113 Policy & Politics vol 37 no 1 • 113–28 (2009) • 10.1332/030557308X313714 © The Policy Press, 2009 • ISSN 0305 5736 Key words: technology • health • markets • expertise Final submission July 2007 • Acceptance April 2008 Beyond implementation and resistance: how the delivery of ICT policy is reshaping healthcare Susan Halford, Aud Obstfelder and Ann Therese Lotherington New information and communication technologies (ICTs) offer great promise for the organisation of healthcare. Despite diffculties in implementation, commitment to the use of ICT in healthcare policy remains strong. Using examples from Norway, this article argues that this has set in motion changes beyond concerns about implementation and resistance, tied to an emergent mode of policy delivery dependent on private sector contractors and ICT experts working inside healthcare bureaucracies. We explore the consequences of this, as new centres of knowledge driven by distinctive and often conficting rationalities come to shape the policy outcomes of strategic importance in healthcare. Introduction The rapid development and diffusion of information and communication technology (ICT) is a defining feature of contemporary society. Not least, the opportunities afforded by ICT have been instrumental in the global restructuring of investment, business and industry. As this ‘informational paradigm’ (Castells, 1996) has spread, governments worldwide have promoted ICT in the organisation of the public sector and especially in healthcare. In the UK, for example, the National Health Service (NHS) information technology programme constitutes the largest ICT procurement project in the public sector worldwide (Booth, 2003). While much research and popular interest has focused on telemedicine – where clinical interventions are made at a distance – the substantial part of this programme, and similar ones elsewhere, involves the extended use of information systems such as electronic patient records (EPRs). These are represented discursively through a formation that combines affordability, rationality and efficiency with quality, consumerism and individual care (DH, 2002; Haux, 2006; Technology CEO Council, 2006). In short, information systems are presented as key to a technological solution for delivering high-quality, cost-effective and equitable healthcare. However, research on the introduction of ICT into healthcare suggests that, in general, such policies are built on questionable assumptions, about their cost- effectiveness (Whitten et al, 2002), clinical application (Medix, 2005) and patient satisfaction (Williams et al, 2001) and that the evaluation of technological applications in health has been flawed (May et al, 2003;Williams et al, 2003). Furthermore, there is now a substantial body of research highlighting the specific difficulties of bringing information systems into clinical practice, in particular the considerable resistance that may be faced ‘on the ground’ to implementation (Dent, 1990; Berg, 1997, 2001; Rappert and Brown, 2000; Hartswood et al, 2003; Timmons, 2003; Doolin, 2004; Heeks, 2006). Despite these difficulties, the promises of the informational paradigm continue to hold weight and commitment to the development of an Delivered by Ingenta to: University of Georgia IP : 188.72.127.122 On: Mon, 06 Jun 2016 05:49:08 Copyright The Policy Press