Exploring the formation of a healthcare information infrastructure: Hierarchy or meshwork?

The digitalization of economic and social activity has brought information infrastructures (IIs) to the forefront of research. This paper studies II formation processes and their outcomes; namely, II architecture and distribution of control rights. We conduct an in-depth exploratory case study of an electronic prescription II and report on two formation processes: stratification and mesh working. The stratification process in our case study involved classifying the IIs’ diverse socio-technical components into homogeneous groups and consolidating them into a coherent hierarchical structure that standardized the components’ behavior. The outcome of this stratification was a dual and hierarchical architecture and a fairly centralized locus of control. The mesh working process, by contrast, assembled heterogeneous components without homogenizing them; the components were distributed in a way that enabled them to self-organize. The outcome of this mesh working process was a modular architecture that decoupled the central nodes from the users’ installed base and a more decentralized structure. Consequently, the final II architecture was a hybrid offering both centralized control and autonomy of the parts. Our research further illustrates how this architecture then influenced the project’s complexity and the actors’ position in the sector. We build our contribution on extant II research.