The Contribution of Conceptual Independence to IT Infrastructure Flexibility: The Case of openEHR

Debbie Tarenskeen*, Rogier van de Wetering, René Bakker, Sjaak Brinkkemper

*Corresponding author for this work

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In the Netherlands demands on IT support in healthcare organizations are increasing. New visions on healthcare focus on patient-centered healthcare, where mutual consultation among healthcare professionals in the network becomes a standard process. Recent governmental regulations prescribe that patients must be able to access personal health records. IT flexibility is needed to allow organizations to meet new demands. In this study we focus on Conceptual Independence (CI) because CI, as a design principle, can improve the adaptability of Information Systems (IS). Software with CI operates on flexible data models that are independent of the CI based application. Therefore, it is claimed that a standalone IS becomes more flexible with CI. We extend the claim by demonstrating that CI affects the flexibility of the entire IT infrastructure. We investigate which dimensions of IT flexibility are responsible for the improvement. Multi-case study research has been performed following a mixed-methods approach in 10 mental healthcare organizations. Five have implemented openEHR, a proxy for CI, and five have not. Data has been collected with a questionnaire of IT infrastructure flexibility and semi-structured interviews. The data synthesis shows a positive effect of CI on IT flexibility, as CI increases the adaptability of IS, transparency and standardization of the IT infrastructure.

Original languageEnglish
Pages (from-to)235-246
Number of pages12
JournalHealth Policy and Technology
Issue number2
Publication statusPublished - Jun 2020


  • Conceptual Independence
  • IT infrastructure flexibility
  • mixed-methods research
  • openEHR


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