Complexity and Distress in Open-Source Health Information System Implementations in Countries with Developing Economies – The Case of Lesotho

Many countries with developing economies (CDEs) are currently engaged in strengthening their national health information systems (HIS) through Free/Libre and open-source software (FLOSS). While open-source provides a cost-efficient means compared to the proprietary alternatives, there are many challenges to their successful implementation, thereby hindering the optimal leverage of these open-source products. Underestimation of complexity and distress are attributed to FLOSS-based HIS implementation failure. Complexity refers to how intricate and sophisticated a system is. The concept of distress is used in information systems (IS) to characterize a system that experiences challenges during its lifetime. Understanding HIS complexity is crucial to navigating the challenges that cause distress in HIS implementation. This research-in-progress aims to propose an investigation to identify underlying causal mechanisms that give rise to distress in FLOSS-based HIS implementations in CDEs. A critical realism (CR) case-based research lensed through a complex adaptive systems (CAS) theory with multiple sources of data will be employed. A purposefully chosen case will be abductively and retroductively analysed to develop new theoretical positions. Interviews, field observations, and focus group discussions will be used to collect data. A CR case-based approach to this research will lead to a novel theoretical explication of the complex interactions occurring within the HIS implementations, which can contribute to more effective strategies for mitigating distress and improving the HIS implementation processes. This study is important given the potential for IS to contribute to the improvement of health outcomes in CDEs.