Infrastructures in healthcare: The interplay between generativity and standardization

ObjectiveTo investigate how the design, development and implementation process of a new patient-centered portal unfolds by focusing on its evolutionary infrastructural development.DesignWe conducted a case study on a patient-centred portal in Norway. We used qualitative data collection techniques including observations, interviews and attendance of design workshops with users. We performed an interpretive analysis of the data through the lens of technology enactment.ResultsThe case analysis reveals that the patient-centred portal has a strong generative character. However, for the enactment of the technology continuous sociotechnical negotiations take place. Grounded in the empirical data and their analysis we complement and expand the existing understanding of generativity.DiscussionWe characterize generativity as sociotechnical and resulting from negotiations for technology enactment. We discuss in detail such negotiations and show how they shape the evolution of infrastructures that are generative while standardized.

► Taking an information infrastructure perspective, we examined the introduction of a novel patient-centered portal.
► Examining how technology gets enacted through participants’ activities, aspects of the generativity–standardization interplay emerged.
► The generativity–standardization interplay is fundamentally sociotechnical.
► Infrastructures have to be standardized in a way that does not harm their generative capacity.
► This type of analysis can support the further elaboration of design principles for different classes of infrastructures.