This seminar reports the findings from a seven-year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large scale national ICT programme at an estimated value of £12.4bn. Using a longitudinal research method, data is collected on the policy-practice nexus. We apply institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalization. Our findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the healthcare environment. A process analysis shows that as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process. This research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice. The findings demonstrate the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound 'business case' have not been achieved. This research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices reaching a process of sedimentation (institutionalization) or it fails to take hold and fades from view.

This paper is due to be published in the Journal of Enterprise Information Systems in 2011.

Prof. Wendy L. Currie is Director and Co-founder of the International Policy and Technology Research Unit at Warwick Business School. Previously, she was Professor in Information Systems at Brunel University, and was awarded a Personal Chair in Management at the University of Sheffield in 1997. She has obtained research funding from the ESRC, EPSRC, European Union and the Chartered Institute of Management Accountants for studies on policy, strategy and management of information and communications technology (ICT). She is currently on the editorial board of 10 scholarly journals, including Information Systems Research, the IEEE TMIS, Journal of Information Technology, Journal of Strategic Information Systems; and formally for Management Information Systems Quarterly and the European Journal of Information Systems. She served as European, Middle East and Africa representative for the Association for Information Systems, and was joint Conference Chair for the International Conference on Information Systems held in Arizona in Dec 2009. Her research is published in the information systems and management journals and she works with several 'blue chip' companies on various research projects. In 2009, she served in the Editorial Board on the special issue on “institutional theory in information systems research” in Journal of Information Technology.

Dr. David. J. Finnegan gained his PhD in Information Systems from Warwick Business School, focusing on business systems integration and customer relationship management. With twenty years of senior management experience, he specializes in business systems integration. His PhD in this area was sponsored by IBM. With an international background in management and IT consultancy, he combines research and experiential learning where students apply theory to practice. He is co-founder of ‘Business Technology Leadership and Management Unit’ at Warwick Business School (WBS). The unit seeks to reinforce WBS's partnership with Industry Practitioners with a focus on shared interests and benefits. Previous roles have included working for the Swedish Home Office and working in the e-business environment in strategic leadership, mentoring and auditing roles. David is currently conducting research into ICT business, management and leadership. His research areas include Financial Sector, Healthcare, Intelligence Integration and Church of England. He recently published a book on customer relationship management and is currently working on a research study comparing integrated healthcare in Sweden and the UK.