User-Controlled Standardisation of Health Care Practices

The need to access information across different levels of the health care system has prompted attention to standardising electronic patient record (EPR) systems. However, this has proven extremely difficult to achieve. One reason is that much structuring of the EPR content translates into the need to standardise related routines and practices. In this paper, we demonstrate that the Norwegian national performance standard “cancellations of surgery” is adapted locally in ways that promote many different understandings and thus applications of the standard. We have identified differing interests in the performance standards relating to the various organisational levels of users. Using the emerging international openEHR framework as a backdrop, we discuss the effects of offering users the technical means to control standardisation processes given the different interests