The organizing vision of integrated health information systems

The notion of integration in the context of health information systems is ill-defined yet in wide-spread use. We identify a variety of meanings spanning from purely technical integration of information systems to integration of services. This ambiguity (or interpretative flexibility), we argue, is inherent rather accidental: it a necessary prerequisite for mobilising political and ideological support among stakeholders for integrated health information systems. Building on this, our aim is to trace out the career dynamics of the vision of integration/ integrated. The career dynamics is the transformation of both the imagery and material (technological) realisations of the unfolding implementation of the vision of integrated care. Empirically we draw on a large, ongoing project at the University hospital of North Norway (UNN) to establish an integrated health information system

💡 Research Summary

The paper tackles the pervasive yet vague use of the term “integration” in health information systems (HIS). The authors argue that this ambiguity is not accidental but a deliberate feature that provides interpretative flexibility, allowing diverse stakeholders—clinicians, administrators, IT vendors, policymakers—to align the concept with their own interests and values. This flexibility constitutes an “organizing vision” that mobilises political and ideological support for integrated HIS initiatives.

The authors delineate three concentric layers of integration. The first, technical integration, focuses on linking heterogeneous subsystems such as electronic medical records (EMR), laboratory information systems (LIS), and pharmacy management modules. This layer involves data standardisation (e.g., HL7, FHIR), middleware development, and the re‑engineering of data governance structures. The second layer, service integration, expands the focus to patient‑centred care pathways, enabling real‑time data sharing across diagnosis, treatment, rehabilitation, and preventive services. It requires the dissolution of traditional departmental silos, the redesign of clinical workflows, and the establishment of multidisciplinary decision‑making mechanisms. The third layer, strategic‑political integration, embeds the vision within broader policy narratives—patient safety, cost containment, digital innovation—to secure legitimacy and resources.

To illustrate how the organizing vision evolves, the paper presents an empirical case study from the University Hospital of North Norway (UNN). In the project’s early phase, the vision was dominated by technical goals: establishing interoperable data models, implementing a common interface layer, and creating a data‑governance committee to resolve ownership disputes. As the implementation progressed, the vision broadened to encompass integrated patient journey management and enterprise‑wide decision support. New functionalities such as a unified clinical dashboard and cost‑analysis modules emerged, reshaping clinical practice and managerial oversight.

Crucially, the authors identify a feedback loop between the vision’s imagery and its material realisation. The initial image guides technology selection; the chosen technology, in turn, reshapes organisational culture, workflows, and power relations, prompting a revised image. This iterative process demonstrates that integration is not a static endpoint but a dynamic, evolving discourse that continuously negotiates stakeholder expectations and constraints.

The paper concludes with several implications. First, integrated HIS should be understood as a socio‑technical transformation rather than a mere technical linkage. Second, project leaders must explicitly recognise the multi‑layered nature of the vision and design governance mechanisms that mediate conflicts among stakeholders at each layer. Third, policymakers should provide flexible policy frameworks that allow the vision to be re‑articulated as implementation realities unfold. By foregrounding the organising vision concept, the study offers a theoretical lens and practical guidance for future HIS integration efforts, highlighting the necessity of aligning technical design with service redesign and strategic narrative construction.