Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-20T11:43:05.009Z Has data issue: false hasContentIssue false
  • English
  • Français

Disruptive Innovation in Health Care: Business Models, Moral Orders and Electronic Records

Published online by Cambridge University Press:  18 December 2013

Karin Garrety ,
Ian McLoughlin  and
Gregor Zelle
Karin Garrety
Affiliation:
School of Management and Marketing, University of Wollongong E-mail: [email protected]
Ian McLoughlin
Affiliation:
Department of Management, Monash University E-mail: [email protected]
Gregor Zelle
Affiliation:
School of Management and Marketing, University of Wollongong E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

There is widespread consensus that current healthcare costs are unsustainable, and that efficiencies could be achieved by reorganising care and making greater use of information technology, in particular nationally available electronic health records. Such approaches have, however, been difficult to implement, partly because incentives for uptake are weak. In this article we argue that the difficulties go deeper than calculations of costs and benefits, and include disruptions to the complex moral orders that surround the production and exchange of health information. Using the introduction of national electronic health records in England and Australia as examples, we show how attempts to reshape and transfer distributions of rights and responsibilities developed in the age of paper into the digital world go awry. We suggest that a fundamental rethinking of the role of ‘records’ in healthcare may be an integral component of the moral re-ordering required to transform health care through such means.

Keywords

Disruptive innovationelectronic health recordsmoral orderpositioning theory
Type
Themed Section on Hiding in plain sight or Disappearing in the rear view mirror?: Whatever happened to the revolution in information for Health and Social Care – Learning from England and Australia
Information
Social Policy and Society , Volume 13 , Issue 4 , October 2014 , pp. 579 - 592
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, R. (2010) ‘Do Summary Care Records have the potential to do more harm than good? Yes’, British Medical Journal, 340, c3020.CrossRefGoogle Scholar
Anonymous (2005) ‘No single opt-out on medical records database’, E-Health Insider, 8 March, http://www.ehi.co.uk/news/ehi/1080 (accessed 27 April 2011).Google Scholar
Anonymous (2006) ‘Summary Care Record delayed and abridged’, E-Health Insider Primary Care, 25 April, http://www.ehiprimarycare.com/news/item.cfm?ID=1850 (accessed 2 October 2009).Google Scholar
Anonymous (2007) ‘BMA votes for non-co-operation on central records’, E-Health Insider, 29 June, http://www.ehi.co.uk/news/ehi/2827/bma_votes_for_non_co-operation_on_central_records (accessed 27 May 2013).Google Scholar
Anonymous (2008) ‘GPs vote to halt Care Record Service development’, E-Health Insider, 16 June, http://www.ehi.co.uk/news/EHI/3851/gps-vote-to-halt-care-record-service-development (accessed 27 May 2013).Google Scholar
Anonymous (2010) ‘London GPs make it easy for patients to “opt-out” of central NPfIT database’, ComputerWeekly.com, 25 February, http://www.computerweekly.com/news/1280092199/London-GPs-make-it-easy-for-patients-to-opt-out-of-central-NPfIT-database (accessed 27 May 2013).Google Scholar
Australian Medical Association (2011) ‘Submission to the Department of Health and Ageing on the draft concept of operations relating to the introduction of a personally controlled electronic health record system’, http://ama.com.au/system/files/node/6777/AMA+Submission+on+PCEHR+Draft+Concept+of+Operations.pdf (accessed 14 September 2011).Google Scholar
Australian Medical Association (2012) ‘AMA guide to using the PCEHR’, https://ama.com.au/ama-guide-using-pcehr (accessed 28 September 2012).Google Scholar
