How LINCs were made: alignment and exclusion in American medical informatics

Electronic computers in information systems are often seen as "ready-to-use" technology, which simply becomes applied to certain domains. This article explores the sociotechnical processes involved in the development of information systems by studying two cases of medical informatics, the Laboratory Instrument Computer (LINC) and a medical information system at a hospital. They show that information systems have from the beginning been a result of multiple alignment processes between the relevant actors, among which are users, developers, and the technology itself. The first case reveals that information systems are successful when actors become aligned and coordinated across boundaries. This alignment includes user interfaces as well as parts and components of the computer. The second case exhibits disalignment between relevant actors, which leads to an unstable information system. The two mechanisms are found coexisting in medical informatics.