Digital Institutionalization: The Case of E-Prescribing

Abstract

Digital institutionalization processes are fundamentally changing society. They occur when rules and norms are encoded into a digital infrastructure and change practices. For institutionalization to occur, numerous actors must alter their behavior similarly, which accompanies a shift in infrastructural technology. Digital infrastructures and their design play a crucial role in institutionalization processes, as they enable and restrict social interaction in the exchange of digital institutional entities across contexts. Such entities are constitutive of digital institutional systems—medical prescriptions, money, insurance, and taxes are all institutional entities that have been digitalized. Although several studies have described the challenges of digital infrastructure design, there has been little consideration of the institutional context that legitimizes the design. To fill this research gap, we applied the critical perspective of designers, who intentionally perform and are responsible for the design and legitimacy of digital institutional systems. To address the challenge of institutional design, we developed an exchange contract within an institutional context featuring a change in digital infrastructure and practices. Through this, we illuminate several design principles for digital institutionalization. This contribution captures critical design decisions and the knowledge acquired through insights gained from the design of a highly impactful scalable digital infrastructure, which ultimately transformed an institutional system. We also provide theoretical reflections informed by speech act theory and institutional theory and thereby emphasize the need to rethink institutionalization processes in an era of digitalization.