Health Information Systems Enabled Transformation of Service Ecosystems: The Case of Indonesian Healthcare

Abstract

Information and Communication Technology (ICT) has contributed significantly to the socio-economic development of societies. In particular, developing countries are now beginning to undertake ICT-enabled transformations that previously took place in the western world. However, while the proliferation of ICT is considered a crucial enabler of this transformation, ICT for Development (ICT4D) projects continue to fail as they do not achieve the anticipated societal impacts. Therefore, a holistic and systemic perspective of ICT4D research is needed to enhance the current understanding of these phenomena.

This study addresses this knowledge gap through an in-depth investigation on how the structure of public health ecosystem in Indonesia is changed and transformed following Health Information Systems (HIS) introduction. A qualitative multiple case study was conducted across three district-level government. The analysis reveals the distinctive impacts of HIS introduction on the structural properties of the ecosystem, which include institutional rules, resources configuration, actors’ institutional logics, and practices. This study also identifies three mechanisms (adoption-incorporation, breaking-making, and self-reinforcing) of HIS enabled transformation which constitute two pathways (enslaving and emergence) of the ecosystem's transformation.

The findings of this study offer theoretical contributions to ICT4D and service literature and practical contributions to HIS implementation in Indonesia. The transformation process of the ecosystem’s structure offers a systemic perspective of ICT4D, which overcomes the tendency to overemphasise the significance role of technology and agency in developing countries. The pathways of transformation complement those earlier studies investigating the reasons for numerous failures of the top-down technological transfer and the importance of inclusion, engagement, and empowerment of the societal groups in ICT4D. To service literature, this study offers insights into the origins and lifecycle of practices and how they emerge in the ecosystem, which shed light on the dynamic and evolving nature of ecosystem’s structure that currently has not been adequately understood. Finally, the results of this study advocate the autonomy of the district’s health providers, the inclusion and engagement of local actors, and the use of the incremental approach to HIS implementation in public health ecosystem.