CPOE workarounds, boundary objects, and assemblages

We conducted an ethnographically based study at a large teaching hospital to examine clinician workarounds engendered by the adoption of a Computerized Prescribe Order Entry (CPOE) system. Specifically, we investigated how adoption of computerized systems may alter medical practice, order management in particular, as manifested through the working-around behavior developed by doctors and nurses to accommodate the changes in their day-to-day work environment. In this paper, we focus on clinicians' workarounds, including those workarounds that gradually disappeared and those that have become routinized. Further, we extend the CSCW concept of boundary object (to "assemblage") in order to understand the workarounds created with CPOE system use and the changing nature of clinical practices that are increasingly computerized.

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