Building EHRs at National and Local Level
This chapter delves more deeply into the problems and challenges involved in co-ordinating and fostering consultation, engagement, and collaboration in EHR projects amongst diverse communities where there is little or no consensus between diverse ‘worlds’ and their underlying moral standpoints. This is explored by comparing the national projects in Australia and England with two local projects in the same countries. The analytical basis of this comparison is provided by the widely used notion of ‘boundary objects’ and insights from research which has sought to conceptualize the building of EHR systems in terms of information infrastructures. The key ‘objects’ in the four projects are outlined and the extent to which they satisfied the informational needs of divergent stakeholders assessed. It is suggested that the concept of information systems infrastructures assists in providing a better understanding of the tension between the need for global co-ordination and bottom-up enactments.
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