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Advanced Electronic Medical Records (EMR) provide many potential benefits to hospitals. However, because of their broad scope, many stakeholders deal with the EMR and a continuous effort has to be made to keep up with internal and external change. Therefore, hospitals need to deliberately shape their organizational competencies considering the pursuit of alignment, i.e. making sure that the EMR remains optimally aligned with strategies, goals and needs of the hospital and its stakeholders. This paper aims to investigate the evolutionary paths of these alignment competencies and their drivers, from a theoretical perspective of co-evolutionary information systems alignment (COISA).

This paper reports on a longitudinal multiple case study of three Dutch hospitals which each recently implemented an advanced EMR system. The authors conducted 35 in-depth interviews in 2 phases (before and after go-live of the EMR), and studied documentation related to the EMR implementations.

The findings show that each hospital's COISA capability shows a different evolutionary path. However, two of the three case hospitals ended up coordinating part of their COISA capability to an ecosystem level, i.e. they incorporated other hospitals using the same EMR system to coordinate their alignment efforts, either from an operational perspective, or in terms of orchestration and strategy. The found evolutionary paths' key drivers include “stakeholder initiative”, “accumulating experience”, “driving events” and “emerging issues”.

The findings help healthcare practitioners to deliberately shape their organization's COISA capability in pursuit of EMR alignment. Furthermore, the authors add to the knowledge base on co-evolutionary approaches to alignment through the longitudinal approach.

Via embracing the idea that one who directly experiences a problem is keener to develop more innovative solutions, local governments have started to engage smart communities in the innovation of public services’ delivery. Even if the meaning of “smart community” generally refers to the community participation in the innovation of public services for urban living, local governments have predominantly stimulated the participation of their citizens. But innovative ideas can potentially spring out also from the insiders. The purpose of this paper is to find the managerial and technological issues that public managers have to consider when planning an internal smart community initiative.

For this purpose, the authors analyse the case study of the Municipality of Turin that developed a participatory smart community project named Innova.TO, through the theoretical lens of sensemaking (Weick, 1979; Weick et al., 2005).

Results show that there are three main aspects to be considered when implementing smart community initiatives in local governments.

Even if there is the potential, the engagement of public employees in a smart community of innovators is not straightforward, and several complexities may challenge its success. Moreover, real-life examples and empirical studies are still episodic. As a consequence, if it is concretely possible to build a smart community of innovators inside a local government still remains a question, to which this paper aims to respond.