1. Information systems/infrastructure complexity Actor Network Theory

2. Complexity Types of components, types of links, speed of change Types of components, types of links, speed of change Unpredicable (or uncontrollable) interactions, unpredicatable (or uncontrollable) outcomes Unpredicable (or uncontrollable) interactions, unpredicatable (or uncontrollable) outcomes (propagation of) side-effects (propagation of) side-effects ANT’s contribution: “Types” ANT’s contribution: “Types”

3. Actor Network Theory Understanding heterogeneity: interaction between the social, technical, institutional, … (humans and non-humans/technological and non-technological components) Understanding heterogeneity: interaction between the social, technical, institutional, … (humans and non-humans/technological and non-technological components) Network of actants Network of actants Origin: Social studies of science Origin: Social studies of science The interaction between social, political, technological, institutional elements in construction of scientific facts and theories (Kuhn) The interaction between social, political, technological, institutional elements in construction of scientific facts and theories (Kuhn)

4. Actor Network Theory 2 Theory/fact and technology: heterogeneous network Theory/fact and technology: heterogeneous network Science and technological development: Science and technological development: –Transforming/building networks –Actors: (heterogeneous) networks

5. Actors Always heterogeneous network Always heterogeneous network No assumptions about differences between human and technology No assumptions about differences between human and technology There ARE differences: constructed - not given There ARE differences: constructed - not given Inscriptions of rules and programs-of-action, delegations of roles and competences,.. Inscriptions of rules and programs-of-action, delegations of roles and competences,.. Humans are different - technologies are different Humans are different - technologies are different Ideal for studying interaction between humans, organizations and technology (I.e. the role of the technology. Compare with Orlikowski’s technological artefact/technology-in-use distinction) Ideal for studying interaction between humans, organizations and technology (I.e. the role of the technology. Compare with Orlikowski’s technological artefact/technology-in-use distinction)

6. Concepts Actants Actants Associations/networks/collectives (of humans and non-humans) Associations/networks/collectives (of humans and non-humans) Association, Translation, composition, enrollment Association, Translation, composition, enrollment Interference Interference –Ex.: gun, man, gun+man Inscription, delegation Inscription, delegation Program-of-action Program-of-action Black-boxing Black-boxing Irreversibility Irreversibility ”Immutable mobiles” ”Immutable mobiles” Fluids (”mutable mobiles”) Fluids (”mutable mobiles”) Order’s dis-order Order’s dis-order

7. Assumptions Everything – theories, facts, technologies, humans – are networks/collectives Everything – theories, facts, technologies, humans – are networks/collectives Network building is a political process Network building is a political process All actors have interests All actors have interests Building alliances (humans and non- humans) Building alliances (humans and non- humans) Power = size of the network Power = size of the network The process is embedded in the product The process is embedded in the product

8. Example: Lab reports Lab reports - Fürst Lab reports - Fürst Solution = sequence of translations (of interests and existing solutions and technologies) Solution = sequence of translations (of interests and existing solutions and technologies) Interests and translations: Interests and translations: –Increased profits =>More customers =>Better service =>Electronic transmission =>Specific design

9. Lab. reports - continued Integration with medical record system Integration with medical record system Giving away modems for free Giving away modems for free Integration with local practices Integration with local practices For each translation: the network (collective) grows, alignment is maintained For each translation: the network (collective) grows, alignment is maintained

10. Lab orders Interests Interests –lab: increased profits -> cost containment --> cut manual registration work –doctors: ? –patients: security, … –vendors, authorities, standardization bodies, standards, … : ????

