Electronic Health Records and the Changing Roles of Health Care Professionals: A Social Informatics Perspective

Our longitudinal study examines the changing roles of health care professionals (physicians, nurses, medical assistants, practice managers, and secretaries) before and after an EHR implementation in a large, multi-location group practice. We take a social informatics perspective and focus on the changing social identities of health care professionals as they adapt to their EHR-enabled roles. A year after go-live, a few professionals were still in reactive mode, trying to cope with the new system, but many others were actively shaping the technology and their roles in a variety of ways. A few went beyond shaping to find ways to provide additional value to themselves and to patients in ways that became possible only because of the EHR. In this paper, we explore these responses to the EHR as a basis for building theory about the potential for EHR systems to improve health care delivery, and the mechanisms by which that potential is realized.

[1]  C. Brodsky The Discovery of Grounded Theory: Strategies for Qualitative Research , 1968 .

[2]  A. Strauss,et al.  The discovery of grounded theory: strategies for qualitative research aldine de gruyter , 1968 .

[3]  B. Glaser Theoretical Sensitivity: Advances in the Methodology of Grounded Theory , 1978 .

[4]  Daniel L. Sherrell,et al.  Communications of the Association for Information Systems , 1999 .

[5]  Michael D. Myers,et al.  A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems , 1999, MIS Q..

[6]  Karen Locke Grounded Theory in Management Research , 2000 .

[7]  Rob Kling,et al.  Reconceptualizing Users as Social Actors in Information Systems Research , 2003, MIS Q..

[8]  David W. Bates,et al.  Position Paper: A Proposal for Electronic Medical Records in U.S. Primary Care , 2003, J. Am. Medical Informatics Assoc..

[9]  M. Berg,et al.  ICT in health care: sociotechnical approaches. , 2003, Methods of Information in Medicine.

[10]  J. Grossman,et al.  Building a Better Delivery System: A New Engineering/Health Care Partnership , 2005 .

[11]  Mike Chiasson,et al.  Contextual influences on technology use mediation: a comparative analysis of electronic medical record systems , 2005, Eur. J. Inf. Syst..

[12]  Suzanne Rivard,et al.  A Multilevel Model of Resistance to Information Technology Implementation , 2005, MIS Q..

[13]  Thomas G Rundall,et al.  Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study , 2005, BMJ : British Medical Journal.

[14]  Shanan G. Gibson,et al.  EXPLAINING PHYSICIAN TECHNOLOGY ACCEPTANCE OF COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) , 2005 .

[15]  Yajiong Xue,et al.  Understanding Team Influence on Professionals' Acceptance of Large- Scale Systems , 2006, PACIS.

[16]  Bengisu Tulu,et al.  Information Systems and Health Care XIV: Continuing Use of Medical Information Systems by Medical Professionals: Empirical Evaluation of a Work System Model , 2006, Commun. Assoc. Inf. Syst..

[17]  Guy Paré,et al.  Research Paper: The Effects of Creating Psychological Ownership on Physicians' Acceptance of Clinical Information Systems , 2006, J. Am. Medical Informatics Assoc..

[18]  Elizabeth J. Davidson,et al.  Bridging the IT Adoption Gap for Small Physician Practices: An Action Research Study on Electronic Health Records , 2006, Inf. Syst. Manag..

[19]  Cynthia LeRouge,et al.  Healthcare information systems research, revelations and visions , 2007 .

[20]  Bonnie Kaplan,et al.  Expanding multi-disciplinary approaches to healthcare information technologies: What does information systems offer medical informatics? , 2007, Int. J. Medical Informatics.

[21]  Elizabeth Davidson,et al.  An organizational learning perspective on the assimilation of electronic medical records among small physician practices , 2007, Eur. J. Inf. Syst..

[22]  Brian D. Janz,et al.  Information Systems and Healthcare XVI: Physician Adoption of Electronic Medical Records: Applying the UTAUT Model in a Healthcare Context , 2007, Commun. Assoc. Inf. Syst..

[23]  W. Chismar,et al.  The interaction of institutionally triggered and technology-triggered social structure change: an investigation of computerized physician order entry , 2007 .

[24]  E. Hing,et al.  Electronic medical record use by office-based physicians and their practices: United States, 2006. , 2007, Advance data.

[25]  Jeanette Van Akkeren,et al.  An epidemic of pain in an Australian radiology practice , 2007, Eur. J. Inf. Syst..

[26]  Tina Blegind Jensen,et al.  How Healthcare Professionals “Make Sense” of an Electronic Patient Record Adoption , 2006, Inf. Syst. Manag..

[27]  J. Øvretveit,et al.  Improving quality through effective implementation of information technology in healthcare. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[28]  Anol Bhattacherjee,et al.  Physicians' resistance toward healthcare information technology: a theoretical model and empirical test , 2007, Eur. J. Inf. Syst..

[29]  Reuben R. McDaniel,et al.  An Exploration of Heterogeneity in Electronic Medical Record Use: Information Technology Use as Emergent and Driven by Values and Expertise , 2008, ICIS.

[30]  Chun-Ju Hsiao,et al.  Electronic medical record use by office-based physicians and their practices: United States, 2007. , 2010, National health statistics reports.

[31]  Rachel Robinson A prescription for change: Physicians' perceptions of moving to an electronic health record , 2011 .