Berg, M. and Bowker, G. (1997) ‘The multiple bodies of the medical record’, The Sociological Quarterly, 38, 3, 513–37.CrossRefGoogle Scholar
Bower, J. L. and Christensen, C. M. (1995) Disruptive Technologies: Catching the Wave, Harvard Business Review Video, Cambridge, MA: Harvard Business School.Google Scholar
British Medical Association (2008) ‘BMA response to “Clinical development of the NHS care records service”’, http://www.bma.org.uk/Archive/ncrsresponse.jsp (accessed 20 June 2011).Google Scholar
Brown, J. S. and Duguid, P. (2002) The Social Life of Information, Cambridge, MA: Harvard Business Press.Google Scholar
Caldicott, F. (1997) Report on the Review of Patient-Identifiable Information, London: Department of Health.Google Scholar
Caldicott, F. (2013) Information: To Share or Not to Share? The Information Governance Review, London: Department of Health.Google Scholar
Carlisle, D. (2008) ‘SCR consent model changes’, E-Health Insider, 18 September, http://www.ehi.co.uk/news/primary-care/4157 (accessed 27 May 2013).Google Scholar
Carlisle, D. (2011) ‘All very SUSpicious’, E-Health Insider, 21 April, http://www.ehi.co.uk/insight/analysis/727/all-very-suspicious (accessed 14 June 2011).Google Scholar
Carvel, J. (2006a) ‘Health officials reject requests to opt out of patient database’, The Guardian, 4 December, http://www.guardian.co.uk/society/2006/dec/04/health.epublic?INTCMP=SRCH (accessed 6 April 2011).Google Scholar
Carvel, J. (2006b) ‘Ministers to put patients’ details on central database despite objections’, The Guardian, 2 November, http://www.guardian.co.uk/politics/2006/nov/02/publicservices?INTCMP=SRCH (accessed 6 April 2011).Google Scholar
Carvel, J. (2006c) ‘Minister admits U-turn on NHS database amid privacy fears’, The Guardian, 19 December, http://www.guardian.co.uk/uk/2006/dec/19/politics.humanrights?INTCMP=SRCH (accessed 28 February 2011).Google Scholar
Carvel, J. (2006d) ‘GPs revolt over patient files privacy’, The Guardian, 21 November, http://www.guardian.co.uk/society/2006/nov/21/health.epublic?INTCMP=SRCH (accessed 28 February 2011).Google Scholar
Carvel, J. (2007) ‘Family doctors to shun national database of patients’ records’, The Guardian, 20 November, http://www.guardian.co.uk/society/2007/nov/20/nhs.health?INTCMP=SRCH (accessed 28 February 2011).Google Scholar
Christensen, C. M. and Overdorf, M. (2000) ‘Meeting the challenge of disruptive change’, Harvard Business Review, 78, 2, 66–77.Google Scholar
Christensen, C. M., Grossman, J. H. and Hwang, J. (2009) The Innovator's Prescription: A Disruptive Solution for Health Care, New York: McGraw-Hill.Google Scholar
Christensen, C. M., Hatkoff, C. and Kula, I. (2013). ‘Disruptive innovation theory revisited: toward quantum innovation’, The Off-White Papers, http://offwhitepapers.com/?p=21 (accessed 15 September 2013).Google Scholar
Christensen, C. M., Horn, M. B. and Johnson, C. W. (2008) Disrupting Class: How Disruptive Innovation Will Change the Way the World Learns, Vol. 98, New York: McGraw-Hill.Google Scholar
Clarke, R. (1988) ‘Just another piece of plastic for your wallet: the “Australia Card” scheme’, Computers and Society, 18, 1, 7–21.Google Scholar
Consumers’ Health Forum (2012) ‘Submission to the Senate Community Affairs Committee Inquiry into the PCEHR Bill 2011, http://www.chf.org.au/pdfs/chf/Submission-to-the-PCEHR-Inquiry.pdf.Google Scholar
Collins, T. (2006) ‘Experts strike new NHS warning note’, ComputerWeekly.com, 10 October, http://www.computerweekly.com/Articles/2006/10/10/218985/Experts-strike-new-NHS-warning-note.htm (accessed 8 March 2011).Google Scholar
Crispin, S. (2011) ‘HealthSpace up for review again’, E-Health Insider, 17 August, http://www.ehi.co.uk/news/mobile/7100/healthspace-up-for-review-again (accessed 27 September 2011).Google Scholar
Cross, M. (2011) ‘Government announces end of NHS IT programme – for second time’, British Medical Journal, 343, d6125.Google Scholar