11. Order continued... EDIFACT solution: failed to enroll doctors EDIFACT solution: failed to enroll doctors Failed to align standardized solution and doctors’ interests Failed to align standardized solution and doctors’ interests Fürst: “continuous ordering” Fürst: “continuous ordering” Appears to be impossible to align with established (EDIFACT/e-mail) standards Appears to be impossible to align with established (EDIFACT/e-mail) standards

12. Prescriptions Social security: cost containment – more strict control Social security: cost containment – more strict control Pharmacy: Cutting manual registration work, improved logistics Pharmacy: Cutting manual registration work, improved logistics Patients: Less waiting (reiterated prescriptions ?) Patients: Less waiting (reiterated prescriptions ?) Physicians: Quality control Physicians: Quality control Failed to make a solution that anybody would pay for Failed to make a solution that anybody would pay for Failed in translating the interests into an aligned network Failed in translating the interests into an aligned network

13. More on Prescriptions Failed standardization Complex socio-technical networks (failed to understand the complex network of relations between the social and the technical) Failed standardization Complex socio-technical networks (failed to understand the complex network of relations between the social and the technical) Focused isolated on standardization Focused isolated on standardization Didn’t address the need for translating technology into use Didn’t address the need for translating technology into use Blind for interests Blind for interests

14. Design: Making inscriptions of programs-of-action of programs-of-action which one? which one? How? How? Who? Who? How strong is the inscription? How strong is the inscription? Can users change it? Can users change it? Flexibility!! Flexibility!!

15. Inscriptions in standards

16. Example: Hotel keys (Latour) Problem: Customers not returning keys Problem: Customers not returning keys Anti-programs Anti-programs 1. trial: Sign behind the counter: ”Please remember to return the key” 1. trial: Sign behind the counter: ”Please remember to return the key” 2. trial: Ordering the ”doorman” to remind customers 2. trial: Ordering the ”doorman” to remind customers 3. trial: Adding a metal nob to the key 3. trial: Adding a metal nob to the key Inscribing = building network Inscribing = building network Make it strong enough Make it strong enough

17. Inscriptions in standards ”Materials” ”Materials” –The standards organizations –Systems architecture –EDIFACT syntax –Messages –Data elements The socio-technical network! The socio-technical network! The EDIFACT network: Big and strong The EDIFACT network: Big and strong

18. Inscriptions in the EDIFACT actor network Emergent property: No user participation Emergent property: No user participation –Must know the rules and the network –The complexity of the network –The EDIFACT mafia in control –No flexibility Emergent inscriptions, aggregation of side-effects Emergent inscriptions, aggregation of side-effects

19. Systems architecture Message based, transaction oriented, client/server, event-driven Message based, transaction oriented, client/server, event-driven EDIFACT: message based (modelling paper forms) => email (X.400) EDIFACT: message based (modelling paper forms) => email (X.400) Labs: Labs: –Complete orders and reports –Ordering new analysis

20. EDIFACT Syntax No sub typing => no specialization No sub typing => no specialization General standard that includes everything General standard that includes everything Defining new subsets of this one Defining new subsets of this one New local needs must New local needs must –Be included in the general standards –Defining new subsets

21. More on EDIFACT syntax Implications Implications –Low flexibility –Centralized control –Complexity –=> aligned with inscriptions into the standardization organization

22. Individual messages Data elements determines the use are of a message Data elements determines the use are of a message Economic data in lab messages? Support administrative processes Economic data in lab messages? Support administrative processes References internally in a message? References internally in a message? Including the order in the report? Including the order in the report? –Huge amounts of date –Complex definitions –Order sometimes required Inscriptions in organization too strong Inscriptions in organization too strong

23. Data elements Identifying drugs in prescriptions Identifying drugs in prescriptions Text? Text? Code? Code? Selecting identifiers Selecting identifiers Establishing organization? Establishing organization? Extend GP’s systems Extend GP’s systems Distribution of new versions to GPs Distribution of new versions to GPs

24. Extending the network to increase its strength How to make GPs use the codes? How to make GPs use the codes? –Integration with EPR –Integration with common catalogue? –Extend the list with additional information? –Quality assurance?

25. Technology as ally Vendors tried to ally themselves with a standard to strengthen own position Vendors tried to ally themselves with a standard to strengthen own position HL-7, Medix, EDIFACT HL-7, Medix, EDIFACT...CEN...CEN The dept.’s initiative was killed The dept.’s initiative was killed