In the county of Sogn & Fjordane there is long experience with electronic messaging between the first line of service and the hospital, but now they are about to realize the paperless interaction.  There are still challenges to solve, but in three pilot municipalities the implementation is a success and the long awaited process has been completed. Local initiative in the health sector can be hampered by stakeholders with large degree of freedom. Even when following national regulation and standards the process has taken time and effort. It demonstrates how too many actors influence and delay a local health sector projects, forcing unforeseen development of new software for national use and organizational procedures with national impact.

This process has already proven to be more than the top-down technology diffusion envisioned at the start in 2006. Both in the three pilot projects and in the remaining 23 municipalities the process involves change in large and small organizations and require learning, new procedures and establishment of new relations, reallocation of resources and new organisational structures. This article discusses these and the chosen strategies in light of aspects from Leavitt’s Diamond.

Larsen, Ø. H. and I. Skogseid (2009). Electronic interaction in health services and organizational change - projects with national impact from the county of Sogn & Fjordane SHI 2009 Scandinavian Conference on Health Informatics ,Arendal. SHI2009 Proceedings tapir academic press, ISBN 978-82-519-2443-6