What does it take to replace an old functioning information system with a new one? A case study.

Abstract

PURPOSE: To investigate the case of a municipal wound care practice and the process of designing a specific computer documentation record system. In carrying out our kind of action research, creation of the system that integrate digital photos, was supposed to remake the old wound care documentation system and transform it into a more advanced and unified tool. METHODS: Ethnographic studies were conducted before and parallel to the design work. Nurse practitioners were involved in design and actively determining essentials of the computer artefact. Developmental Work Research (DWR) is the framework against which data from the work practice and system development where analyzed and interpreted. RESULTS: First, an old-fashioned information system (IS) within health care work will not successfully be replaced by a new one, unless the new is better "as a whole", that is, better supports work practices of a range of occupational and professional workers. Second, when designing information system for the public sector, system designers will almost always face dilemmas based on a contradiction between central, high level interest and a local level work-practice perspective. DISCUSSION: Our study reveals that the work practice of the municipal nurses is characterized by three distinctive features: High mobility, the need for face-to-face interaction in different locations, and a great variety of artefact usage. This implies that a new information system has to be "better as a whole" dealing with those characteristics.