Currie, W. L. and Finnegan, D. J. (2011) ‘The policy-practice nexus of electronic health records adoption in the UK NHS: an institutional analysis’, Journal of Enterprise Information Management, 24, 2, 146–70.Google Scholar
Davies, B. and Harré, R. (1990) ‘Positioning: the discursive production of selves’, Journal for the Theory of Social Behaviour, 20, 1, 43–63.Google Scholar
Davies, M. (2013) ‘“Pull the plug” on Summary Care Records, says GPC IT lead’, Pulse, 14 February, http://www.pulsetoday.co.uk/pull-the-plug-on-summary-care-records-says-gpc-it-lead/20001851.article#.UaVk7sp-XWc (accessed 29 May 2013).Google Scholar
Davies, S. (1996) ‘Dystopia on the health superhighway’, The Information Society, 12, 1, 89–93.Google Scholar
Dearne, K. (2007) ‘Canberra to cancel access card’, The Australian, 27 November, http://www.australianit.news.com.au/story/0,24897,22823422–15306,00.html (accessed 26 October 2009).Google Scholar
Dearne, K. (2012) ‘Sceptics warn of risks and inadequacies in shared e-health records system’, Australian IT, 30 June, http://www.theaustralian.com.au/australian-it/government/sceptics-warn-of-risks-and-inadequacies-in-shared-electronic-health-records/story-fn4htb9o-1226412887806 (accessed 1 October 2012).Google Scholar
Department of Health (1992) An Information Management and Technology Strategy for the NHS in England, London: Department of Health.Google Scholar
Department of Health (2002a) Delivering 21st Century IT Support for the NHS: National Strategic Programme, London: Department of Health.Google Scholar
Department of Health (2002b) Delivering 21st Century IT Support for the NHS: National Specification for Integrated Care Records Service – Consultation Draft, London: Department of Health.Google Scholar
Department of Health (2008) High Quality Care for All: NHS Next Stage Review Final Report, Cm. 7432, London: The Stationery Office, http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085828.pdf (accessed 14 September 2011).Google Scholar
Department of Health (2012) The Power of Information: Putting All of Us in Control of the Health and Care Information We Need, London: Department of Health.Google Scholar
Department of Health and National Health Service (2012) Informatics: The Future, London: Department of Health, https://www.wp.dh.gov.uk/publications/files/2012/07/Informatics-the-future_final.pdf (accessed 25 October 2012).Google Scholar
Department of Health and Ageing (2011) Concept of Operations: Relating to the Introduction of a Personally Controlled Electronic Health Record (PCEHR) System, Canberra: Australian Government.Google Scholar
Dunlevy, S. (2012) ‘Defiant doctors force e-Health backdown’, The Australian, 15 June, http://www.theaustralian.com.au/australian-it/defiant-doctors-force-e-health-backdown-on-pcehr-liability/story-e6frgakx-1226396024950 (accessed 18 June 2012).Google Scholar
Dunlevy, S. (2013) ‘Outrage as eHealth record sign-up squads hit Australian hospital patients in bid to boost numbers’, Herald Sun, 14 April, http://www.heraldsun.com.au/news/national/outrage-as-ehealth-record-sign-up-squads-hit-australian-hospital-patients-in-bid-to-boost-numbers/story-fncynkc6–1226619874616 (accessed 22 July 2013).Google Scholar
Dunston, R., Lee, A., Boud, D., Brodie, P. and Chiarella, M. (2009) ‘Co‐production and health system reform – from re‐imagining to re‐making’, Australian Journal of Public Administration, 68, 1, 39–52.Google Scholar
Evenstad, L. (2013), ‘Privacy watchdogs back biting NHS’, E-Health Insider, 26 April, http://www.ehi.co.uk/news/EHI/8545/privacy-watchdogs-back-biting-nhs (accessed 29 May 2013).Google Scholar
Fasano, P. (2013) Transforming Health Care: The Financial Impact of Technology, Electronic Tools and Data Mining, Hoboken, NJ: Wiley.Google Scholar
