Institutional logics of the EMR and the problem of 'perfect' but inaccurate accounts

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