Margunn Aanestad
email: margunn@ifi.uio.no

Information Systems Innovation Research: Between Novel Futures and Durable Presents

Keywords: Innovations, infrastructural inversion, maintenance, installed base

In this paper, I argue that we should not only orient ourselves to the future by looking forward to the yet unrealized. When researching the future, we should also develop a sensibility to the durability of our past and present creations, and understand how they impact the scope for future innovations. The common emphasis on the visionary and novel components of innovation needs to be complemented with an emphasis on the constants, the slowly changing or non-changing aspects. In the paper, I seek to articulate how we could increase our ability to recognize the durability of the present with respect to empirical study objects, analytic approaches, and theoretical resources.

Introduction: The Durability of the Present

The call for papers for this conference announced that Ait is now time to explore, develop and substantiate the new directions through which our field can shape and influence the future of ICT-based practices. If anticipating and influencing the future is something qualitatively different than immediate research relevance, we must then ask whether and how our approaches to inquiry can affect our ability to do so.@ In this paper, I will present an argument for researching the future in ways that also pay attention to the role of Adurable presents@ [START_REF] Risan | The Duration of the Present and the Risk of Not Telling Large Stories[END_REF].

The dominant way to think about the future in the IS field seems to be to link information and communication technologies (ICT) and innovation. ICTs are often proclaimed to be crucial for the economic growth of nations or regions. This could be directly through the production of innovative ICT solutions for a market, or indirectly in facilitating cost-efficient provision of (public) services through ICT deployment. This coupling between the technology and the wished-for innovation offers an opportunity for IS research to present its research as relevant by contributing to the successful operation of this engine of growth. Such a position entails the risk of sliding into instrumental research, rather than maintaining a questioning and critical position to the legitimacy, purpose, and directions of innovation attempts. A certain pro-innovation bias can be identified both in the IS literature and innovation research (Swanson and Ramiller 2004, p. 554). Mainstream IS research on innovation has mainly sought to produce useful knowledge for managers on topics relevant for increased profitability and market share. If we follow Schumpeter=s (1934) distinction between invention (making an idea manifest) and innovation (the practical and commercially viable exploitation of an invention), we can say that the management-oriented literature has focused mainly on innovation at the expense of the process of invention. Becoming Ainnovative@ may thus be limited to only deciding to purchase a novel technology or jumping onto a new bandwagon [START_REF] Fiol | Waking Up! Mindfulness in the Face of Bandwagons[END_REF][START_REF] Swanson | Innovating Mindfully with Information Technology[END_REF]). Typically based on studies of the diffusion of innovations within a population of potential adopters, this research stream has sought to establish either why some organizations are more innovative than others, or what makes certain innovations more adoptable than others (Fichman 2004, p. 317). In more design-oriented research stream the focus has been on the efforts required to bring the invention forth, and researchers study how new ideas become manifest in future workshops, scenario building, and innovation laboratories [START_REF] Ehn | From Systems Description to Scripts for Action[END_REF][START_REF] Kensing | Generating Visions: Future Workshops and Metaphorical Design[END_REF]. Different techniques to facilitate imaginative leaps and study creativity in describing new artifacts, practices, or narratives have been developed. However, within both of these streams the studies tend to emphasize the break with current solutions, expectations, theories and practices.

We tend to assume that the topic for IS innovation research is the activity of creating something new. However, when we look at our world, we see that the Anovel futures@ that we seek to design are only one part of the story. Continuity with the past has also played a significant role in historical development. Many of our cities consist of buildings belonging to different historical epochs, and the cities may be organized according to street plans laid out several hundred years ago. Our legal and political systems have ancient roots and elements, and historical aspects also feature strongly in the academe=s self-perception. As a research field, we should not only look towards novel futures but also develop our ability to examine, assess, and deal with the durable present. The future will consist not only of new stuff; it will also consist of what we have built and what we are building now. Thus the theme of researching the future should also stimulate us to develop a sensitivity to what will remain from what we do today, and how the elements, fragments, and remnants of the past and of the present will form parts of the future=s palimpsest.

The motivation for this emphasis is the observation that we, the human race, are capable of (actively) building and (passively) accumulating more complex technological systems that we can hope to fully understand or manage. Our ability to construct complex socio-technical systems may sometimes seem to outrun our capability to govern them. One example of this is our apparent inability to achieve concerted action to avert massive climate changes. In the next section, I will show how challenges stemming from accumulated complexity are also significant within the field of information systems. Thus my motivation is related to the challenges our organizations and societies face when trying to live with the historically accumulated complexity of digital technologies. In the remainder of the paper, I seek to articulate how we can conceptualize these issues and how our research approaches can become sensitive to them.

Empirical Motivation: Historical Accumulation of Complexity

In this section, I will argue that the field of information and communication technology has been strongly shaped by a dynamic where self-induced complexity and remedial action are central. In a retrospective view, we see that major innovations and trends have been spurred by efforts to deal with the emergent consequences, both positive and negative, of previous actions or decisions.

For instance, programmers in the 1960s and 1970s attempted to minimize space and capacity requirements for code, since computer memory and storage was expensive. Saving two digits for every date field was considered a sound engineering trade-off that became best practice. At that time, no one expected programs to live very long: AThe near immortality of computer software has come as a shock to programmers. Ask anyone who was there: We never expected this stuff to still be around@ (Ullman 1999, p. 126). We then learned that code doesn=t evolve; it accumulates [START_REF] Ullman | The Myth of Order[END_REF], and the realization of the potential impact of this Abest practice@ spurred massive activity in preparation for the year 2000, called by some Athe largest concerted repair operation in human history@ (Graham and Thrift 2007, p. 12). However, while these activities were enormously costly, they also brought about a boom for the industry and widespread renewal of systems portfolios and creation of new backup, redundancy, and maintenance structures.

This intertwined nature of problems and solutions, of success and trouble, is fundamental to the field. When companies today struggle with the Alegacy crisis@ [START_REF] Seacord | Modernizing Legacy Systems: Software Technologies, Engineering Processes, and Business Practices[END_REF], one of the reasons is the unexpectedly long-lived and still functioning information systems, an aspect captured by the title of Bennett=s (1995) seminal paper on legacy systems: ACoping with Success.@ However, another reason is the concurrent development of novel solutions to deal with the problems. For instance, when mainframe systems started to age, but could not be easily replaced, middleware technologies emerged. These then offered alternatives to full-blown and dramatic migration, by allowing old legacy systems to be wrapped in newer software (Bennet 1995;[START_REF] Bisbal | Legacy Information Systems: Issues and Directions[END_REF]. While this allowed short-term problem solving, it also contributed to the survival of the legacy systems and thus caused today=s heterogeneous systems portfolios. In many companies, multiple platforms, operating systems, programming languages, applications, and user interfaces are intertwined into complex assemblages, which are maintained at enormous costs. A widespread claim is that maintenance costs tend to vary between 65 and 80 percent of an IT departments budget [START_REF] Webster | Surviving Complexity[END_REF]). In the late 1970s it was already apparent that maintenance, improvements, and adjustments were responsible for the larger part of life-cycle costs (Lienz and Swanson 1981;Lienz et al. 1978). More recently, some studies claim that over 90 percent of total software costs were devoted to maintenance and evolution both in 1990 [START_REF] Moad | Maintaining the Competitive Edge[END_REF]) and in 2000 [START_REF] Erlikh | Leveraging Legacy System Dollars for E-Business[END_REF]. A significant amount of time (around half) is used to understand the old software, which typically has undocumented and unsystematized code, held together by ad hoc patches and kludges. Another major challenge is caused by interdependencies, as fixes in one part of the system (or in the hosting environment) can have ripple effects in other parts, with cascading errors [START_REF] Webster | Surviving Complexity[END_REF]. Security suffers in these complex system assemblages, and the demand for integration and interoperability currently constitute vast markets for consultants and solution vendors.

This accumulated complexity is thus of large practical significance, and currently it strongly shapes the IS practice field. The prime rationale for managerial IT decisions used to be related to arguments about companies= competitive advantage and business agility. However, from practitioners= reports in recent years it may seem that these aspects are overshadowed by the challenges of just coping with IT. IT decisions seem to now be driven by cost considerations and an emphasis on streamlining systems portfolios, reducing complexity and interoperability conflicts, and facilitating manageability. A recent study argued that Asoftware is becoming the limiting factor for progress in all kinds of organizations@ (Kalleberg 2007, p. 4). The historically accumulated complexity of information systems has been called Aa growing storm on the IT horizon@ and a Anightmare of IT staff@ that Aappears to be approaching the limits of human capability@ [START_REF] Murch | Autonomic Computing[END_REF].

