Strategic management of complex IT systems
International Journal of Information Technology and Management
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Information Technology (IT) is relatively new to the British National Health Service (NHS). The NHS is learning how to use IT and information systems (IS) for the benefit of patients and for clinical processes. Rather than adopt IT governance practices from the private sector, it is seeking to develop its own best practices because of the unique socialist principles of theorganization and its history. It values are deeply rooted in socialism.The overall aim of the research proposed in this paper is to inform health informatics governance in its early stages of development in the NHS through researching deferred IT/IS methods, tools and techniques. Deferment is defined as enabling contextual, situated and semantic information design by action developers (so-called users). Deferment is proposed asrelevant in the NHS because of the national and distributed structure of the organization. A deferred IT/IS infrastructure will be capable of catering for contextual and situated information needs of domain experts 驴 clinicians.This research concerns how to make hospital information management in the NHS adaptable to particular contexts and situations. The NHS is a public sector organization funded by the British government. We are investigating how to make Commercial Off-The-Shelf (COTS) systems adaptable to support administrative and clinical staff 驴 the domain experts 驴 in their roles. Laerum et al.'s [10] cross-sectional survey concluded that domain experts in healthcare, in particular doctors, made less use of electronic medical records than the systems allowed. To resolve lack of system's usage, context and situation have become the focus of design. Yahidov [19] proposes situated aspects of decision support systems that attempt to situate the system in the problem environment.The problem we address is how domain experts use systems in context and in particular situations. Our aim is to design software-tailoring tools for COTS to make healthcare IS adaptable to the context and situation of usage. We will apply the Deferred System's Design(DSD) approach [11] [13] because it accounts for contextual situated and semantic IS usage. DSD makes IS independent of design decisions made by software vendors and allows domain experts to merge IS to their particular context. Our research is interdisciplinary as we draw on the Alexandrian pattern approach in architecture of enabling people affected by design tocontribute directly to that solution.The deferred perspective and its relevance for IT governance is explained in the following section. Our phenomenological approach to understanding the problem and the aims and objectives of the research are set out in section 3. The case hospital is described in section 4. We apply the DSD approach to the problem and account for its choice in sections 5 and 6. Our interim findings of the proposed three years project are discussed in section 7. We conclude by identifying the deliverables of our research and its beneficiaries.