Implementing healthcare information systems – Mirroring a wide spectrum of images of an IT project

•The use of images as a concept to study HIS implementation and use.•An analysis of HIS implementation challenges using ST.•Illustrative case study of HIS implementation and use.•CSF literature critique.

The main purpose of this paper is to discuss the spectrum of interpretations that can be related to the implementation and use of a healthcare information system (HIS). The empirical part of this paper is based on a qualitative case study of a Swedish healthcare provider, called “Alpha”, where a HIS was implemented. By studying how different actors interpret technological and organizational changes in a healthcare case, we mirror different images of the implementation project. Put together, this diversity of images provides an illustration of the complexity associated with the process of implementing a HIS. We apply an adjusted version of Orlikowski's practice lens, with its roots in Structuration Theory, in order to study technology in organizations (focusing inertia, application and change). The implementation process of a HIS is much too complex to be judged as being either entirely positive or negative; instead it offers an illustration of the multi-faceted and reciprocal relation between IS and organization. This challenge literature on critical success factors. This study illustrates several images of HIS implementation and use. Highlighting images is one way to illustrate reluctance, support, complexity and power that are present in HIS implementation and use. This is one important contribution from this article. The complexity in the implementation is linked to healthcare organizations as professional bureaucracies, being highly politicized and institutionalized and to the IT artefact as an integrated HIS. Viewing images as rational myths is also discussed in this paper as an original approach to understand HIS implementation.