Historically accumulated complexity also characterizes the situation if we look beyond the organization. Most developed countries struggle with a fragmented digital infrastructure in the public sector. For instance, well-funded, nationally coordinated attempts to standardize information systems and communication in the public health sector have struggled in several countries, including Norway (Hanseth et al. 2006), Denmark [START_REF] Jensen | National Initiatives to Build Healthcare Information Infrastructures[END_REF] and in the United Kingdom, with the NHS=s massive National Programme for Information Technology [START_REF] Currie | Conflicting Institutional Logics: A National Programme for IT in the Organisational Field of Healthcare[END_REF][START_REF] Greenhalgh | The Devil=s in The Detail: Final Report of the Independent Evaluation of the Summary Care Record and Healthspace Programmes[END_REF][START_REF] Jones | Learning the Lessons of History? Electronic Records in the United Kingdom Acute Hospitals, 1988B2002[END_REF]. Within e-governance, the preexisting information systems where multiple and incompatible standards are inscribed constitute core obstacles. The complexity associated with this, however, has to do not only with heterogeneous technologies and different organizational structures and cultures. These are also deeply intertwined within an institutionalized Aregime@ that is upheld by more or less formal regulations of different kinds [START_REF] Contini | ICT and Innovation in the Public Sector[END_REF]. As a result, despite massively funded and nationally coordinated initiatives, widespread interoperability and integration is relatively seldom achieved. Currently, interoperability frameworks and enterprise architectures are the preferred direction of investments [START_REF] Guijarro | Interoperability Frameworks and Enterprise Architectures in Egovernment Initiatives in Europe and the United States[END_REF][START_REF] Zachman | A Framework for Information Systems Architecture[END_REF]).

Consequently, it seems that after having digitized the work practice, the organization, and the society, we now have to learn to live with the digital, complex systems assemblages that we have created. This should be a core topic for researchers within the IS field. What are we really doing when we build with information technology? Which futures are we deliberately or inadvertently creating? These are questions that will have great relevance for researching the futures, and the question that I want to develop in the rest of the paper.

Resources for Understanding Durability in Innovation

In this section, I seek to identify some relevant resources from the literature on general or ICT-specific innovations.

Innovation Literature

Research on innovation has, to a small degree, thematized the durability or continuity of preexisting systems, practices, and understandings. Naturally, the preexisting reality is relevant in that it constitutes the basis upon which one builds and from which one simultaneously departs; this is in particular the case for incremental innovations and to a lesser degree for radical innovations. It seems fair to say, however, that in general the preexisting has been conceptualized mainly in the form of barrier and resistance against the new. Since Schumpeter=s (1934) emphasis on creative destruction, there seems to have been a stronger interest in the field for radical innovations. For instance, Christensen=s (1997) well-known model of disruptive innovations is typical, as it emphasizes how new technologies can surpass the existing, seemingly superior technologies and turn the market landscape upside down.

However, the theme of accumulation, especially of know-how, has been thematized by some researchers. [START_REF] Henderson | Architectural Innovation: The Reconfiguration of Existing Product Technologies and the Failure of Established Firms[END_REF] distinguish between component and architectural innovation, where the latter requires changes (reconfigurations) in the overall scheme of how a solution=s components are interrelated. Since the architectural knowledge related to a relatively stable dominant design tends to get embedded into information processes and organizational structures within a firm, established firms may have difficulty reshaping their information processes to fit with architectural innovations. Such conceptualization also has been brought to the study of IT innovations, where significant parts of the innovation process are distributed across heterogeneous networks of actors (Anderson et al. 2008;[START_REF] Boland | Wakes of Innovation in Project Networks: The Case of Digital 3-D Representations in Architecture, Engineering, and Construction[END_REF][START_REF] Steinmueller | Does Information and Communication Technology Facilitate Codification of Knowledge? Industrial and Corporate Change[END_REF][START_REF] Tuomi | Networks of Innovation: Change and Meaning in the Age of the Internet[END_REF].

IT innovations may not follow the traditional manufacturer-oriented and supply-pushed innovation patterns, and research has pointed to the role of open and user-driven innovations (Chesbrough et al. 2006;[START_REF] Von Hippel | The Sources of Innovation[END_REF]. In these networked innovation processes the technology can be both a target and an engine of the innovation [START_REF] Boland | Wakes of Innovation in Project Networks: The Case of Digital 3-D Representations in Architecture, Engineering, and Construction[END_REF]. A crucial challenge for such distributed innovation processes is whether cumulative innovation is actually facilitated; that is, whether intellectual property rights allow or block competitors building on each others achievements and result in collective innovations [START_REF] Scotchmer | Innovation and Incentives[END_REF]. A core observation made by IS innovation scholars is that these innovations will, to a large extent, incorporate existing technologies and reuse parts from existing solutions in new designs within new architectures. Such is the claim by [START_REF] Yoo | The New Organizing Logic of Digital Innovation: An Agenda for Information Systems Research[END_REF], who presents a model of the layered modular architecture. Exemplified by the digitization of the book, they describe how devices, networks, services, and content, conceptualized as different layers, are recombined and how the e-book=s product architecture changes over time. Such incorporation and reuse of existing solutions will bring a new organizing logic of innovations, demanding new strategic frameworks and new corporate infrastructures. Their model of the layered modular architecture represents insights that are highly relevant contributions for emphasizing the durability of the present. It mobilizes the notion of architecture and components, and thus allows us to thematize interdependencies between components as well as between layers. Such approaches, which allow us to Adis-entangle@ rather than black-box the actual innovations, offer possibilities to better grasp the intricate interplay between the existing and the novel in ICT-related innovations.

Innovation in the Context of Evolutionary Technological Change

Compared with mainstream innovation research, theories of change developed within an evolutionary paradigm seem to be more oriented toward emphasizing the role that the past and the present play in innovations. For instance, [START_REF] Nelson | An Evolutionary Theory of Economic Change[END_REF] work on an evolutionary theory of technological change describes the stability and conservative effect of existing routines, technologies, etc. Dosi (1982) emphasized the impact by the dominant technological paradigm on innovation processes. He claimed that market forces (i.e., demand) will have a successful impact only within some boundaries defined by the paradigm. This restrictive view on the role of the past also figured in other discourses, evidenced to the focus on path dependency both in historical sociology [START_REF] Mahoney | Path Dependence in Historical Sociology[END_REF] and economic theory [START_REF] David | Clio and the Economics of QWERTY[END_REF].

Within science and technology studies (STS), we find several relevant historical analyses of technology development in large technical systems (see Summerton 1994). For instance, Thomas [START_REF] Hughes | Networks of Power: Electrification in Western Society, 1880B1930[END_REF], in his well-known account of the electrification of America, described the constraints shaping the process of network building. From this and other studies, the notion of Ainstalled base@ has spread to the IS field. Specifically, it has been taken up in studies of information infrastructure studies. In a seminal study of the evolution of a distributed collaborative system, [START_REF] Star | Steps Toward an Ecology of Infrastructure: Design and Access for Large Information Spaces[END_REF] formulated key characteristics of information infrastructures. One of them was that Ainfrastructure does not grow de novo: it wrestles with the inertia of the installed base and inherits strengths and limitations from that base@ (Star and Ruhleder 1996, p. 113), a claim that has been further developed and exemplified [START_REF] Hanseth | The Economics of Standards[END_REF][START_REF] Hanseth | Developing Information Infrastructure: The tension between Standardization and Flexibility[END_REF][START_REF] Monteiro | Social Shaping of Information Infrastructure: On Being Specific About Technology[END_REF].

Within the information infrastructure literature, the installed base is seen to offer strengths and opportunities as well as limitations. Its importance is perceived to be so central that Acultivation of the installed base@ is proposed as the generic change strategy, replacing traditional planning-oriented and top-down design and development approaches [START_REF] Ciborra | A Critical Review of the Literature on the Management of Corporate Information Infrastructures[END_REF][START_REF] Hanseth | Information Infrastructure Development: Cultivating the Installed Base[END_REF][START_REF] Hanseth | Design Theory for Dynamic Complexity in Information Infrastructures: The Case of Building Internet[END_REF]. Cultivation consists of gradual and incremental extensions, often a long-term process [START_REF] Hepsø | Ecologies of eInfrastructures[END_REF]), replacement of elements, utilizing the role of gateways to mitigate conflicts of heterogeneity [START_REF] David | The Economics of Gateway Technologies and Network Evolution: Lessons from Electricity Supply History[END_REF][START_REF] Hanseth | GatewaysCJust as Important as Standards: How the Internet Won the AReligious War@ Over Standards in Scandinavia[END_REF], or to deal with the politicized nature of information infrastructure building [START_REF] Lyytinen | Configuration Analysis of Inter-Organizational Information Systems Adoption[END_REF][START_REF] Sahay | Configurable Politics and Asymmetric Integration: Health e-Infrastructures in India[END_REF]. Thus this stream of research, despite being less innovation-oriented, offers a rich conceptual framework to analyze networked and distributed ICT-related change processes where the existing reality plays a significant role. In particular, the notion of an installed base and the dynamics around it is valuable in this context. Moreover, studies within this stream aim to both encompass the concrete details of their study objects and the larger social and organizational networks of which they are parts, constituting heterogeneous assemblages [START_REF] Contini | ICT and Innovation in the Public Sector[END_REF], and to explicitly theorize the relations between small and large.

