The Discursive Construction of Configurable Artifacts : Following Initial Steps of a Clinical Information System Implementation

This paper addresses the issue of the adoption of a clinical information system (CIS) in two multi-hospital centres during the initial periods of CIS selection and pre-implementation. From a theoretical perspective that combines structurationist premises with a critical discourse analysis approach, we explore how the discursive practices of CIS managers help make sense of and shape reality and lead to decisions and actions that influence the CIS configuration being developed. Although CIS managers appear to be aware of the risks and organizational impact of the adoption of a new CIS, their discursive practices, decisions and actions over the period examined are mainly driven by financial constraints and power struggles between different groups involved in the process. The meaning of the CIS is therefore being constructed in a context of both willingness and high uncertainty. Nonetheless, this project is also generating an important and unexpected institutional phenomenon: the inter-organizational collaboration between heretofore competitors in the local health care delivery system.