Healthcare practice ISOlation: Articulating systems that drift toward higher quality

Can higher quality healthcare practices emerge from the development and use of a loosely integrated set of intranets? This paper examines that question through a series of empirical examples that draw on data from one healthcare organization that was part of a multi-year, multi-industry study of intranets. Some of this organization's intranets link clinical practice guidelines to healthcare delivery, in ways that mimic manufacturing sector efforts to improve product quality and reliability. Others act as staging grounds and information repositories for coordinating responses to new rulings and changing interpretations of how to implement recently enacted healthcare legislation. This activity is reminiscent of coordinated responses, among firms and their legal counsel, to new legislation in other industries, like telecommunications; and to wide-reaching regulatory efforts, like environmental protection. Although the technologies have changed and the legislative objectives vary greatly, organizational approaches to such improvements are less varied. Ironically, these overarching similarities focus attention on the need for continued articulation of changes and local differences in information system use, and the ability of boundary-spanners to introduce ways of working that bridge these gaps and refine healthcare practices that drift toward higher quality.