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The lack of alignment of these positions was apparent in ongoing tensions and eventually broke up the network, reflected in the media discourse surrounding “the spectacular failure of the NPfIT”. 4. Discussion This chapter has illustrated that drawing on ANT can be helpful in conceptualizing technology implementation in healthcare settings. In particular, the approach can help to inform sampling and to examine how technology actively shapes human relationships and vice versa. It can further inform deliberations on the alignment of various networks at different levels including healthcare professional work, organizational practices, political and supplier relationships. In line with this, ANT-informed approaches continue to be used by health service researchers as tools to facilitate tracing networks of human actors and technologies over time. However, these are mostly small-scale studies exploring health IT implementations in particular settings [24-26]. Due to its limitations, the traditional “purist” ANT approach is likely to be too restrictive and too prone to getting lost in detail to be usefully employed in studying health IT implementation and this is reflected in the current literature, where the use of ANT to inform analysis is generally less common than its role in informing design considerations [24-26]. It is therefore often employed in conjunction with other theoretical lenses under the more general sociotechnical umbrella [20,25]. Sociotechnical lenses are well suited to explore processes surrounding technology implementation across a variety of different stakeholder levels [27,28]. These approaches are proving to be relatively flexible, in particular when considering large-scale implementations of complex programmes where drawing on one single lens may be quite restrictive [29]. However, many existing approaches still examine health IT at one selected level, be it micro contexts, meso (organizational) contexts or macro contexts [30-33]. The relationships between these are often poorly understood and this is where pragmatic ANT-informed approaches, as outlined in the case study above, may be useful for evaluators going forward. It is difficult to predict if the NPfIT would have had more successes if the design of technologies and implementation strategy had drawn on ANT. This is because the application of the method is very much subjective. However, more generally, rigorous independent formative evaluation methods (informed by ANT in combination with other sociotechnical lenses) are crucial to accelerate learning and optimization of implemented technologies and practices. Teaching questions for reflection 1. Consider which objects in your environment may be viewed as having agency. 2. Would you draw on ANT in your work? How could you do this? 3. What do you consider to be the most helpful/unhelpful aspects of ANT in health IT implementation? K.Cresswell /UsingActor-NetworkTheory toStudyHealth InformationTechnology Interventions 95