The current literature on discourse theory in IS offers powerful lenses for describing, and explaining how organizations manage their encounter with new digital technologies. These contributions have mostly conveyed an actor-centric view of discourse as dominated by communication. Less attention has been paid to the systemic role of discourse, important to understand programme shifts and the emergence of new programmes in large-scale digital infrastructures. To investigate this issue, we ask: how does discourse influence the emergence of new programmes in large-scale digital infrastructures? And, how can policymakers and managers make sense of the public and professional discourse around large e-health infrastructures?

Our in-depth case study investigates 18 years of the development of a regional e-health infrastructure in Norway. Drawing on Foucault (2002), we identified three important programme shifts, each reflecting the interaction between digitalization trends promoted through macro-discourses, and infrastructure conditions through micro-discourse. We found that programme shifts happen when macro and micro discourses converge leading to the emergence of discursive formations. We identified three processes through which this happens: connection, matching, and merging. In our second contribution, we discuss how policymakers and managers can use this framework to make sensible decisions.