The novelty of thesis findings compared to the reference theory

The theoretical stance this thesis is built upon is: information infrastructure design theory, i.e.

(Hanseth and Lyytinen, 2010). As a result, the design framework developed through this thesis contributes to literature in those areas. I will now try to position my findings in relation to the existing literature, how it challenges that reference theory and goes beyond it.

This thesis contributes primarily to the information infrastructure theory. Using the basis of the design rules of Hanseth and Lyytinen (2010), I have added 4 design problems accompanied by a set of 5 design principles to address them. These findings contribute to this reference theory in a number of ways.

First, the thesis extends the original design theory by making its design problems more specific and augmenting them with additional problems. For example, the problem of competing systems is a more detailed and specific version of the adaptability problem. In Hanseth and Lyytinen’s work, there is no explicit discussion on the issue of systems directly encroaching each other’s.

In addition, the thesis identifies and discusses the problem of all or nothing. This problem shares both similarities and differences with the adaptability problem defined by Hanseth and Lyytinen (2010). All or nothing is similar to adaptability, as both of them have to be able cope with change, especially when there is an increase in number of users. However, the all-or-nothing problem demands that all users in a particular geographical area, e.g., a district or a province, etc., must be enrolled whereas the adaptability problem focuses on how to adapt to increased number of users or increased requirements.

Second, the design principles and rules proposed in the thesis are developed to address issues inherent to health information systems in developing countries. While Hanseth and Lyytinen’s work has a particular focus on a bottom-up approach where bootstrapping and self-adapting drives system evolution, this thesis emphasizes the role of politics and governmental agencies in the adoption and scaling processes.

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Third, the problem of data use is not discussed in the reference theory, though it is a common issue in the health information systems domain (see, for example, Braa et al. (2012)) and probably in other domains as well. The current trend in Big Data (Wyber et al., 2015, John Walker, 2014), Data Mining (Hand, 2007), and Business Intelligence (Chen et al., 2012) are good examples showing how data use is critical in large-scale and complex information systems. This thesis suggests a number of approaches to dealing with this issue in the particular context of HISs in Vietnam. It shows that once the data use problem is resolved, it can contribute back in order to sustain and expand the system. For example, when a system shows that its data can be used for action or decision-making, it is easy to earn support and legal permission to expand so that it can enrol more users and attract more funding.

In summary, this thesis extends the reference theory by identifying additional design problems that have not been covered by the original design theory. Based on the identified design problems, the thesis suggests new and revised design principles and rules to deal with the problems.

Table 11 summarizes the design principles and design rules that address the emergent design problems related to HII, as well as the empirical evidence that formed the basis of the

principles.

Table 11: Summary of the amendment to the II design theory

Design problems

Design principles

Design rules Evidence that formed the design principles

Scaling and

- Because DHIS2 is a web-based software, it shortened the time required for

implementation

- The use of a number of temporal software programs reduced the time it took to switch from paper to the online system, e.g. the Excel importing tool.

- Licensing officers at the first 5 provinces supported the systems and helped convince provinces when it came to using the systems.

- A dedicated support team helped increase the adoption coverage

- Functionality to export data to Word, Excel formats increased the use of the systems All or New Year reporting as a focus helped gain more support from the MoH

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- Leverage the power and position of politically relevant individuals

- Direct lobbying through foreign consultants and IT specialist resulted in a number of official dispatches that mandated the use of the systems.

- The Team only focused on health professionals licensing management functionality and left the other areas for the BigFirm

- VAMS only focused on hospital data and shared them with GDPM and other stakeholders

- GDPM summoned political support to enact a decree that legitimates its authority in epidemic data.

- The public was only concerned about few important numbers such as traffic accidents, violence, etc.

- Hundreds of news articles about traffic accidents and violence attracted public interests.

- The MoH was very careful in verifying data with hospitals before publishing them.

This chapter has answered the research question posed in the introduction chapter through articulating design problems related to HIIs in Vietnam and discussing design principles and design rules to address those problems. The next chapter discusses how these insights contribute to the body of knowledge relating to health information systems and information infrastructure and to the practice of developing and implementing HIIs in developing countries.

90 7 CONTRIBUTIONS

The primary aim of this research is to improve our ability to design and implement HISs in developing countries. To that end, II theory is employed as a theoretical lens to examine the challenges related to HISs in developing countries and to build theoretically informed interventions to deal with these challenges. Specifically, this research identifies design problems related to HIIs in developing countries and suggests design principles and design rules to resolve them within a framework of II design theory. The thesis thus mainly contributes to the literature on HISs in developing countries. It also contributes to II literature by framing more design problems and defining more design principles and rules to the II design theory.

While the summary of the papers in chapter 5 focuses primarily on the findings from the individual papers, this chapter seeks to bring them together and develop broader contributions.