Foo, F. (2013) ‘Sector calls for transparency and end to mistakes in PCEHR’, The Australian, 17 September, http://www.theaustralian.com.au/technology/sector-calls-for-transparency-and-end-to-mistakes-in-pcehr/story-e6frgakx-1226720434416 (accessed 19 September 2013).Google Scholar
Greenhalgh, T., Stramer, K., Bratan, T., Byrne, E., Mohammad, Y. and Russell, J. (2008) ‘Introduction of shared electronic records: multi-site case study using diffusion of innovation theory’, British Medical Journal, 337, 1786–96.Google Scholar
Greenleaf, G. (2007) ‘Australia's proposed ID card: still quacking like a duck’, Computer Law and Security Report, 23, 2, 156–66.Google Scholar
Harré, R. and Slocum, N. (2003) ‘Disputes as complex social events: on the uses of positioning theory’, Common Knowledge, 9, 1, 100–18.Google Scholar
Harré, R., Moghaddam, F. M., Cairnie, T. P., Rothbart, D. and Sabat, S. R. (2009) ‘Recent advances in positioning theory’, Theory and Psychology, 19, 1, 5.Google Scholar
Hendy, J., Reeves, B. C., Fulop, N., Hutchings, A. and Masseria, C. (2005) ‘Challenges to implementing the national programme for information technology (NPfIT): a qualitative study’, British Medical Journal, 331, 331–6.Google Scholar
House of Commons Committee of Public Accounts (2011) The National Programme for IT in the NHS: An Update on the Delivery of Detailed Care Records Systems, London: The Stationery Office, http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/nhs-it-report-/ (accessed 22 August 2011).Google Scholar
House of Commons Committee of Public Accounts (2013) The Dismantled National Program for IT in the NHS, London: The Stationery Office.Google Scholar
House of Commons Health Committee (2007) The Electronic Patient Record, London: The Stationery Office, http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/422/422.pdf (accessed 29 March 2011).Google Scholar
Keogh, B. and Saddler, J. (2010) ‘Reviews into the Summary Care Record’, http://www.connectingforhealth.nhs.uk/systemsandservices/scr/scrfinalreportletter.pdf (accessed 31 May 2013).Google Scholar
Leaning, M. S. (1993) ‘The new information management and technology strategy of the NHS’, British Medical Journal, 307, 217.Google Scholar
Leigh, D. and Evans, R. (2006) ‘Warning over privacy of 50m patient files’, The Guardian, 1 November, http://www.guardian.co.uk/society/2006/nov/01/health.medicineandhealth1 (accessed 6 April 2011).Google Scholar
medConfidential (ND) Keep My Secrets, http://medconfidential.org/ (accessed 31 October 2013).Google Scholar
National e-Health Transition Authority (2013) NEHTA Scorecard August 2013, Sydney: NEHTA, http://www.nehta.gov.au/component/docman/doc_download/1777-nehta-scorecard-august-2013?Itemid=(accessed 1 September 2013).Google Scholar
National Health and Hospitals Reform Commission (2009a) A Healthier Future for all Australians: Final Report, Canberra: Australian Government, http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report (accessed 15 March 2011).Google Scholar
National Health and Hospitals Reform Commission (2009b) Person-Controlled Electronic Health Records, Canberra: Australian Government, http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/BA7D3EF4EC7A1F2BCA25755B001817EC/$File/Person-controlled%20Electronic%20Health%20Records.pdf (accessed 9 July 2010).Google Scholar
National Health Service (2003) Output Based Specification for Integrated Care Record Service: Part III. Common Requirements, London: Department of Health.Google Scholar
National Health Service (2005) The Clinical Development of the NHS Care Record Service, London: NHS, http://www.providersedge.com/ehdocs/ehr_articles/The_Clinical_Development_of_the_NHS_Care_Record_Service-draft.pdf (accessed 17 June 2011).Google Scholar
National Health Service (2011a) ‘Summary Care Record scope’, http://systems.hscic.gov.uk/scr/documents/scrscope.pdf (accessed 17 June 2013).Google Scholar
National Health Service (2011b) ‘NHS Care Record guarantee: version 5’, http://www.nigb.nhs.uk/guarantee/nhscrg5 (accessed 8 February 2012).Google Scholar