Innovation in Practice Studies

If we turn to empirical, practice-oriented studies of inventions and innovation processes, we will see a close engagement with the existing reality. Studies from the STS field as well as the ethnographically inspired work practice studies within organizational studies (e.g., [START_REF] Gherardi | To Transfer is to Transform: The Circulation of Safety Knowledge[END_REF] and within streams such as CSCW and PD, all take part in a move of Arelocating innovations@ (Suchman and Bishop 1999). The achievement (i.e., the innovation) is here conceptualized as socially constructed (i.e., a result achieved through collective work) in situated material practices occurring within distinctive locations. Several laboratory studies described how scientific facts are established, how a certain understanding and mode of working won through, and how innovation activities are deeply enmeshed into a sociotechnically heterogeneous network [START_REF] Fujimura | Crafting Science: Standardized Packages, Boundary Objects and ATranslations[END_REF][START_REF] Knorr-Cetina | Epistemic Cultures: Forms of Reason in Science[END_REF]Latour and Woolgar, 1986;[START_REF] Lynch | Art and Artifact in Laboratory Science[END_REF]. Through such an approach, attention is turned toward, not the outcome of the invention or innovation, but the effort and work that goes into producing it. As such, it describes more explicitly the impact of the preexisting technologies, practices, skills, and resources.

It is important to note that this approach, despite the close empirical contact with concrete cases, does not necessarily imply a Asituationism,@ where one is content with studying local achievements and situated interactions [START_REF] Kallinikos | Recalcitrant Technology, Cross-Contextual Systems and Context-Embedded Action[END_REF]. Many of these studies explicitly address the theme of how the invention or discovery spreads beyond the local situation, and how stabilization and standardization of large-scale collaborative networks are achieved [START_REF] Bowker | Sorting Things Out: Classification and its Consequences[END_REF][START_REF] Fujimura | Crafting Science: Standardized Packages, Boundary Objects and ATranslations[END_REF][START_REF] Ribes | Organizing for Multidisciplinary Collaboration: The Case of the Geosciences Network[END_REF]Ribes andFinholt 2007, 2009;[START_REF] Star | Infrastructure and Ethnographic Practice: Working on the Fringes[END_REF]). In the same vein, [START_REF] Latour | Reassembling the Social: An Introduction to ActorBNetwork Theory[END_REF] emphasized that account of an action or situation that limits itself to the local is insufficient, as there is a lot more to it than local context or situated interactions. AThe word interaction was not badly chosen; only the number and type of >actions= and the span of their >inter= relationship has been vastly underestimated@ (Latour 2005, p. 212). Any action overflows its context; actors far away in space and time have an impact. Action is dislocated, redispatched, and redistributed, and Latour holds that our theories need to encompass the temporal dislocation of present actions, both into the future and in the past.

Although not stemming from the STS discourse, the study of innovation practices by [START_REF] Spinosa | Disclosing New Worlds: Entrepreneurship, Democratic Action and the Cultivation of Solidarity[END_REF] in a similar manner describe how the past is crucial for innovation. Here they discussed which activities and skills go into innovation (termed history-making), and emphasize how the existing is the point of departure that stimulates accumulation, reuse, and recombination. Thus they do not paint a traditional picture of a Aheroic innovator@ [START_REF] Sørensen | ABehold, I Am Making All Things New@: The Entrepreneur as Savior in the Age of Creativity[END_REF]) that identifies a problem or an unmet need and then produces an innovation to solve the problem or fill the need. Rather Spinosa et al. describe practices of working with that which is already present in the situation, and how everyday practices contribute to Ahistorical disclosing@ through the practices they name: reconfiguration, cross-appropriation, and articulation. The novelty lies in disclosing, reusing, and interpreting the given and existing in new ways.

These practice studies can contribute to our aim by exemplifying a different take on the empirical object. The practice orientation constitutes a gestalt switch, com-parable to what [START_REF] Bowker | Science on the Run: Information Management and Industrial Geophysics at Schlumberger, 1920B1940[END_REF] called an Ainfrastructural inversion.@ To do an infrastructural inversion means that rather than accepting the grand claims about the effects of new technologies, we should Alook at the infrastructural changes that preceded or accompanied the effects@ (Bowker 1994, p. 235). It is an inquiry driven by uncovering the hidden; we are encouraged to look for the infrastructure this new technology requires, what large hidden system in space and time that has (or will) facilitated its grand, observed (or proclaimed) effects. In the next section, I will argue that, in a similar way, when researching IS innovations, we can perform such an infrastructural inversion and approach our study objects differently, from the bottom up.

Studying Durability of the Present

Initially I argued that researching the future should not only emphasize novelty and discontinuity with the past, but should also recognize the continuity with the existing reality. I argued that a core practical problem in the IS field is the ongoing accumulation of complexity that obstructs organizational as well as interorganizational attempts to realize the benefits of information systems. Another, more positive entry point leading to the same argument is the nature of current IS innovation, and to show how recombinations and reuse of existing and new elements make up innovative products and services. In todays highly dynamic product and service ecologies, novel reconfigurations and combinations of existing elements, as well as additions of new elements are central features. Here, the dynamics between the durable presents and the novel futures are playing out before our eyes, and IS researchers should be able to contribute with adequate and relevant understanding of these dynamics. A solid understanding of the evolution dynamics of the technology would allow the IS field to impact the way our society approaches the tasks of design, construction, and governance of ICTs. In this section, I will offer some opinions on how we could pursue such an understanding.

Empirical Objects: Living with Technologies

Several of our field=s constitutive research traditions (such as HCI, CSCW, and ISD) have their roots in design traditions; therefore, the field has developed within a construction or production paradigm. This, I argue, needs to be expanded, and we need to study the reality of living with technologies. When IS researchers during the 1980s started to investigate the phenomena beyond the design and development horizon, such as users= actual usage of systems [START_REF] Gasser | The Integration of Computing and Routine Work[END_REF][START_REF] Kling | The Web of Computing: Computer Technology as Social Organization[END_REF], or organizational implementation [START_REF] Keen | Information Systems and Organizational Change[END_REF][START_REF] Markus | Power, Politics, and MIS Implementation[END_REF], different issues were brought to light and new questions could be asked. Use became a domain that offered novel conceptualizations in its own right. Researchers did not just study use and users in order to offer implications for design, which for a long time was a necessary legitimation of a study [START_REF] Dourish | Implications for Design[END_REF]. Today, the thriving field of implementation studies has given us significantly more insight into the interplay between information and communication technologies and organizations, and a better grasp of what characterizes the technologies.

We may need a similar expansion today with respect to innovation studies and future research. We need to complement the design, development, and innovation orientation of our field with empirical studies of how organizations actually live with the innovative technologies we create. Specifically, I argue, we could perform a gestalt switch, or Ainfrastructural inversion@ [START_REF] Bowker | Science on the Run: Information Management and Industrial Geophysics at Schlumberger, 1920B1940[END_REF]) and address the actual work of usage, maintenance, upgrading, repairing, caring for, and dismantling systems in organizational and interorganizational contexts. Such an orientation toward maintenance and repair is suggested by [START_REF] Graham | Out of Order[END_REF], and some of the same empirical orientation is seen in studies of how technology is made to work [START_REF] Jewett | The Dynamics of Computerization in a Social Science Research Team: A Case Study of Infrastructures, Strategies and Skills[END_REF], especially in studies of support work (e.g., [START_REF] Orr | About Machines. An Ethnography of a Modern Job[END_REF], thus it is not novel to the field (see also [START_REF] Ciborra | A Critical Review of the Literature on the Management of Corporate Information Infrastructures[END_REF].

Such an orientation toward experienced realities can help uncover the way that durability of the present actually plays out. This focus constitutes an infrastructural inversion, a la Bowker, in that it can help us describe the actual work of realization that lies behind the vision, at which cost of maintenance the novel system works, the opportunities it opens, and the ones it closes. Thus we may have a basis from which to estimate the future opportunities, limitations, and costs that we incur in innovative undertakings.

Analytic Approach: Focus on Relations and Interdependencies

Besides choosing other empirical topics, an appropriate analytic take on the issue is required. Here I suggest we turn to Andrew [START_REF] Barry | Political Machines: Governing a Technological Society[END_REF], who has formulated Aa different account of invention; one that does not equate technical novelty with inventiveness@ (p. 211). He emphasizes the transformative potential of an invention, the opening up of possibilities as its defining aspect. From this perspective, the notion that technology as something like an isolated artefact is problematic. Technology is viewed not so much as an artefact, but as a series of relations and connections between artefacts, physical and mental skills, desires and interests, concepts and information. Seen in these terms, inventiveness should not be equated with the development of novel artefacts, or indeed with novelty and innovation in general. Rather, inventiveness can be viewed as an index of the degree to which an object or practice is associated with opening up possibilities.YWhat is inventive is not the novelty of artefacts and devices in themselves, but the novelty of the arrangements with other objects and activities within which artefacts and instruments are situated, and might be situated in the future (Barry 2001, pp. 211-212).

Following Barry, I suggest that the criteria upon which we should assess innovations (or future-generating practices) should consider whether, how, and to what extent they open up possibilities, as well as whether, how, and to what extent they introduce constraints. Our attention should be on the arrangements, the way elements are interrelated. Such an analytic orientation would steer our attention to consider not just the novelty of the specific artifact being designed, but the opportunities and constraints that are introduced when we attempt to reuse, recombine, and accumulate.

This implies that interactions and interdependencies should constitute core targets for our analyses. Which relations are introduced or changed when we recombine elements, or when we add new elements to the existing socio-technical networks? When the set of relations is changed, what implications could it have? Where and for whom will the changes stimulate further innovation; where and for whom will they constitute barriers to growth? In order to investigate such questions, we need theoretical concepts that help us focus on the relationality of socio-technical networks.

