), 371–382.

    Google Scholar 

  • Lutz B and Bowers B (2000) Patient-centered care: understanding its interpretation and implementation in healthcare. Scholarly Inquiry for Nursing Practice 14 (2), 165–83.

    Google Scholar 

  • Mathar T (2011) Managing health(-care systems) using information health technologies. Health Care Analysis 19 (2), 180–191.

    Article  Google Scholar 

  • Matthews-King A (2014) NHS England delays care.data scheme to ‘build understanding’ of benefits. Pulse 18 February.

  • May C, Finch T, Mair F and Mort M (2005) Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom. Social Science & Medicine 61 (7), 1485–1494.

    Article  Google Scholar 

  • Mead N and Bower P (2000) Patient-centredness: a conceptual framework and review of the empirical literature. Social Science & Medicine 51 (7), 1087–1110.

    Article  Google Scholar 

  • Morrison Z, Marsden K, Cresswell K, Fernando B and Sheikh A (2013) Utilizing a discourse-based understanding of organizational change to explore the introduction of national electronic health records in England. Journal of Change Management 13 (3), 266–282.

    Article  Google Scholar 

  • Mort M and Smith A (2009) Beyond information: intimate relations in sociotechnical practice. Sociology 43 (2), 215–231.

    Article  Google Scholar 

  • Motion J and Leitch S (2009) The transformational potential of public policy discourse. Organization Studies 30 (10), 1045–1061.

    Article  Google Scholar 

  • Murray P, Cabrer M, Hansen M, Paton C, Elkin P and Erdley W (2008) Towards addressing the opportunities and challenges of Web 2.0 for health and informatics. Yearbook of Medical Informatics: 44–51.

  • NHS England (2013) Safer hospitals, safer wards: achieving an integrated digital care record. [WWW document] http://www.england.nhs.uk/wp-content/uploads/2013/07/safer-hosp-safer-wards.pdf, accessed 5 February 2014.

  • Oborn E, Barrett M and Davidson E (2011) Unity in diversity: electronic patient record use in multidisciplinary practice. Information Systems Research 22 (3), 547–564.

    Article  Google Scholar 

  • Oliver A (2005) The english national health service: 1979–2005. Health Economics 14 (S1), S75–S100.

    Article  Google Scholar 

  • Payton FC and Kiwanuka-Tondo J (2009) Contemplating public policy in HIV/AIDS online content, then where is the technology spirit? European Journal of Information Systems 18 (3), 192–204.

    Article  Google Scholar 

  • Perlin JB, Kolodner RM and Roswell RH (2004) The veterans health administration: quality, value, accountability, and information as transforming strategies for patient-centered care. The American Journal of Managed Care 10 (11, ppt 2), 828–836.

    Google Scholar 

  • Petrakaki D, Klecun E and Cornford T (2014) Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital. Organization, doi: 10.1177/1350508414545907.

  • Randell B (2007) A computer scientist's reactions to NPfIT. Journal of Information Technology 22 (3), 222–234.

    Article  Google Scholar 

  • Ranerup A (2010) Transforming patients to consumers: evaluating national healthcare portals. International Journal of Public Sector Management 23 (4), 331–339.

    Article  Google Scholar 

  • Rivard S, Lapointe L and Kappos A (2011) An organizational culture-based theory of clinical information systems implementation in hospitals. Journal of the Association for Information Systems 12 (2, Article 3).

  • Robertson A et al (2010) Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. British Medical Journal 341 (c4564).

  • Robey D and Boudreau M-C (1999) Accounting for the contradictory organizational consequences of information technology: theoretical directions and methodological implications. Information Systems Research 10 (2), 167–185.

    Article  Google Scholar 

  • Sauer C and Willcocks LP (2007) Unreasonable expectations: NHS IT, greek choruses and the games institutions play around mega-programmes. Journal of Information Technology 22 (3), 195–201.

    Article  Google Scholar 

  • Scott R, Ruef M, Mendel P and Carona C (2000) Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care. University of Chicago Press, Chicago, IL.

    Google Scholar 

  • Sheikh A et al (2011) Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from a prospective national evaluation in ‘early adopter’ hospitals. British Medical Journal 343 (d6054).

  • Swanson EB and Ramiller NC (1997) The organizing vision in information systems innovation. Organization Science 8 (5), 458–474.

    Article  Google Scholar 

  • Takian A and Cornford T (2012) NHS information: revolution or evolution? Health Policy and Technology 1 (4), 193–198.

    Article  Google Scholar 

  • Theofanos M and Mulligan C (2004) Empowering patients through access to information. Information, Communication & Society 7 (4), 466–490.

    Article  Google Scholar 

  • Ure J et al (2009) The Development of data infrastructures for eHealth: a socio-technical perspective. Journal of the Association for Information Systems 10 (5), 415–429.

    Google Scholar 

  • Vikkelsø S (2010) Mobilizing information infrastructure, shaping patient-centred care. International Journal of Public Sector Management 23 (4), 340–352.

    Article  Google Scholar 

  • Wootton R (2012) Twenty years of telemedicine in chronic disease management – an evidence synthesis. Journal of Telemedicine and Telecare 18 (4), 211–220.

    Article  Google Scholar 

Download references

Acknowledgements

My heartfelt thanks for their support and insightful comments go to the Associate Editor and reviewers, as well as to Chrisanthi Avgerou, Tony Cornford, Ralph Hibberd, Valentina Lichtner and Simon Taylor.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ela Klecun.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klecun, E. Transforming healthcare: policy discourses of IT and patient-centred care. Eur J Inf Syst 25, 64–76 (2016). https://doi.org/10.1057/ejis.2014.40

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/ejis.2014.40

Keywords

Navigation