When Stars Align: The Interactions and Transformations of e-Health Infrastructure Regimes

Abstract

I outline the shifting approaches to digital transformation of the Norwegian e-health sector from the 1970s through the lens of the multi-level perspective and its concept of sociotechnical regime. The digital transformation has taken place through the development, adoption, and use of a huge variety of IT solutions, which also increasingly have become integrated with each other into a complex national e-health infrastructure. This implies that health care institutions become interconnected and interdependent. Accordingly, digital transformation within the health sector needs to be addressed at the national or sector (or industry) level and not just at the organizational level. Digital transformation of health care involves a multitude of actors and stakeholders and is not managed in a hierarchical structure. The various actors have had different ideas and interests related to how the national e-health infrastructure should evolve and how the Norwegian health sector should be transformed. Over time, certain actors coalesce into a constellation that establishes a shared view on how the infrastructure should evolve and how the activities should be organized and governed. My focus is on the nature of different infrastructure regimes and how they interact and are transformed.