Unity in Diversity: Electronic Patient Record Use in Multidisciplinary Practice

Abstract

I n this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a yearlong, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

Hybridity as a process of technology's ‘translation’: Customizing a national Electronic Patient Record

“…Our case suggests that configurability was not a technical barrier but a political in that changes in the software impacted the contractual relation suppliers had with CfH and were on this basis resisted. Ultimately the decision as to what is 'best' for a healthcare organisation to adopt and what is best to change is an outcome of negotiations (Bjørn et al, 2009;Oborn et al, 2011;Wagner & Newell, 2004).…”

“…Customization, one of these interventions, implies making extensive changes in the code of the system and redesigning some of its features so that it becomes contextualised to the implementer health organization (Bjørn et al, 2009;Davidson & Chiasson, 2005;Davidson & Chismar, 2007;Oborn et al, 2011;Williams & Pollock, 2008). Although necessary, customization is often limited as the software's embodied logic cannot be easily fine-tuned (Kallinikos, 2010) and because of the power IT suppliers exercise, through invocation of their technical expertise, to minimise changes in the provided software (Hislop, 2002).…”

“…Inevitably, conflicting goals and power plays emerge between software developers and user organizations as they negotiate how to customize an EPR and which of its embodied 'best practices' are actually 'best' for the user organization (Davidson & Chiasson, 2005;Oborn et al, 2011;Wagner & Newell, 2004;Yeow & Sia, 2008). Bjørn et al (2009) have shown that negotiations between stakeholders are necessary before deciding on the elements of a health technology that can be standardized and used across contexts and those that need to remain local.…”

“…Bjørn et al (2009) have shown that negotiations between stakeholders are necessary before deciding on the elements of a health technology that can be standardized and used across contexts and those that need to remain local. Negotiations between different groups of the same organization have also been reported as being essential to EPR adaptation (Boulus & Bjorn, 2010;Oborn et al, 2011). This is because the monolithic culture of EPR, expressed through its embodied standards, contradicts the multiple local cultures that exist within a healthcare organization (e.g.…”

“…There is a substantial body of literature from Information Systems and Science and Technology Studies (STS) that discusses the outcomes, and to some extent the process, of EPR implementations at a local or national level (Brunsson et al, 2012;Davidson & Chiasson, 2005;Greenhalgh et al, 2008;Håland, 2012;Hanseth et al, 2006;Hanseth & Lundberg, 2001;Kallinikos, 2010;Jones, 2003;Lapointe & Rivard, 2005;Oborn et al, 2011;Pollock et al, 2003;Vikkelsø, 2005;Williams & Pollock, 2008). In most studies customization of EPR is presented as being confined to a single organization, the user, with other stakeholders, such as developers and suppliers, being external to it (Boulus & Bjorn, 2010;Oborn et al, 2011). In this paper we illustrate that the boundaries around EPR customization are dispersed and show how the context of origin of an EPR plays out with the context of its use and its implications.…”