Implications for Theory

We need to go beyond the artifact, device, or system orientation that has been evident in the design-oriented HCI, CSCW, SD, SE, and IS discourses [START_REF] Tilson | Digital Infrastructures: The Missing IS Research Agenda[END_REF]).

Instead we need to utilize conceptualizations that alert us to relations and connections, to system-level issues related to interactions, couplings, and dependencies. There is a long-standing, but not overly visible, tradition within the IS field that has this orientation. In [START_REF] Orlikowski | Research Commentary: Desperately Seeking the AIT@ in IT ResearchCA Call to Theorizing the IT Artifact[END_REF] literature survey focusing on how the IT artifact was conceptualized, one of their classifications was the Aensemble views,@ comprising only 12.5 percent of the articles surveyed. An early and prominent example of such an ensemble conceptualization was web models [START_REF] Kling | The Web of Computing: Computer Technology as Social Organization[END_REF]. The stream of research on information infrastructures (see [START_REF] Hanseth | Design Theory for Dynamic Complexity in Information Infrastructures: The Case of Building Internet[END_REF][START_REF] Hanseth | Social Shaping of Information Infrastructure: On Being Specific About the Technology[END_REF][START_REF] Star | Steps Toward an Ecology of Infrastructure: Design and Access for Large Information Spaces[END_REF][START_REF] Tilson | Digital Infrastructures: The Missing IS Research Agenda[END_REF] has offered significant contributions to understanding large-scale sociotechnical networks. Recent research on digital ecodynamics [START_REF] El Sawy | Seeking the Configurations of Digital Ecodynamics: It Takes Three to Tango[END_REF]) and platform-centric eco-systems [START_REF] Tiwana | Platform Evolution: Coevolution of Platform Architecture, Governance, and Environmental Dynamics[END_REF]) approach similar phenomena from different angles. Such theoretical resources would constitute appropriate fundaments for an IS approach that aims to understand and conceptualize the dynamics of technological development.

Final Remarks

What do we want to be durable? What do we want to end? How can we distinguish between durability that restricts the envisioned and desired futures from becoming realized, versus durability that allows cumulative innovation? How can we build the future with an orientation toward the consequences of today=s action? How can we research today=s actions with an orientation toward the future? I have argued that we need an alternative to the common view on the large-scale, digitally interconnected information systems assemblage that we create. We need other studies and other perspectives in order to complement and emphasize the novel. In her study of innovation, Laura Watts (2009, p. 3) emphasizes that, like the past, the future is made of stuff, of materials, landscapes, and people. Durability and heritage are as much a matter of the future, as a matter of the past. Things endure from past into future. It takes ongoing, unceasing work to conserve, to make things for the world to come.

In her search for a Afuture archaeology,@ Watts seeks to create enduring things and bring artifacts into being. Here I wanted to emphasize a related but slightly distinct side of this work to create futures, by arguing that we need to turn our attention to the way our creation has endurance, both in intended and in not intended ways. What we construct today can persist for a long time, either in its original form, or modified and reappropriated in a dynamic digital ecology.

I have suggested that we should perform research investigating the conditions, constraints, and consequences of ICT growth and innovation. In order to do this, studies of the architects and builders (i.e., the designers, developers, managers) should be complemented by studies of repair and maintenance; of the ongoing learning and coping activities of all organizational members and technology users. Based on such studies we can improve our understanding of technology development, our capacity for intervention, and the ensuing implications for action. While the traditional innovation orientation exposes research to the dangers of becoming instrumental and uncritical, an approach that is sensitive to the durability of our creations offers a different critical potential for helping us identify the choices we are facing regarding which futures we will create.

About the Author

Margunn Aanestad is an associate professor of Information Systems in the Department of Informatics, University of Oslo, Norway. She is interested in understanding the interaction between technical, social, organizational, and regulatory elements in the development of large-scale information infrastructures, and has studied ICTs in healthcare, both in developed and developing countries. Her research has been published in Journal of Information Technology, MIS Quarterly, European Journal of Information Systems, Journal of the Association for Information Systems, and other journals.


Dimitra Petrakaki

Tony Cornford

Ralph Hibberd

Valentina Lichtner

Nick Barber

The Role of Technology in Shaping the Professional Future of Community Pharmacists: The Case of the Electronic Prescription Service in the English National Health Service

Keywords: Professionals, technology, community pharmacy, electronic prescriptions

des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

The future is already here-it is just unevenly distributed.

(attributed to William Gibson)

Information and communication technology (ICT) has in the last decade been extensively proposed as a means to reform, modernize, and even reshape national health systems. Introduction of ICT based systems is expected to achieve cost effectiveness, support clinical decision making, improve patients' privacy and safety, speed-up delivery, and improve the quality of healthcare (Bates and Gawade 2003;[START_REF] Berg | Rationalizing Medical Work: Decision-Support Techniques and Medical Practices[END_REF][START_REF] Chiasson | Pushing the Contextual Envelope: Developing and Diffusing IS Theory for Health Information Systems Research[END_REF]. Introducing ICT systems is not without consequences; they challenge health professionals' work practices and roles, the types of knowledge they use, and the modes of collaboration they employ [START_REF] Aarts | Extending the Understanding of Computerized Physician Order Entry: Implications for Professional Collaboration, Workflow and Quality of Care[END_REF]. The focus of this paper is on the possibilities that ICT opens up for reshaping the work and profession of community pharmacists. Community pharmacists serve the public in high street shops, supermarkets, and some medical centers. They constitute the largest subgroup within the overall pharmacy profession, which includes hospital pharmacists who provide clinical advice to hospitals and healthcare professionals and those who work in pharmaceutical research. From now on reference, to pharmacy(-ists) will imply community pharmacy(-ists).

Our account here is a possible projection of professionalism in the future that is created from research interviews and by an amalgamation of people's recollections of the past, experiences from the present, and expectations for the future. The motivation for the paper is found in the introduction of the electronic prescription service (EPS) into primary care in the English National Health Service. This is a national program to allow doctors to send electronic prescriptions to community pharmacists, and for pharmacists subsequently to send them on for reimbursement by the NHS.

1 This requires a sound infrastructure, networks, software, databases, and new operating procedures, indicating the increased role of ICT in mediating for the generation, transmission, and receipt of prescriptions between doctors and community pharmacists, as well as in serving the processes of reimbursement. We are interested here in exploring the role of this new technical intervention in shaping pharmacists' work practices and profession. To do so, we draw upon a part of our current research evaluating EPS. 2 We develop two arguments in this paper. First, we propose that EPS can shape six aspects of pharmacists' work: work practices, values, roles, jurisdictions, power, and professional boundaries. Second, we see the consequences of this technology for the pharmacy profession are multiple and often contradictory; on some occasions, technology strengthens and expands pharmacists' professional standing by fostering their values and expanding their jurisdictions, opening up opportunities for re-professionalization. On other occasions, technology challenges pharmacists' role, power, and professional boundaries by allowing new business models and logic to emerge, conditioning in that way possible deprofessionalization. We propose a framework that depicts how and in what ways ICT might shape professional futures.

The paper is structured as follows. Section 2 presents our theoretical framework, drawing upon the sociology of professionals, critical studies on technology, and secondary studies on pharmacists' profession. Section 3 describes our research methodology. Section 4 provides an account of our research into EPS, which is followed by a discussion. The paper ends with some concluding remarks.

2

Theoretical Framework

Conceptualizing Professionalism

Professions constitute a "homogeneous group of occupations sharing a unique character and destiny" [START_REF] Johnson | Expertise and the State[END_REF]. Professionals are typically organized into associations, which are established in order to promote and protect their interests and rights [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF]. Professional associations define the skills needed in order to become a legitimate member, establish career patterns, and set up mechanisms that regulate entrance and operation in their profession [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF][START_REF] Clarke | The Managerial State: Power, Politics and Ideology in the Remaking of Social Welfare[END_REF][START_REF] Perkin | The Rise of Professional Society: England Since 1880[END_REF][START_REF] Timmermans | The Gold Standard: The Challenges of Evidence-Based Medicine and Standardization in Health Care[END_REF]. Implicit in this is the establishment of norms, values, and standards of occupational behavior, what is understood as professional conduct [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF]). The process of establishing a profession (professionalization) is, therefore, a boundary-making process that binds professionals under a specific regime of work [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF][START_REF] Kirkpatrick | Archetype Theory and the Changing Professional Organization: A Critique and Alternative[END_REF]. Professionalization is both a process of enactment, in as far as it depends on individuals acting their assigned roles as professionals, and a process of subjectification during which individuals are "made-up" as professionals [START_REF] Hodgson | Putting on a Professional Performance": Performativity, Subversion and Project Management[END_REF].

For [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF], the most distinctive characteristic of professionals is the "abstractification" of their knowledge which distinguishes professionals' claims from those of ordinary technical work [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF]). This differentiation serves to create a relationship of dependence between professionals and laymen [START_REF] Johnson | Expertise and the State[END_REF] and is thought to (re-)produce professionals' power and authority [START_REF] Kerr | The New Genetics: Professionals' Discursive Boundaries[END_REF]. Abstract knowledge legitimizes professionals' status and prestige because it is typically associated with science, logic, and future practical value. Of course, professionals also undertake mundane tasks, rendering their work a hybrid of conceptual and manual activities [START_REF] Causer | Professionals as Managers across the Public Sector[END_REF].

Professional groups are expected to exercise high degrees of power and authority [START_REF] Flynn | Professionals and the New Managerialism in the Public Sector[END_REF]. Their power is their ability to retain jurisdiction [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF], for example, to make decisions based upon 'internalised norms and expert knowledge' [START_REF] Flynn | Clinical Governance and Governmentality[END_REF][START_REF] Timmermans | The Gold Standard: The Challenges of Evidence-Based Medicine and Standardization in Health Care[END_REF], to influence policy, and to decide on their remuneration [START_REF] Edmunds | The Re-professionalization of Community Pharmacy? An Exploration of Attitudes to Extended Roles for Community Pharmacists Amongst Pharmacists and General Practitioners in the United Kingdom[END_REF]. Professional power is largely dependent upon the state's support by, for instance, defining the type and mode of services they alone can offer [START_REF] Johnson | Professions and Power[END_REF].

Further, professionals' power is influenced by institutional standards, codes of ethics, and behavioral norms drawn from the profession but also, to degrees, from their employing organizations [START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF][START_REF] Johnson | Professions and Power[END_REF]. It can be further limited by clients' ability to organize themselves into powerful groups that set requirements, pursue their rights, and demand certain types of service [START_REF] Johnson | Expertise and the State[END_REF].

(Re-)Constructing Professionals through Information Technology

The introduction of ICT in any work setting conditions changes to work practices, roles, and identities. Typically, ICT is used to gather, maintain, process, and disseminate data and information across temporal and spatial boundaries. ICT can achieve a parallel centralization and decentralization of data and information as it renders it available to anyone, anywhere [START_REF] Bellamy | Governing in the Information Age[END_REF]Bloomfield and Coombs 1992;[START_REF] Zuboff | In the Age of the Smart Machine: The Future of Work and Power[END_REF]. Further, such data can be statistically processed, ranked, compared, accumulated, and inscribed into reports, generating in that way new types of information with new uses and users [START_REF] Clarke | The Managerial State: Power, Politics and Ideology in the Remaking of Social Welfare[END_REF][START_REF] Doolin | Narratives of Change: Discourse, Technology and Organization[END_REF][START_REF] Latour | Science in Action: How to Follow Scientists and Engineers Through Society[END_REF][START_REF] Zuboff | In the Age of the Smart Machine: The Future of Work and Power[END_REF]). One significant way in which ICT influences professionals' work is by rendering their outputs visible [START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF], for example, concerning work aspects such as performance, outputs, time and date of work, and history of activities. This then renders professionals legible, in particular to managers [START_REF] Lyon | Identifying Citizens: ID Cards as Surveillance[END_REF]. This transparency that technology provides enables constant surveillance and control, which in turn may influence reward structures and the way in which professionals do their work. For instance, [START_REF] Aarts | Extending the Understanding of Computerized Physician Order Entry: Implications for Professional Collaboration, Workflow and Quality of Care[END_REF] describe how the introduction of a computerized physician order entry (CPOE) system depersonalized healthcare professionals' collaboration and made nurses lose visibility of, and thus power over, aspects of their work.

ICT is also used to automate processes and practices [START_REF] Bellamy | Governing in the Information Age[END_REF], with implications of simplification, rule following, and tasks undertaken without human knowledge, judgment, or discretion. This promotes predictability, quantification, and centrally controlled rule-based decision making [START_REF] Garson | The Electronic Sweatshop: How Computers Are Turning the Office of the Future into the Factory of the Past[END_REF]. Automation is often associated with attempts to de-skill professionals and undermine their claims to professional status [START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF].

ICT is not always perceived as a machine that automates but may be seen as an intervention that informates work [START_REF] Zuboff | In the Age of the Smart Machine: The Future of Work and Power[END_REF]. It does so by eliminating unnecessary activities, undertaking mundane tasks and then providing back to professionals processed information upon which they can act. In this way, ICT serves professionals in decision making and may encourage them to develop new capacities as they exploit the value of this new information [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF]. This then conditions possibilities for re-skilling by expanding the breadth and depth of their responsibilities [START_REF] Zuboff | In the Age of the Smart Machine: The Future of Work and Power[END_REF]. In a study of a health information system in a cardiology department, [START_REF] Cho | Contextual Dynamics During Health Information Systems Implementation: An Event-Based Actor-Network Approach[END_REF] found that ICT provided opportunities for re-skilling nurses by allowing them to download patients' images and discuss them with doctors during ward rounds.

Pharmacists as Health Professionals

Unlike other clinical professions, pharmacists do not specialize in specific parts of the body and do not directly intervene in the body [START_REF] Barber | The Pharmaceutical Gaze-The Defining Feature of Pharmacy[END_REF]. Their work is fundamentally technological3 [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF]) in that it deals at the primary level with material objects, namely chemical components and models, delivery devices, medications, prescriptions, tokens. What distinguishes pharmacists from other healthcare professionals involved with medicines is their knowledge (abstracttion) about the ingredients of medicines, the way in which they work in the body, and their effects on it. This knowledge constitutes for [START_REF] Barber | The Pharmaceutical Gaze-The Defining Feature of Pharmacy[END_REF] the "pharmaceutical gaze." Another critical feature of community pharmacists working in the high street is their hybrid role as both healthcare professionals with clinical expertise, jurisdictions, and social-service orientation, and as business owners who look for the future viability of their business [START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF][START_REF] Edmunds | The Re-professionalization of Community Pharmacy? An Exploration of Attitudes to Extended Roles for Community Pharmacists Amongst Pharmacists and General Practitioners in the United Kingdom[END_REF][START_REF] Hibbert | Consumerism and Professional Work in the Community Pharmacy[END_REF][START_REF] Hughes | Perceived Interprofessional Barriers between Community Pharmacists and General Practitioners: A Qualitative Assessment[END_REF]. The intrusion of the business orientation into pharmacists' profession is thought by some to condition de-skilling and standardization, leading to the rise of what Bush et al. ( 2009) described as the "McPharmacist." Nonetheless, pharmacists tend to follow a scientific and rational model of thinking and acting that draws largely upon the law, and their own codes, rules, and standard operating procedures and policy guidelines [START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF][START_REF] Mcdonald | Professional Status in a Changing World: The Case of Medicines Use Reviews in English Community Pharmacy[END_REF][START_REF] Timmermans | The Gold Standard: The Challenges of Evidence-Based Medicine and Standardization in Health Care[END_REF]. The profession is driven by two major values. The first is the value of managing medicines in a safe and reliable way [START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF]); the second is treating the patient as a person with particular needs, values, culture, and beliefs.

In practice, however, pharmacists' work is not as rational and normative as it may look from the outside. [START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF] present a number of examples which illustrate that pharmacists work in a non-prescriptive way in their attempt to deal professionally with complex situations. For instance, pharmacists often need to bend the rules in order to treat a patient in a "better" way or they may ration services by prioritizing some patients over others [START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF].

Traditionally skills and expertise of pharmacists are founded on combining the right ingredients in order to compound medicines [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF][START_REF] Eastoe | Victorian Pharmacy Remedies and Recipes[END_REF][START_REF] Edmunds | The Re-professionalization of Community Pharmacy? An Exploration of Attitudes to Extended Roles for Community Pharmacists Amongst Pharmacists and General Practitioners in the United Kingdom[END_REF]. Industrialization and increasing regulation of medicines reduced some medical risks, automated the production of many medicines, thereby increasing it, and led to the creation of new drugs with new adverse effects [START_REF] Barber | The Pharmaceutical Gaze-The Defining Feature of Pharmacy[END_REF][START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF][START_REF] Edmunds | The Re-professionalization of Community Pharmacy? An Exploration of Attitudes to Extended Roles for Community Pharmacists Amongst Pharmacists and General Practitioners in the United Kingdom[END_REF]. These changes limited the involvement of pharmacists in the production of drugs, which was now the responsibility of drug manufacturers [START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF], and reduced pharmacists' work to labeling and record keeping [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF] and their role to "mere dispensers" [START_REF] Mcdonald | Professional Status in a Changing World: The Case of Medicines Use Reviews in English Community Pharmacy[END_REF]. However, in the last few years, the role of pharmacists has been reconsidered and some have argued for it to be transformed from a product-focused [START_REF] Wilson | Pharmacy Professionalism: A Systematic Analysis of Contemporary Literature (1998-2009[END_REF]) profession into a more clinical profession with new responsibilities for the management of prescriptions, common ailments, and long-term illness, and for the provision of medical advice on healthy lifestyles [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF][START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF]).

