title: Infrastructures for healthcare: From synergy to reverse synergy.
abstract: The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.
authors.affiliation: IT University of Copenhagen, Denmark.
authors.forename: Tue Odd
authors.initials: TO
authors.lastname: Langhoff
authors.affiliation: IT University of Copenhagen, Denmark.
authors.forename: Mikkel Hvid
authors.initials: MH
authors.lastname: Amstrup
authors.affiliation: IT University of Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Mørck
authors.affiliation: University of Copenhagen, Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Bjørn
mesh_terms: D000077488:Data Science / Q000379:methods*; D016208:Databases, Factual / Q000706:statistics & numerical data; D003718:Denmark; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D020399:Practice Management / Q000592:standards* / Q000706:statistics & numerical data
keywords: data security and confidentiality; databases and data mining; electronic health records; information and knowledge management; information infrastructures; primary care; quality control; sustainability; synergy