A informatização da saúde no Brasil: uma análise multi-paper inspirada na teoria ator-rede
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Information and Communication Technologies (ICT) have been used in many areas and common activities, but although there are initiatives undertaken by government and private institutions, health informatics are still an open challenge in Brazil. Today’s scenario raises questions about difficulties related to informatics usage in health and healthcare practices, as well as, the effects of these difficulties on Brazilian society. Aiming to discuss the aforementioned questions, this thesis presents four papers about health informatics in Brazil. The first paper reviews literature about ICT in health. Therefore, based on two theoretical perspectives – (a) European studies about Health Information Systems (HIS) in Developing Countries and (b) studies on Information and Informatics in Health, in the Sanitary Reform Movement –, the paper proposes an integrated model linking analytical dimensions and contextual factors in order to understand HIS in Brazil. The second paper presents theoretical and methodological concepts from Actor-Network Theory (ANT), a research approach to investigate controversies associated with scientific discoveries and technological innovations, based on the network of actors related to such actions. The ANT theoretical approach has supported IS research since 1990 and inspired the analysis conducted in the third and fourth papers presented in this thesis. The final two papers have been written based on the case analysis from the deployment of an HIS in a public hospital in Brazil, conducted during 2010 and 2012. In order to analyze the case, the actors involved in the controversies that emerged during the deployment of the HIS were followed. The third paper focuses on the activities of system analysts and users involved in the HIS deployment. The changes observed over the course of the system deployment reveal that success has not been achieved by the strict and technical execution of the planned tasks. Rather, the success has been constructed collectively through negotiation among actors and the introduction of ‘devices of interessement’ during the project. The fourth paper, based on the Information Infrastructures concept, discusses how the CATMAT system has been merged with the E-Hosp. The analysis reveals how the installed base of CATMAT has been a relevant condition leading to is selection during the E-Hosp deployment. Moreover, it describes negotiations and heterogeneous operations that occurred during the integration of CATMAT into E-Hosp. Thus, this thesis argues that HIS deployment is an effort of collective construction, involving system analysts, health professionals, politicians and technical artifacts. In addition, it makes clear how HIS inscribes definitions and agreements, influencing actors’ preferences in health and healthcare.