Abstract
Although computerization is increasingly advocated as a means for hospitals to enhance quality of care and control costs, few studies have evaluated its impact on the day-to-day organization of medical work. This study investigated a large Computerized Patient Record (CPR) project ($50 million U.S.) aimed at allowing physicians to work in a completely electronic record environment. The present multiple-case study analyzed the implementation of this project conducted in four hospitals. Our results show the intricate complexity of introducing the CPR in medical work. Profound obstructions to the achievement of a tighter synchronization between the care and information processes were the main problems. The presence of multiple information systems in one (Communication, Decision Support, and Archival record keeping) was overlooked. It introduced several misconceptions in the meaning and codification of clinical information that were then torn apart between information richness to sustain clinical decisions and concision to sustain care coordination.
Similar content being viewed by others
REFERENCES
Barley, S.R., Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments. Admin. Sci. Quarterly 31:78–108, 1986.
Huber, G.P., A theory of the effects of advanced information technologies on organizational design, intelligence, and decision making. Acad. Manag. Rev. 15: 47–71, 1990.
Orlikowski, W.J., The Duality of technology: Rethinking the concept of technology in organizations. Organ. Sci. 3:398–427, 1992.
DeSanctis, G., & Scott Poole, M., Capturing the complexity in advanced technology use: Adaptive structuration theory. Organ. Sci. 5(2):121–147, 1994.
Yin, R.K., Case Study Research (revised edition), Sage, Beverly Hills, 1989.
Drazen, E.L., Metzger, J.B., Ritter, J.L., & Schneider, M.K., Patient Care Information Systems, Springer Verlag, 1995.
Institute of Medicine. The Computer-Based Patient Record, Institute of Medicine, National Academy Press, Washington, 1991.
Kaplan, B., Development and acceptance of medical information systems: An historical overview. J. Health Hum. Res. Admin. Summer 1988, 9–29, 1988.
Ball, M.J., & Collen, M.F., Aspects of the Computer-Based Patient Record, Springer-Verlag, 1992.
Rights and permissions
About this article
Cite this article
Sicotte, C., Denis, J.L., Lehoux, P. et al. The Computer-Based Patient Record Challenges Towards Timeless and Spaceless Medical Practice. Journal of Medical Systems 22, 237–256 (1998). https://doi.org/10.1023/A:1022661701101
Issue Date:
DOI: https://doi.org/10.1023/A:1022661701101