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Paper short abstract

Using Scotland’s Key Information Summary, this study theorizes how information infrastructures evolve over time, with formal workarounds extending them to new settings and user-driven repair work enabling adoption in line with evolving expectations for integrating health and care providers.

Paper long abstract

Background:

Digital technologies such as summary care records aim to support collaborative work by enabling professionals to coordinate care and integrate fragmented health and social care services. However, adoption varies across settings, with users developing workarounds to meet local information needs. In Scotland, the Key Information Summary (KIS) has been used for over 13 years to share key patient information from General Practices (GPs) with other health and care providers for Future Care Planning. Using KIS as a case study, this research examines how workarounds and adoption strategies have shaped the evolution of regional information infrastructures integrating health and social care providers.

Method:

This multi-sited ethnographic study examined KIS adoption across health and care settings. Data collection included interviews with users, implementers, and vendors; analysis of policy documents and user guides; and observations of multidisciplinary meetings and technology use. Analysis combined deductive coding using the Technology–People–Organization–Macroenvironment framework with inductive application of Science and Technology Studies concepts to examine local adaptation.

Results:

Data comprised 54 interviews, 59 documents, two websites, and 20 hours of observation (April 2024–March 2025). Adoption strategies varied over time due to misalignments between system design, evolving expectations of integrated care, and national initiatives during COVID-19. Formal workarounds extended the healthcare-centric infrastructure into non-clinical settings, while informal user-driven repair practices supported ongoing adaptation.

Conclusion:

Regional information infrastructures evolve incrementally as they become embedded in local practices. Workarounds and user-driven repair practices play a key role in sustaining and expanding these infrastructures over time.