Qualitative case research methods offer a flexible approach to the understanding of large and complex health service delivery systems embedded within their extended social context. Taken as the relevant unit of analysis, the Indian national health care system is a complex inter-organizational network valuable to the process of scientific study as a critical case, particularly for analysis of the co-evolution and integration of networks under a diverse ideologies. Despite recognition of the importance of systems science in medical informatics, little research has focused on studies of health care at the national system level, in part because of the size and complexity of such systems and the lack of interdisciplinary consensus regarding appropriate methodologies and theoretical foundations for this important field of study. Some authors suggest that there is a pragmatist epistemic argument for use of qualitative and mixed research methodologies in the field of medical informatics as clinical practice is a hybrid sociotechnical field. This view rejects belief in a single “scientific method” and recognizes that research is always situated in a particular context.
This research contributes to development of a methodology and conceptual framework for comparative analysis of the virtual infrastructures of national health care systems. Health care is defined as the preservation of mental and physical health by prevention or treatment of illness through services offered by the health professions. A health care system is a dynamic set of interconnected individuals, institutions, organizations, and projects offering products and services in health care markets. The functions of the health system include all categories of service delivery, resource generation and allocation, and governance. Governance includes both policy making and regulation of the system. Service delivery encompasses information, research, and education services as well as public health and delivery of patient care, both preventative and curative. These functions, as well as their interrelations, are critically important to the performance of an integrated health care system and the quality of health care services.
Data are drawn from published accounts of system development and the websites of the constituent organizations, networks and services to describe the configuration of virtual infrastructures. The context of the case analysis is developed using historical data to show how the current system has unfolded over time. E-mapping software is used to visualize the linkages among institutions and resources identified in the case analysis. Electronic linkages among institutions and services are considered in the analysis as well as linkages integrating national health care systems with international institutions. Using this specialized software, an online database includes a dynamic electronic representation of virtual infrastructures identified in the research program. Visualization of data reveals how information resources are linked and integrated in development of the virtual infrastructure. These data describe configurations of web-based services revealing patterns associated with electronic markets and hierarchies.
2. Bireme: The Latin American Region