Since the 1980s, the English NHS has undertaken a number of initiatives in an attempt to re-professionalize pharmacists such as campaigns that prompt patients to turn to pharmacists for medical advice and initiatives to use their skills in order to assess patients' use and experience from medicines [START_REF] Mcdonald | Professional Status in a Changing World: The Case of Medicines Use Reviews in English Community Pharmacy[END_REF]. These initiatives, however, have not been successful in substantially strengthening the pharmacists' profession. It has been suggested that this is because pharmacists often have insufficient skills to undertake clinical responsibilities, the risk of potential conflicts with doctors, and their general weak professional power to shape public policy [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF][START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF][START_REF] Edmunds | The Re-professionalization of Community Pharmacy? An Exploration of Attitudes to Extended Roles for Community Pharmacists Amongst Pharmacists and General Practitioners in the United Kingdom[END_REF]. In contrast to such concerns, a recent official report on hospital doctor prescribing errors 4 acknowledged that almost all errors are detected and corrected by pharmacists, illustrating the high level of clinical expertise hospital pharmacists have.

Research Methodology

This research drew upon the qualitative paradigm [START_REF] Creswell | Research Design: Qualitative and Quantitative Approaches[END_REF][START_REF] Maykut | Beginning Qualitative Research: A Philosophical and Practical Guide[END_REF] and specifically interpretivism [START_REF] Klein | A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems[END_REF][START_REF] Orlikowski | Studying Information Technology in Organizations: Research Approaches and Assumptions[END_REF]. In following an interpretivist methodology, we intended to understand through participants' oral and written accounts the meaning they attributed to EPS and how they projected its consequences on pharmacists' work and profession [START_REF] Klein | A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems[END_REF]. This paper draws upon data gathered through interviews and documents. A total of 19 interviews were conducted with a number of different organizations and their representatives involved in EPS such as software suppliers for dispensing systems, community pharmacists, clinical and local EPS leads, representatives of pharmacists' associations, and representatives of Connecting for Health, the agency commissioned by the Department of Health to manage EPS. Interviews took place from June 2009 until March 2010. They were semi-structured, recorded, and when this was not possible, notes were kept. Interviews lasted 60 minutes on average and were transcribed (when possible) verbatim.

We also drew upon government documents and reports concerning the future of pharmacies, contractual arrangements, and business and workflow models. Documents and secondary studies on the profession of pharmacists, outlined above, were important in contextualizing our research and enabling us to discuss our findings in a dialogical manner that confirmed or disconfirmed our arguments [START_REF] Klein | A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems[END_REF].

Data were analyzed by following a thematic analysis. Themes and sub-themes emerged by both our theoretical underpinnings (e.g., automation, visibility, jurisdictions, professional roles, jurisdictions) and our data (e.g., clinical orientation, temporal flexibility, patient orientation). Themes were then compared and contrasted and during this process some were merged, eliminated, further developed, and refined [START_REF] Creswell | Research Design: Qualitative and Quantitative Approaches[END_REF]. Through our analysis, we constructed an analytical framework (Table 1 in Section 5) which, we hope, contributes to the more general debate about the implications of technology for professions.

4

The Case of the Electronic Prescription Service (EPS) businesses. Yet, their relation to the NHS is at times a contested area; one of our respondents described community pharmacists as being "in name only part of the NHS family," reflecting a view of them as independent enterprises or parts of multiple retailers rather than essentially of the health care system [START_REF] Hibbert | Consumerism and Professional Work in the Community Pharmacy[END_REF]. However, in most cases, the majority of their income derives from fulfilling prescriptions for the NHS and their very existence is largely dependent upon NHS policy decisions which often open up critical business issues for them.

The EPS was initiated in 2003. It is a part of the National Programme for IT (NPfIT) for the NHS in England, which is delivered by the Department of Health agency Connecting for Health (CfH). EPS refers to the electronic generation, transmission, and receipt of prescriptions from a prescribing authority (e.g., doctor or nurse) to a dispensing authority (e.g., community pharmacist). EPS is being rolled-out in two releases. The first (EPS1) aimed to set up and test the central infrastructure and the second (EPS2) to achieve a paperless and fully electronic transmission of prescriptions.

5 EPS2 also introduced new electronic functionalities: electronic cancellation, repeat dispensing of prescriptions, and pharmacy nomination. We explore the last two functions and their potential consequences for pharmacists' professional work in the following subsections.

With EPS, electronic prescriptions are sent via a central server, the Spine, which is linked to community pharmacies and general practices via the NHS's own network, N3. The Spine holds some patient demographic information and it is planned one day to hold a summary care record of each patient [START_REF] Greenhalgh | The Devil's in the Detail: Final Report of the Independent Evaluation of the Summary Care Record and Health Space Programmes[END_REF]. The Spine is supported by a message handler and a broker whose role is to integrate and ensure consistency between the messages being exchanged. Prerequisite for accessing the Spine are EPS-compliant local systems and role-based access through personal user smartcards. A number of prescribing and dispensing software suppliers have been modifying their systems in line with centrally set specifications to enable the creation and exchange of electronic prescriptions. EPS has been envisioned as a project that will bring considerable benefits to pharmacists' work such as cost reduction, legible prescriptions, faster dispensing process, faster access to information, and time savings.

6 Most importantly for this paper, EPS opens up opportunities for (re-)shaping pharmacists' work and profession. This is discussed below.

Changing Pharmacists' Work Practices through EPS

Ideally, the introduction of EPS will automate aspects of the dispensing process (for example, labeling) and reduce the amount of paper that is generated. In theory, electronic prescription messages can be downloaded from the Spine and accessed and dispensed by any EPS-enabled community pharmacy across the country. Electronic prescriptions are more legible, and thus safer, and are devoid of costs associated with paper prescriptions. A paperless/paper-light process implies that pharmacists will dispense from information presented onscreen.

In the non-EPS world, the time of dispensing is defined by the patient at the point of his or her request. Under EPS, dispensing becomes temporally dispersed; it can start as soon as the prescription message is forwarded to a pharmacy. EPS2 facilitates repeat dispensing, the issuing of multiple instances of the same prescripttion for a patient to collect at the pharmacy as and when medication runs out, without the patient having to request a new prescription from the doctor each time. Through repeat dispensing, pharmacists may be able to pre-dispense and so manage better their stock and time, reduce patient waiting time, and potentially keep a patient as a repeat customer.

The prescription message populates the local computer record with patients' demographic details and the prescribed items reducing the need for manual data entry while ensuring data consistency. At the same time, it may make a pharmacy's daily functions more dependent upon complex technology and infrastructure (N3, Spine, prescribing software, etc.). In case of a technological breakdown, the pharmacy's function is likely to be brought to a halt with patients redirected to other dispensers (with possibly significant business implications).

Changing the Values of Pharmacy Work

Some interviewees described EPS as a means to render the relationship between doctors and pharmacists less dependent on personal acquaintance and familiarization. A representative of a pharmacists' association argued that in the pre-EPS model, the pharmacist who encountered a prescription error would, after a discussion with the doctor, perhaps by phone, dispense the correct medication and wait for the correct prescription to arrive in retrospect. This process leaves the pharmacist in a limbo both legally and financially and renders professional trust essential. In the EPS world, however, when an error is detected and changes agreed with the doctor, the pharmacist can expect the doctor to send in real time a new prescription-and indeed may not feel able to proceed until it is done. This manifests the role of technology in rendering familiarization and trust a secondary issue in computer mediated interprofessional communication. As a community pharmacist told us, At the moment I receive a prescription which clearly has an error I attach a note to that prescription, possibly write a note on it and send it back to the surgery telling the error and the reasons for the error. If you just cancel a prescription-which is effectively what you are doing by sending it back to the spine, then…they become disconnected, which actually adds another weakness to the system possibly.

In contrast to this view, other interviewees argued that EPS could be a mechanism that fosters trust between doctors and pharmacists through the functionality of repeat dispensing. In this case, as described above, doctors rely on pharmacists to dispense the correct medication, advise on the correct dosages, pick up patient queries, and continue dispensing for the prescribed period of time. Further, a dispensing software supplier argued that the possibilities for electronic monitoring that EPS enables could potentially allow doctors to monitor whether (or not) their prescriptions have been dispensed, facilitating trust, although this functionality is not a part of EPS2.

Some participants highlighted the risks that may emerge as a prescription message gets "translated" while being transferred from a prescribing to a dispensing EPS-enabled system. This may happen because different prescribing and dispensing software systems are embedded with different dictionaries-especially in relation to how medicines and their dosages are coded. As a dispensing software supplier explained,

You don't have the proof of a piece of paper and the GP sees on his screen that he's typing out Gaviscon for instance, but what is actually sent in the message, he doesn't see that.

Some participants suggested that pharmacists will be rendered liable for undertaking these risks by using their professional judgment in order to dispense without often having complete or correct information. Professional judgment is also required with the current paper-based system, but the feeling expressed was that EPS could increase the volume of such cases.

The other new functionality that EPS2 provides is nomination, which refers to a patient's choice as to which pharmacy to use. Patients are given the opportunity to nominate any EPS2-enabled pharmacy across England from which to collect their medication. In the patient interest, and in the interest of maintaining flexibility and competition among pharmacist, nominations are expected to be easily changed. Assuming the patient does not change her nomination too frequently, nomination may allow pharmacists to accumulate data concerning patients' treatment and thus to provide more customized advice, monitor patients' health, and intervene when necessary. To a degree, such data is already held by pharmacies, but the nomination process may enable more complete information. As a representative of a dispensing software supplier said, It's sort of like a loyalty card in the sense that, I'll always come back to you and I'll always come and get my prescriptions from you. You're tied to the patient. Therefore, you get to know who Mr Smith is.

