Adoption Strategies and Workarounds in the Evolution of Information Infrastructures Integrating Health and Social Care Providers in Scotland: Multimethod Qualitative Case Study of the Key Information Summary.

Abstract

Background: care records are digital technologies designed to support information sharing and care coordination across fragmented health and social care systems. However, adoption and use of these technologies can vary across diverse health and care settings, with users using workarounds and other strategies to meet their specific information needs. In Scotland, the Key Information Summary (KIS) has been in use for over 13 years, sharing key patient information from general practitioners (GPs) with other health and care providers for future care planning.

Objective: Using the KIS as a case study, this study examines how various adoption strategies and workarounds have shaped the evolution of regional information infrastructures integrating health and social care in Scotland over time.

Methods: This multimethod qualitative study examined the various contextual factors influencing adoption and use of the KIS across diverse health and care settings. Data collection included interviews with KIS users from health and care settings, implementers, and vendors; documentary analysis of user guides, websites, reports, and policies; and observation of multidisciplinary team meetings and technology use. Data analysis involved a hybrid approach. The technology-people-organization-macroenvironment framework was applied to code interview, documentary, and observational data, followed by an inductive analysis informed by science and technology studies theories of information infrastructures, domestication, and workarounds to examine strategies and workarounds for adapting the KIS to local contexts and evolving needs.

Results: Data comprised 54 qualitative interviews, 59 documents, 2 websites, and 20 hours of observational field notes collected between April 2024 and March 2025. Findings indicate that adoption of the KIS varied across settings and over time due to misalignment between system design, evolving expectations of integrated care, and national initiatives during the COVID-19 pandemic that repurposed its use. Professional roles and associated information needs shaped differing expectations of what constituted useful information, generating tensions between users who relied on the KIS and GPs responsible for maintaining it. Formal workarounds enabled the extension of the health care-centric infrastructure into nonclinical settings to facilitate information sharing with GPs and, in some cases, supported clinician access to the KIS during system outages. Across settings, informal user-driven repair practices enabled diverse professionals to adopt and realign the KIS with its intended use.

Conclusions: This study demonstrates how regional information infrastructures integrating health and care evolve incrementally as they become embedded within local routines, practices, and existing systems. Adoption was shaped by professional roles, information needs, and users' capabilities, with formal workarounds extending infrastructures into new settings and informal, user-driven repair practices supporting ongoing use and maintenance. Policymakers and vendors must recognize that workarounds and user-driven repair practices are central to infrastructural growth and sustainability, and understanding these strategies can inform future technology development and innovation.