E-messages as a tool for improved information exchange across levels in the health care sector: intentions and realities

PURPOSE: The purpose of this paper is to present a study exploring how an electronic message (e-message) system was adapted and used in health care. The e-message system was developed to support and strengthen communication and information exchange between health care providers in a university hospital and the affiliated municipality. Implementing e-messages is expected to enhance quality of care for patients in need of municipal health care services post-hospital. THEORY: Latour's (1987) model of translation is used to analyse users' adoption of the e-message system. The translation model emphasises agency on part of all users, and is therefore useful for understanding varying acceptance of technologies and consequently varying technological working practices. METHODS: In total 25 semi-structured interviews were conducted with approx. 50 different actors, covering physicians, nurses, nursing assistants, clerical staff and project leaders for the e-message system. The interviews took place over three periods during 2006 and 2007. RESULTS AND CONCLUSION: The e-message system is understood and deployed in different ways by various actors, though the overall conclusion by the health personnel is that e-messages are a useful service. DISCUSSION: Applying a translation approach is useful for understanding how people put a technology to use, including providing knowledge about both enabling and constraining elements when implementing a technological tool. Changes in working practices and internal routines should accompany the implementation of e-messages in order to utilise its potential.