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Short abstract:

This paper employs infrastructural imaginaries to explore a digital health initiative for Integrated and Close Care. Despite transformative goals, our study shows how infrastructure perpetuates existing ways of working. Our insights aid in aligning infrastructures with intended outcomes.

Long abstract:

This paper identifies how the concept of infrastructural imaginaries may help us analytically to understand the tensions behind a digital health initiative. In Sweden, the government is investing heavily in Integrated and Close Care (ICC), where the patient is promoted as an active co-creator through person-centered care. With the ICC transformation everything should be up for grabs; moving healthcare to people's homes and changing what it means to be a patient. Amidst this rhetoric, vendors for example describe how they offer innovative interfaces for an integrated patient journey, yet the existing infrastructure hides other aspects that hinder this change and perpetuates existing practice. The consequence is paradoxical: these changes aim to emancipate patients as active participants, yet further cement them into passive roles. Such digital transformation aims for change but instead entrenches the status quo.

Our objective is to identify the characteristics of a digital infrastructure enabling ICC. Our study is based on interviews with stakeholders involved in the implementation of a platform for automated triage and virtual consultations, one of the first digital developments in this initiative’s person-centered approach. Additionally, we draw on secondary data from public documents to enrich our analysis. This allows us to critically explore how infrastructures can both give shape to imagined implementations, but also hinder our ability to create meaningful change. We contribute to broadening the discourse at the intersection of digital health and infrastructures as well as providing insight in how to increase the fit between infrastructures with the practices it should support.