Electronic Interaction in Health Services and Organizational Change – Lessons From the Norwegian County of Sogn & Fjordane

November 2012

In the large, sparsely populated, but resourceful Norwegian county of Sogn & Fjordane, there is need for electronic messaging between the primary care service and hospitals. Several years and significant resources have been spent setting up this initiative which attempts to take the paper out of paperwork. A consortium of local organizations established in 2006 is still working to this aim. The question remains though as to why this desired transition to a paperless form of communication has not taken place? Barriers initially appear technological in nature, but this paper argues that local initiatives in the health sector can easily be hampered by stakeholders, both large and small, whose influence greatly shapes how and when actions are implemented. The electronic messaging project has had success in key areas, with impacts both at regional and national level. Due to modest national regulations and standards open to interpretation the obstacles have been harder to overcome than our many high mountains and deep fjords. This article discusses the challenges faced and the strategies chosen by exploring the goals, participants, the technology and the social structures which are all influencing the change process to answer the question; 'why has the desired transition to an electronic communication taken so long time?'.


The IADIS e-Health 2011 conference received 103 submissions from more than 29 countries. Each submission has been anonymously reviewed by an average of four independent reviewers, to ensure that accepted submissions were of a high standard. Consequently only 19 full papers were approved which means an acceptance rate below 19 %. A few more papers were accepted as short papers, reflection papers and posters. An extended version of the best papers will be published in the IADIS International Journal on Computer Science and Information Systems (ISSN: 1646-3692) and/or in the IADIS International Journal on WWW/Internet (ISSN: 1645-7641)