Nursing Terminologies as Evolving Large-Scale Information Infrastructures

This paper describes the slowly evolving nature of large-scale terminologybased information infrastructures. The strategic aim of implementing standardized terminologies is to share and compare information within and across domain-specific and organizational boundaries. We are particularly interested in working classification systems focused on specific domains’ and classes, and even more specifically in reference terminologies with the capability to interconnect different existing classification systems. We examine this empirically through a threefold case based on data from three Norwegian university hospitals, where we also track a national recommendation of a reference terminology. The reference terminology, which was initially promoted as a means to achieve integration and harmonization, is increasingly perceived as competing with other terminologies. This “gateway” has been presented as a purely technical and politically neutral system, but may be more complex in reality: such integration processes require considerable adaptations, negotiations, and manual maintenance.