Dealing with Dissonance: Misfits between an EHR System and Medical Work Practices

This paper focuses on the question how misfits between an EHR system’s capabilities and medical professionals’ work practices influence these professionals’ work practices. We explore the literature on misfits between ES and organizations, as well as the resulting dissonance between work practices before and after implementation of such systems. Our empirical study builds on qualitative data collected before, during, and after the implementation of an EHR system within one department in an academic hospital. Our findings show various misfits between system and work practices, leading to feelings of dissonance among medical professionals. In response to such dissonance, we find, users devise workarounds that entail either adjusting routines, or changing the use of technology in these routines. Based on these findings, our paper provides in-depth insight into the relationship between (1) misfits between systems and medical work practices, (2) dissonance and (3) workarounds in the implementation and use of EHR systems.

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