National Health Service (2012) ‘NHS Summary Care Record guide for GP practice staff’, http://www.connectingforhealth.nhs.uk/systemsandservices/scr/documents/SCRGuideGPPractice_v1.pdf (accessed 27 May 2013).Google Scholar
Nowottny, S. (2009) ‘GPC member leads mass care record opt-out’, Pulse, 1 April, http://www.pulsetoday.co.uk/gpc-member-leads-mass-care-record-opt-out/11001823.article#.UaMCVKP2Qcs (accessed 27 May 2013).Google Scholar
O'Rourke, J. (2011) ‘Online health records face uphill battle’, Sydney Morning Herald, 7 August, http://www.smh.com.au/technology/technology-news/online-health-records-face-uphill-battle-20110806–1igfk.html (accessed 14 October 2012).Google Scholar
Praities, N. (2012) ‘Summary Care Record improving GP out-of-hours prescribing and helping patients die where they choose, DH data shows’, Pulse, 3 February, http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13383154/summary-care-record-improving-gp-out-of-hours-prescribing-and-helping-patients-die-where-they-choose-dh-data-shows (accessed 16 February 2012).Google Scholar
Ramesh, R. (2013) ‘£140 could buy private firms data on NHS patients’, The Guardian, 18 May, http://www.guardian.co.uk/technology/2013/may/17/private-firms-data-hospital-patients (accessed 2 June 2013).Google Scholar
Raywood, D. (2012) ‘Proposed NHS portal raises questions about data security’, SC Magazine UK, 25 May, http://www.scmagazineuk.com/proposed-nhs-portal-raises-questions-about-data-security/article/242804/ (accessed 11 June 2012).Google Scholar
Robinson, K., Williamson, D. and Grain, H. (2007) ‘Conflicting values in health information policy’, in Barraclough, S. and Gardner, H. (eds.), Analysing Health Policy: A Problem-Oriented Approach, Sydney: Elsevier, pp. 139–54.Google Scholar
Royal Australian College of General Practitioners (2011) ‘Submission to the Department of Health and Ageing on the personally controlled electronic health record system’, Legislation Issues Paper, http://www.yourhealth.gov.au/internet/yourhealth/blog.nsf/0B3BC405CA522FACCA25791A00090F6E/$FILE/62.RACGP,%20Judy%20Evans%20-%20Att1.pdf (accessed 3 October 2012).Google Scholar
TheBigOptOut.0rg (ND) About the Campaign, http://www.thebigoptout.com/about-nhs-confidentiality/ (accessed 31 October 2013).Google Scholar
Timmins, N. (2011) ‘Only the bare bones’, Financial Times, 17 May, http://www.ft.com/cms/s/0/60546d42–7ff3–11e0-b018–00144feabdc0.html#axzz2WWR92ane (accessed 17 June 2011).Google Scholar
Todd, R. (2013) ‘“Grave concerns” over new GP dataset’, E-Health Insider, 16 January, http://www.ehi.co.uk/news/primary-care/8313/%27grave-concerns%27-over-new-gp-dataset (accessed 7 February 2013).Google Scholar
Townsend, R. (2012) ‘Doctors and patients uneasy about new e-health records system’, The Conversation, 5 July, http://theconversation.edu.au/doctors-and-patients-uneasy-about-new-e-health-records-system-7706 (accessed 6 July 2012).Google Scholar
Tsoukas, H. (1997) ‘The tyranny of light: the temptations and the paradoxes of the information society’, Futures, 29, 9, 827–43.Google Scholar
Weed, L. (ND) ‘The Medical Record: a tool to provide problem orientated patient care’, http://www.youtube.com/watch?v=kVzBzE04wZA (accessed 13 June 2013).Google Scholar
Westbrook, J. I. and Braithwaite, J. (2010) ‘Will information and communication technology disrupt the health system and deliver on its promise?’, Medical Journal of Australia, 193, 7, 399.Google Scholar
Whitfield, L. (2012a) ‘Final death knell for Health Space’, E-Health Insider, 22 May, http://www.ehi.co.uk/news/EHI/7767/final-death-knell-for-healthspace (accessed 11 June 2012).Google Scholar
Whitfield, L. (2012b) ‘Southampton launches My Health Record’, E-Health Insider, 20 September, http://www.ehi.co.uk/news/EHI/8074/southampton-launches-my-health-record (accessed 25 October 2012).Google Scholar