Conceptual independence as an enabler of IT Flexibility

Abstract

Healthcare organizations are currently confronted with many social and technological developments. Moreover, medical processes and procedures are changing, mostly because of patients’ increasing involvement. Also, medical processes have to be adapted to the deployment of IT innovations, such as machine learning and the application of e-health systems. The challenges that organizations face lead to organizational transformations and intensified management of business and IT alignment. This thesis studies the approaches healthcare organizations in the Netherlands apply when adapting Information Technology (IT) infrastructure to new demands. This research’s main focus is on the IT practice of changing existing systems to new requirements needed for flexibility in IT infrastructure. This research is divided into various themes that study IT professionals’ views on different levels in the organization. Case studies have been performed to study the practices of different types of IT professionals. We found that change in existing IT applications and information systems (IS) remains difficult for IT architects because of technical and organizational factors. Bottlenecks in applying enterprise architecture in existing IT infrastructure were found in the inflexibility of IS in healthcare, especially in electronic health record (EHR) systems. Software suppliers provide these EHR systems because the development of IS in the organization had been outsourced. The proposition emerged that conceptual models play an essential role in realizing IT flexibility based on functional requirements prompted by McGinnes and Kapros. They argue that underlying software structures can significantly improve or hinder IS’s flexibility. Their design principle of Conceptual Independence for IS recommends a software design that separates the conceptual models from the application logic. Analysis of existing open-source software for EHR systems indicated that openEHR was a promising candidate to study the principle of CI. In the last phase of the study, remarkable differences were found in organizations that had implemented openEHR in the IT infrastructure and organizations that had not. This outcome was demonstrated in a multi-case study conducted at 10 mental healthcare organizations. With a mixed-methods approach, we applied a validated survey on the concept of IT flexibility in organizations. Results suggest that it is precisely the specific characteristics of CI in openEHR that have significantly improved the flexibility of the organization’s entire IT infrastructure. The effect was not limited to the openEHR modules. The influence of an independent conceptual model in the IS was even observable in the relationship between IT supplier and organization, which positively influenced the IT outsourcing practice. We conclude that the IS design as an IT resource has a substantial effect on IT flexibility. We argue that the influence of the implementation of CI extends to the entire organization-wide IT infrastructure.