TY - JOUR
T1 - Infrastructures for healthcare
T2 - from synergy to reverse synergy
AU - Langhoff, Tue Odd
AU - Amstrup, Mikkel Hvid
AU - Mørck, Peter
AU - Bjørn, Pernille
N1 - © The Author(s) 2016.
PY - 2018
Y1 - 2018
N2 - The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.
AB - The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.
KW - data security and confidentiality
KW - databases and data mining
KW - electronic health records
KW - information and knowledge management
KW - information infrastructures
KW - primary care
KW - quality control
KW - sustainability
KW - synergy
UR - http://www.scopus.com/inward/record.url?scp=85041596485&partnerID=8YFLogxK
U2 - 10.1177/1460458216654288
DO - 10.1177/1460458216654288
M3 - Journal article
C2 - 27389866
SN - 1460-4582
VL - 24
SP - 43
EP - 53
JO - Health Informatics Journal
JF - Health Informatics Journal
IS - 1
ER -