Disruptive Innovation in Health Care: Business Models, Moral Orders and Electronic Records

Abstract

There is widespread consensus that current healthcare costs are unsustainable, and that efficiencies could be achieved by reorganising care and making greater use of information technology, in particular nationally available electronic health records. Such approaches have, however, been difficult to implement, partly because incentives for uptake are weak. In this article we argue that the difficulties go deeper than calculations of costs and benefits, and include disruptions to the complex moral orders that surround the production and exchange of health information. Using the introduction of national electronic health records in England and Australia as examples, we show how attempts to reshape and transfer distributions of rights and responsibilities developed in the age of paper into the digital world go awry. We suggest that a fundamental rethinking of the role of ‘records’ in healthcare may be an integral component of the moral re-ordering required to transform health care through such means.