The Electronic Patient Record as a Meaningful Audit Tool:Accountability and Autonomy in General Practitioner Work

Winthereik, Brit Ross; Ploeg, Irma van der; Berg, Marc

doi:10.1177/0162243906293884

Cited by 48 publications

(43 citation statements)

References 20 publications

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“…The concern for accountability when developing EHRs is relevant for management and decision makers, since health care expenditures seem to continually rise, and new governance policies (e.g. New Public Management), and citizens demand that the sector and its staff and services be more accountable (Cotton et al 2000;Power 1997;Wiener 2000;Winthereik et al 2007). This may pose significant challenges to the efforts to support work and its coordination, which are traditionally the focus in CSCW, and may easily be caught up with a concern for accountability (e.g.…”

Section: Standards User Involvement and Models Of And For Workmentioning

confidence: 99%

Accounting and Co-Constructing: The Development of a Standard for Electronic Health Records

Bossen

2011

Comput Supported Coop Work

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Patient records are central, constitutive parts of health care and hospitals. Currently, substantial sums are being invested in making patient records electronic, in order to take advantage of IT's ability to quickly accumulate, compute, and propagate data to multiple sites, to enhance coordination of health care services and cooperation among staff, and make patient records immediately accessible to distributed actors. Investors also aim to increase health care services' accountability and integration, and improve quality and efficiency. This paper analyses a Danish national standard for electronic health records, on the basis of an application prototype test designed to that standard. The analysis shows that, inscribed in the standard is an ambition to increase the accountability of staff and health care services at the cost of increased work, loss of overview, and fragmentation of patient cases. Significantly, despite the standard having been conceived and developed in a process of co-construction involving clinicians, clinicians did not find it adequate for their work. This analysis argues this was the result of the model of work embedded in the standard coming from a stance external to practice. Subsequently, a flip-over effect occurred, in which the model of work became a model for work. Hence, this paper argues that co-construction processes should not only include users as representatives of a profession, but strive to produce experiences and knowledge intrinsic to practice.

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Section: Standards User Involvement and Models Of And For Workmentioning

confidence: 99%

Accounting and Co-Constructing: The Development of a Standard for Electronic Health Records

Bossen

2011

Comput Supported Coop Work

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“…These alterations are difficult to predict and manage because documents, along with other artefacts in general that are used for organizational coordination, do not work in isolation but are part of a multiplicity of artefacts and technologies that defy easy standardization and integration (Ellingsen & Monteiro, 2003, 2006Hartswood, Procter, Rouncefield, & Slack, 2003). ICT implementations also transform communication practices between health professionals and patients (e.g., Piras & Zanutto, 2010;Vikkelsø, 2005;Winthereik, Van Der Ploeg, & Berg, 2007). Patients, professionals, and health ICTs co-constitute each other in complex ways, and changing such an entanglement of social, organizational, and technical elements is a politically textured negotiation process with uncertain outcomes (Berg, 1999;Vikkelsø, 2010).…”

Section: Introductionmentioning

confidence: 99%

Innovation Of, In, On Infrastructures: Articulating the Role of Architecture in Information Infrastructure Evolution

Grisot¹,

Hanseth²,

Thorseng³

2014

JAIS

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“…In an ethnographic study in UK general practice, Winthereik 55 studied how general practitioners (GPs) managed two potentially conflicting agendas: accountability to external scrutiny [e.g. via the Quality and Outcomes Framework (QOF) and other government-imposed audits and incentive schemes]; and professional autonomy (the need to feel in control of their own clinical practice).…”

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confidence: 99%

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Greenhalgh

Swinglehurst

Stones

2014

Health Services and Delivery Research

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BackgroundNationally mandated information and communication technology (ICT) systems are often locally resented and little used. This problem is sometimes framed in behaviourist terms, depicting the intended user of technology as a rational actor whose resistance stems from Luddism and/or ignorance, and viewing solutions in terms of training, incentives and sanctions. The implication is that if we get the ‘rewards’ and ‘punishments’ right, people will use technologies. Previous research in the social sciences, notably sociotechnical systems theory, actor–network theory and normalisation process theory, have considered the human, social and organisational context of technology use (and non-use). However, these have all had limitations in explaining the particular phenomenon of resistance to nationally mandated ICT systems.ObjectiveTo develop a sociologically informed theory of resistance to nationally mandated ICT systems.Theoretical approachWe drew on Anthony Giddens’ notion of expert systems (comprising bureaucratic rules and classification systems delivered through technology) as well as theories of professional roles and ethical practice. A defining characteristic of expert systems is that they can produce ‘action at a distance’, allowing managerial control to be exerted over local practice. To the extent that people use them as intended, these systems invariably ‘empty out’ social situations by imposing rules and categories that are insensitive to local contingencies or the unfolding detail of social situations.Study design and settingSecondary analysis of data from case studies of three nationally mandated ICT systems in the English NHS, collected over the period 2007–10.ResultsOur analysis focused mainly on the Choose and Book system for outpatient referrals, introduced in 2004, which remained unpopular and little used throughout the period of our research (i.e. 2007–13). We identified four foci of resistance: to the policy of choice that Choose and Book symbolised and purported to deliver; to accommodating the technology’s sociomaterial constraints; to interference with doctors’ contextual judgements; and to adjusting to the altered social relations consequent on its use. More generally, use of the mandated system tended to constrain practice towards a focus on (the efficiency of) means rather than (the moral value of) ends. A similar pattern of complex sociological reasons for resistance was also seen in the other two technologies studied (electronic templates for chronic disease management and the Summary Care Record), though important differences surfaced and were explained in terms of the policy inscribed in the technology and its material features.Conclusion‘Resistance’ is a complex phenomenon with sociomaterial and normative components; it is unlikely to be overcome using atheoretical behaviourist techniques. To guide the study of resistance to ICT systems in health care, we offer a new theoretical and empirical approach, based around a set of questions about the policy that the technology is intended to support; the technology’s material properties; the balance between (bureaucratic) means and (professional) ends; and the implications for social roles, relationship and interactions.We suggest avenues for future research, including methodology (e.g. extending the scope and scale of ethnographic research in ICT infrastracture), theory development (e.g. relating to the complexities of multi-professional team working) and empirical (e.g. how our findings might inform the design and implementation of technologies that are less likely to be resisted).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The Electronic Patient Record as a Meaningful Audit Tool:Accountability and Autonomy in General Practitioner Work

Cited by 48 publications

References 20 publications

Accounting and Co-Constructing: The Development of a Standard for Electronic Health Records

Accounting and Co-Constructing: The Development of a Standard for Electronic Health Records

Innovation Of, In, On Infrastructures: Articulating the Role of Architecture in Information Infrastructure Evolution

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

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