Digitalization of Health Care

Electronic health records are widely regarded as the 'connective tissue' of any modern healthcare system. For some they represent a 'dangerous enthusiasm' and for others a key enabler of 'disruptive innovation'. Many governments have made major policy and financial investments in digitalizing health records but their implementation has frequently run into opposition from doctors, had lukewarm responses from patients, and raised considerable concerns for privacy advocates and others worried by the security of sensitive health data and the risks of national data-bases. This book draws upon the concept of 'orders of worth' to reveal the moral dimensions of the medical division of labour and to delve deeper into understanding why electronic records have been so difficult to implement and the sources of opposition to them. The authors argue that digitalization disrupts the moral orders which define rights and responsibilities for the sharing and exchanging of patient medical data. This is illustrated through longitudinal studies of two of the most controversial attempts to introduce national systems - a patient controlled electronic record in Australia and a national summary care record that was part of the ill-fated NHS national program for IT in England. The authors conclude by using the lessons from these national experiences and insights from two regional projects in each country to suggest how the idea of electronic records might be re-thought. It is a must read for anyone concerned about health information and the implications of how it is shared and exchanged in a digital world.

Ian McLoughlin is Professor of Management at Monash University, in Melbourne, Australia. He has conducted research on organizational change and innovation in the UK, Europe and Australasia with a particular focus on the digitalization of public services, including healthcare. He is currently leading a major Australian research project on The Healthcare System of the Future. He also plays a leading role in the Monash-Warwick University Health Care Innovation Alliance established to conduct global research and education in healthcare service redesign and improvement. He has published widely for leading publishers and academic journals. His previous publications include Digital Government at Work: A Social Informatics Perspective, Oxford University Press (2013).
Karin Garrety has a PhD in Science and Technology Studies from the University of New South Wales. She has been involved in many research projects investigating technological and cultural change in industry and the healthcare sector. She has published more than twenty peer-reviewed journal articles. Her work appears in Human Relations, Social Studies of Science, Science, Technology and Human Values, Social Science and Medicine, Technology Analysis and Strategic Management, Organization and Social Policy and Society.
Rob is a Professor at Newcastle University where he directs the Centre for Knowledge Innovation Technology and Enterprise (KITE). His research interests are in public service innovation and sociotechnical systems: the role that data, information, and information systems play in inter-organizational innovation and relationships. He has over two decades of experience working on and leading public service information system research and development projects. Over the course of his career he has been actively engaged in £4M of research and development projects supported by a range of funding agencies including ESRC, EPSRC, ARC and policy bodies including the NHS and DH.

Introduction
1: Digitalizing Healthcare: 'Dangerous Enthusiasm' or 'Disruptive Innovation'?
2: The Troubled History of Implementing EHRs
3: Moral Orders and Justification in the Division of Medical Labour
4: The Development of a National EHR in Australia I: Trials, Tribulations and Uncertainty
5: The Development of a National EHR in Australia II: The Struggle over 'Personal Control'
6: The Development of a National EHR in England: The Summary Care Record
7: Boundary Objects: Building EHRs at National and Local Level
8: Conclusion: Moral (re-) Ordering and Rethinking the Electronic Record
Appendix 1: Research Design and Methods
Appendix 2: Other Sources not Cited in Text