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

Kathleen Pine, Melissa Mazmanian

Research output: Chapter in Book/Report/Conference proceedingConference contribution

21 Scopus citations

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.

Original languageEnglish (US)
Title of host publicationCSCW 2014 - Proceedings of the 17th ACM Conference on Computer Supported Cooperative Work and Social Computing
PublisherAssociation for Computing Machinery
Pages283-293
Number of pages11
ISBN (Print)9781450325400
DOIs
StatePublished - Jan 1 2014
Event17th ACM Conference on Computer Supported Cooperative Work and Social Computing, CSCW 2014 - Baltimore, MD, United States
Duration: Feb 15 2014Feb 19 2014

Publication series

NameProceedings of the ACM Conference on Computer Supported Cooperative Work, CSCW

Other

Other17th ACM Conference on Computer Supported Cooperative Work and Social Computing, CSCW 2014
CountryUnited States
CityBaltimore, MD
Period2/15/142/19/14

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Keywords

  • Accountability
  • Coordination
  • Electronic medical records
  • Medication
  • New institutionalism
  • Ordering
  • Organizations
  • Safety

ASJC Scopus subject areas

  • Software
  • Human-Computer Interaction
  • Computer Networks and Communications

Cite this

Pine, K., & Mazmanian, M. (2014). Institutional logics of the EMR and the problem of 'perfect' but inaccurate accounts. In CSCW 2014 - Proceedings of the 17th ACM Conference on Computer Supported Cooperative Work and Social Computing (pp. 283-293). (Proceedings of the ACM Conference on Computer Supported Cooperative Work, CSCW). Association for Computing Machinery. https://doi.org/10.1145/2531602.2531652