Pharmacists, however, worry that nomination depersonalizes their relationship with patients because it makes choice less reliant on personal acquaintance and more dependent on convenience of location. Thus nomination is expected to influence the geographical distribution of pharmacies and the business potential of pharmacies in residential areas. The representatives of a pharmacy chain argued that the empowerment of patients to nominate prioritizes speedy collection of medicines over the provision of pharmacists' clinical advice. Also, some interviewees expressed concerns about the potential for "script direction," suggesting that nomination opens up the possibility for a style of competition that improves the position of large pharmacies in the market and excludes smaller pharmacies. As an interviewee said, Pharmacies…are scared of EPS, because they think that they are going to lose control and they are going to lose business. So what pharmacists are going to do, as soon as they become EPS-enabled, is they are going to start collecting nominations from every patient that walks in their door.

Policy makers have attempted to address this risk by imposing new norms that guide prescribers and dispensers' behavior. "EPS Release 2 Business Guidance for Initial Implementers" articulates how prescribers and dispensers should behave in relation to nomination:

[Dispensing staff] shall not give or offer any gift or reward to encourage a patient to nominate them; this also includes the offering of share dividends of points, discounts and loyalty points….NHS Pharmaceutical Service Regulations 2005, prohibit pharmacists or their staff from offering inducements to encourage patients to nominate them (p. 41).

Changing Pharmacy Business

EPS2 constitutes a business critical issue for most pharmacies, clearly linked to their future viability. Its potential to electronically connect pharmacists with the NHS renders pharmacists an identifiable part of it. As an official from CfH said, You put in the technology, so you are making them part of the NHS family technically. They are all connected to N3 either directly or indirectly. They are all having smart cards, so that they can be uniquely identified.

Connection to the Spine requires a large financial investment in purchasing new software and a commitment for its future maintenance. This, according to a representative of a dispensing software supplier, will squeeze pharmacies' profit margins in the future. But this can be seen as part of a wider shift in the ecology; access to the Spine may potentially give pharmacists access to a summary of patients' electronic health record (the Summary Care Record) if and when this becomes widely available. The director of an independent pharmacy saw this as very important because it can inform pharmacists about patient conditions under which medicines are prescribed and allows them to judge the appropriateness of the prescription, as happens in a hospital pharmacy. Visibility of patients' records may empower pharmacists and give them more control over their work and allow them to be more patient-oriented. Apart from just viewing this information, the opportunity for feeding information into a patient record was also highlighted by some participants as an important potential advantage for pharmacists of broader EPS-enabled systems. A representative from a software supplier argued that, unlike doctors, pharmacists know the type of deregulated and over-the-counter medicines that patients take beyond what is prescribed. Feeding this information back could give a more thorough view of the patient to the doctor and lead to better consultations.

Access to patients' records may thus render the pharmacist's profession more clinically oriented. The dispensing process, we may hypothesise, would become more a back-office operation undertaken by non-professional pharmacy staff, such as accredited checking technicians, as pharmacists make better use of their skills focusing on the provision of clinical care. Indeed, as a CfH official said, the inclusion of more clinical services into pharmacists' work seems to be one vision for pharmacies in the future: 7 A first port of call for minor illnesses…and also as an additional service… for long term condition management.

7 "Pharmacy in the Future-Implementing the NHS Plan: A Programme for Pharmacy in the National Health Service," September 2000 (Department of Health, http://www.dh.gov. uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005917).

Further, EPS could potentially give rise to new business models. Web-based pharmacies, existing and new stakeholders, such as Amazon, wholesalers or central supermarket online stores may enter into the pharmacy business in the future. These new models, which are less likely to get into the provision of clinical services, may in the future challenge pharmacists' professional identities.

Finally, the Spine has the potential to provide the Department of Health with real-time information concerning prescribing and dispensing activity. This information, which was up until now obscured and estimated, may enable a more effecttive governing of pharmacies in the future. This is despite the fact that EPS, as a CfH official argued. has not been intentionally designed for such a purpose:

There [are] funny goings on in pharmacies and in prescribing that we don't know about. We do know about, but we've got no evidence. It's not the job of EPS to deal with that, but…there will be better quality information, quality data which people, at some point can take action and look at in detail, should they wish.

Analysis

This section discusses the possibilities that technology opens up to transform pharmacists' work and profession. Table 1 illustrates the core analytical remarks we make below.

Screen-Level Pharmacists: Challenging the Temporal and Material Nature of Pharmacists' Work

The case of the EPS can be seen as a manifestation of the way in which professionals can be influenced by technological advancements [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF][START_REF] Mcdonald | Professional Status in a Changing World: The Case of Medicines Use Reviews in English Community Pharmacy[END_REF]. In summary, EPS can influence pharmacists' work in three ways. To begin with, the parallel centralization and decentralization (Bloomfield and Coombs 1992) of electronic prescriptions intends to eliminate paper and in doing so to dissociate the dispensing process from its material aspects. The strength of paper prescriptions is that they are mobile and combinable [START_REF] Latour | Science in Action: How to Follow Scientists and Engineers Through Society[END_REF]; pharmacists hold a paper prescription throughout the dispensing process and check against it the medications they dispense. The mediation of technology, however, transforms them into "screen-level" pharmacists, to borrow [START_REF] Bovens | From Street-Level to System-Level Bureaucracies: How Information and Communication Technology is Transforming Administrative Discretion and Constitutional Control[END_REF] term, who continuously need to consult a computer interface in order to conduct their daily activities. Also, EPS might bring temporal flexibility to the dispensing process, which has been typically a temporally and spatially bound process that starts with the receipt of a paper prescription and ends with the dispensing of medications. EPS, however, transgresses temporal boundaries by allowing pharmacists to decide when they dispense [START_REF] Giddens | The Consequences of Modernity[END_REF][START_REF] Walsham | Making a World of Difference: IT in a Global Context[END_REF]. Further, EPS affords far more automation of the dispensing process by feeding complete data into pharmacists' systems, eliminating manual data entry [START_REF] Bellamy | Governing in the Information Age[END_REF].

Clinical (Dis)orientation and Responsibilization

EPS has the potential to generate data that informates pharmacists work [START_REF] Zuboff | In the Age of the Smart Machine: The Future of Work and Power[END_REF]. Through the functionality of nomination, pharmacists may be able to acquire large amounts of data concerning patients' treatment and develop a better understanding of them [START_REF] Benson | Understanding Pharmacists' Values: A Qualitative Study of Ideals and Dilemmas in UK Pharmacy Practice[END_REF]. At the same time, the focus of nomination on patients' convenience may, in the long run, transform pharmacists from professionals into mere providers of pre-packed medications. This is likely to weaken their distinctive "pharmaceutical gaze" [START_REF] Barber | The Pharmaceutical Gaze-The Defining Feature of Pharmacy[END_REF], threaten their professional status and condition de-professionalization [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF].

Our initial findings suggest that EPS may expand pharmacists' jurisdictions by adding further responsibilities [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF]. Electronic prescription messages may be modified while being exchanged between doctors and pharmacists. This can happen, for instance, due to possible mismatches in mapping data dictionaries. Pharmacists are then rendered responsible for interpreting the messages they receive and exercising their professional discretion, as they did in the past with handwritten and sometimes illegible prescriptions. With a high level of use of repeat dispensing, one of the main benefits claimed for EPS, pharmacists will become the primary health professional monitoring chronic diseases for periods of up to 12 months. This will often require making decisions when pharmacists have limited knowledge about the detail of a patient's case. Despite the risks that such a scenario may entail, it is likely to raise the status of the pharmacists' profession by prompting their further re-skilling [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF].

Further, a number of participants in this research argued that EPS may provide pharmacists access to an electronic summary of a patient record. This would condition two possibilities. First, pharmacists are informed not only about what has been prescribed but also the reasons for its prescription. By knowing patients' diagnosis and treatments they also know when they should (and should not) provide specific over-the-counter medications based on possible adverse effects. They are thus able to make professional judgments and provide more clinically oriented services. One could, therefore, interpret pharmacists' possible access to a summary patient record as another government attempt to re-professionalize pharmacists by fostering the use of their clinical skills and professional judgment [START_REF] Edmunds | The Re-professionalization of Community Pharmacy? An Exploration of Attitudes to Extended Roles for Community Pharmacists Amongst Pharmacists and General Practitioners in the United Kingdom[END_REF][START_REF] Mcdonald | Professional Status in a Changing World: The Case of Medicines Use Reviews in English Community Pharmacy[END_REF]. Second, and perhaps more important, pharmacists may be able to provide feedback to a patient's record. For instance, by providing information concerning over-the-counter medications patients buy (information that prescribing authorities can hardly know) pharmacists may generate information that assists clinical decision making across the prescribing and dispensing process [START_REF] Doolin | Narratives of Change: Discourse, Technology and Organization[END_REF][START_REF] Latour | Science in Action: How to Follow Scientists and Engineers Through Society[END_REF][START_REF] Zuboff | In the Age of the Smart Machine: The Future of Work and Power[END_REF].

