Institutional logics of the EMR and the problem of 'perfect' but inaccurate accounts
Zotero / D&S Group / Top-Level Items 2020-05-31
Type
Conference Paper
Author
Kathleen H. Pine
Author
Melissa Mazmanian
URL
https://doi.org/10.1145/2531602.2531652
Series
CSCW '14
Place
Baltimore, Maryland, USA
Publisher
Association for Computing Machinery
Pages
283–294
ISBN
978-1-4503-2540-0
Date
February 15, 2014
DOI
10.1145/2531602.2531652
Accessed
2020-05-30
Library Catalog
ACM Digital Library
Abstract
Electronic Medical Records promise to simultaneously enhance coordination and provide transparency and accountability in work process. As such, EMR are purported to benefit both hospitals and patients. In this paper we use grounded empirical data to explore how this promise plays out in the everyday tasks of healthcare providers. Building on the small body of CSCW literature that suggests that the accounting functions of EMR are impinging on the ability of medical personnel to coordinate work, we draw on the theoretical lens of new institutionalism to outline how certain institutional logics around safety and accountability are shaping the experience of EMR systems in situ. We suggest that the institutional logics that currently characterize U.S. healthcare are embedded in the EMR design itself, structuring how institutional values such as 'safety' are achieved and evaluated. Using over one year of ethnographic research in an obstetrical unit, we find that the institutional logics of 'safety' embedded in the EMR create negative organizational outcomes, effectively undermining coordination and necessitating inaccurate accounts of work. We provide design implications to address these issues in the current institutional environment and envision how systems might be designed to promote alternate logics of safety that are social, dynamic, and cast humans as expert agents in the system.
Proceedings Title
Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing