title: Getting the big picture: the macro-politics of information system development (and failure) in a Canadian hospital.
abstract: OBJECTIVE
  While recognized that global actors influence health information system design, studies of health informatics have largely focused on micro politics of technology design and implementation. Here a problematic patient care information system (PCIS) is discussed in relation to federal and provincial policies and corporate strategies to demonstrate that our understanding of health informatics can be enhanced by linking micro studies of health informatics to larger macro contexts.
  
  
  METHODS
  Interviews and document study.
  
  
  RESULTS
  Although the extent to which federal initiatives influenced (or failed to influence) provincial and hospital initiatives remains debateable, events initiated at one level (the hospital's decision to implement software, initiated at the organizational level) are influenced (perhaps indirectly) by developments in other contexts (federal/macro changes gave an initiative more weight; provincial initiatives such as the Labour Accord altered the industrial relations environment in which system development occurred).
  
  
  CONCLUSIONS
  Micro-studies of work practice, invaluable in addressing interactions between technologies, users and work practices, often fail to account for the historic reach of global actors, although it is often these historic circumstances that contribute to present-day interactions between user, information system and organization, and that find expression - often indirectly - in daily work practices.
authors.affiliation: School of Communication, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada. ebalka@sfu.ca
authors.forename: E
authors.initials: E
authors.lastname: Balka
mesh_terms: D002170:Canada; D004059:Diffusion of Innovation; D035082:Federal Government; D018166:Health Care Reform; D006751:Hospital Information Systems / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011050:Policy Making; D011057:Politics; D018511:Systems Integration