System and Interprofessional Trust through Control

Another consequence of EPS for the pharmacy profession concerns interprofessional trust. As our research indicated, EPS has the potential to weaken personal trust by mediating between doctors and pharmacists, thus making them less interdependent. Specifically, personal and often intuitive ways of communicating are overtaken by electronic exchanges of messages between geographically distant recipients often unknown to each other. In this, EPS brings impersonality, devalues interpersonal ties, and fosters system trust [START_REF] Giddens | The Consequences of Modernity[END_REF]. Perhaps some interprofessional trust could be ensured through the (unintended) possibility that EPS provides for electronic monitoring. Specifically, provided that pharmacists and patients are compliant with what is prescribed, doctors may be able to monitor whether (or not) and when their prescriptions have been dispensed independently of personal acquaintance with either the patient or the pharmacist. By making pharmacists' outputs visible and legible [START_REF] Lyon | Identifying Citizens: ID Cards as Surveillance[END_REF], interprofessional trust is strengthened, which confirms the argument by [START_REF] Knights | Chasing Shadows: Control, Virtuality and the Production of Trust[END_REF] that electronic monitoring technologies can substitute for the lack of trust in virtual environments.

5.4

Professional Control, Boundaries, and Inclusion: Pharmacists as Entrepreneurs; Entrepreneurs as Pharmacists?

Finally, Similarly, there are under-explored possibilities that EPS may provide to the government for electronic monitoring of pharmacists' outputs [START_REF] Bush | The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy's Claims to Professional Status in the United Kingdom[END_REF]). The provision of real-time data will shed light on previously obscure aspects of the pharmacy business such as mismatches between prescribed and dispensed items. This may in turn enable auditing and decisions concerning future health budgets and pave the way to more government intervention in and thus control over pharmacists' work [START_REF] Abbott | The System of Professions: An Essay on the Division of Expert Labor[END_REF][START_REF] Johnson | Professions and Power[END_REF]. Being connected to the Spine is also likely to bring about two consequences for pharmacists' professionalization. By allowing pharmacists' access to NHS-related information, such as patients' demographic information and diagnoses and treatments, and by making them identifiable to and tractable by the NHS, it also renders them, to use a participant's words, a part of the NHS family. This indicates one role that technology-as a boundary creating mechanism-might play in professionalizing pharmacists through deeper inclusion into the NHS [START_REF] Adamcik | New Clinical Roles for Pharmacists: A Study of Role Expansion[END_REF]). Access to patient data may also create more business opportunities for pharmacists by allowing them to target patient groups effectively and provide customized services. At the same time, the possibilities for inclusion that EPS provides may shift the boundaries of pharmacists' profession in other ways, for example, by enabling new business models to emerge such as Internet-based pharmacies using the Internet, telephone, and post. Interviewees underlined the risks that new business models may bring for pharmacists. They mentioned the potential for illicit competition and patient direction and the diffusion of a business logic that would corrode pharmacists' professionalism by redirecting it toward a profit-driven delivery model. This aligns with a number of studies that emphasize the entrepreneurial character of many public service professionals [START_REF] Clarke | The Managerial State: Power, Politics and Ideology in the Remaking of Social Welfare[END_REF][START_REF] Gay | Enterprise and its Futures: A Response to Fournier and Grey[END_REF] and suggests that EPS could be perceived as an intensification of entrepreneurialism in healthcare-a feature of the recently elected government's health policy. Such risks are historically counter-balanced by governmental interventions that protect and maintain pharmacists' professional status [START_REF] Johnson | Professions and Power[END_REF], but should we count on it?

Conclusion

The paper discusses the possibilities that technology opens up to transform the pharmacist profession in the future. We have argued that technology has the potential to centralize and decentralize, automate and informate practices and processes, generate new information, mediate communication, and render outputs visible. The six aspects of pharmacists' work we consider, work practices, values, roles, jurisdictions, power, and boundaries, are all open to adjustment. By accommodating multiple interpretations, we present different and often opposing narratives of the future of the pharmacist profession [START_REF] Klein | A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems[END_REF]. One possible interpretation is that pharmacists' work will become an immaterial, temporally dispersed computerized process, and that pharmacists will be transformed into screen-level professionals as providers of accurately specified medicines. But EPS could potentially bring about more fundamental changes that run counter. For example, pharmacists' values may change to become more patient-oriented as they develop more clinical roles. And system trust may be a powerful substitute for interpersonal trust as EPS strengthens their profession by expanding their responsibilities, and thus their jurisdictions. Further, EPS could provide nuanced forms of electronic control that can enable better monitoring and management of dispensing outputs and foster interprofessional trust. These changes, presented in Table 1, constitute the framework we have developed to project and analyze the implications of technology for professionals. We provided a critical analysis of these implications but did not make a prediction about how these will shape professionals in the future. This is not just because EPS has not been nationally rolled-out but primarily because changes in professions and the way that professionalization is enacted are long-term, multidimensionalevolving in parallel with political, technological, and financial changes-and thus open to interpretation. They can hardly be known in advance.

4.1 The Introduction of EPS in English Community Pharmacy In

  England, community pharmacies are contracted by the NHS to provide pharmaceutical services in the local community[START_REF] Mcdonald | Professional Status in a Changing World: The Case of Medicines Use Reviews in English Community Pharmacy[END_REF]. Their function is influenced by a number of other organizations responsible for working with them and protecting pharmacists' interests at a national and local level (National Pharmacy Association, local pharmaceutical committees), negotiating their contractual obligetions (Pharmaceutical Services Negotiating Committee), and reimbursing them (Prescription Pricing Authority). Community pharmacies are paid to deliver NHS services and have a contract to do so, just like family doctors who work in their own

Table 1 .

 1 The Implication of ICT in Pharmacists' Profession

	ICT possibilities	Aspects of Profession	Features of Change
	Centralization/Decentrali-	Work practices	Immaterial aspects
	zation of information		Temporal flexibility
			Elimination of manual tasks
	Automation	Roles	Screen-level pharmacists
	Generation of information	Values	Informatization and patient
			orientation
		Roles	Delivery orientation
		Jurisdictions	Responsibilization
	Transformation	Jurisdictions	Clinical orientation
	Computer Mediated	Values	System trust and impersonality
	Communication
	Visibility	Control and Power	Governing
			Interprofessional trust/control
	Connectivity	Professional boundaries	Inclusion
			New business models

See http://www.connectingforhealth.nhs.uk/systemsandservices/eps.

See http://www.epsevaluation.org.uk/.

Technological is defined here as the ability to use expertise and techniques in order to achieve particular objectives.

See http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_ errors.pdf_28935150.pdf.

EPS Release 2 Business Guidance for Initial implementers, April 2009 (http://www. connectingforhealth.nhs.uk/systemsandservices/eps/staff/guidance/release2guide.pdf).

"Pharmacy in England: Building on Strengths-Delivering the Future," White Paper, 2008 (Department of Health, http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_083815).

Acknowledgments

The authors would like to thank the interviewees that participated in this study, James Davies, Ph.D. candidate at the School of Pharmacy, University of London, and the research team for their comments in an early draft of the paper.

The Evaluation of the Electronic Prescription Service in Primary Care is a collaboration between The School of Pharmacy, University of London, The London School of Economics and Political Science, and The University of Nottingham, under the leadership of Professors N. Barber, A. Avery, and R. Elliott, and Dr. T. Cornford. It is funded by the Connecting for Health Evaluation Programme. This report is independent research commissioned by the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health.

About the Authors

Dimitra Petrakaki is a postdoctoral research officer at the London School of Economics and Political Science. Her research focuses on the relation between information technology, power, and knowledge, and its implication for organizational change. She is currently conducting research into the introduction of electronic health records and electronic transfer of prescriptions in the English NHS. She can be reached at d.petrakaki@lse.ac.uk Tony Cornford is a senior lecturer in Information Systems at the London School of Economics and Political Science. He is interested in IT in health care, IS implementation, the open source software process, and socio-technical and socio-cognitive approaches to IS. His latest work has been in the area of electronic prescribing, electronic health records, and electronic transfer of prescriptions in the English NHS.

He can be reached at t.cornford@lse.ac.uk

Ralph Hibberd is a research fellow at the School of Pharmacy, University London. His research focuses on safety and usability of complex (information) systems and on users' sense making and behavior. He is currently working as a project coordinator and researcher into the electronic yransfer of prescriptions initiative of the English NHS. He can be reached at ralph.hibberd@pharmacy.ac.uk

Valentina Lichtner is a postdoctoral research officer at the London School of Economics and Political Science. She is interested in adoption and adaptation of IT in healthcare, evaluation of systems, identity, and identification technology, human-computer interaction, and patient safety. She is currently conducting research into the introduction of electronic health records and electronic transfer of prescriptions in the English NHS. She can be reached at v.lichtner@lse.ac.uk Nick Barber is Professor of the Practice of Pharmacy at the School of Pharmacy, University London. He held positions at the London School of Economics and Political Science and at Harvard Medical School. His research focuses on medication errors, technology evaluation, adherence, and the philosophy of prescribing and of pharmacy. He is a principal investigator for two research projects that evaluate the National Care Record Service and the Electronic Prescription Service in the English NHS. He can be reached at n.barber@pharmacy.ac.uk.