research-article

Local-universality: designing EMR to support localized informal documentation practices

Authors:

Sun Young Park,

Yunan ChenAuthors Info & Claims

CSCW '13: Proceedings of the 2013 conference on Computer supported cooperative work

Pages 55 - 66

https://doi.org/10.1145/2441776.2441786

Published: 23 February 2013 Publication History

Abstract

In this paper, we describe a practice that is common across multiple heterogeneous contexts but enacted differently depending on the unique constellation of resources and demands present in each local context. Using the case of informal documentation practices in two departments of a single hospital, Emergency and Labor & Delivery, we describe how clinicians in each department develop contextualized informal documentation practices after deployment of a new EMR system. We describe three underlying functions of informal documentation that are inherent to the practice of medical personnel: "memory work," abstraction work," and "future work." We then find that the newly deployed EMR technology does not support these kinds of work. We argue that hospital documentation work systems should be designed with an eye to such universal work practices, while keeping in mind that the effectiveness of informal documentation practices is rooted in its adaptive and flexible deployment in heterogeneous work settings.

References

[1]

Armijo, D., McDonnell, C., Werner, K. Electronic Health Record Usability: Evaluation and Use Case Framework. Rockville, (October 2009), MD: Agency for Healthcare Research and Quality.

[2]

Ash, J. S., Berg, M., Coiera, E. Some Unintended Consequences of Information Technology in Health care. JAMIA, 11(2), 104--112.

[3]

Balka, E., Bjorn, P. and Wagner, I. Steps toward a typology for health informatics. Proc. CSCW 2008, ACM Press (2008), 515--524.

Digital Library

[4]

Bardram, J. E., Bossen, C. Mobility Work: the Spatial Dimension of Collaboration at a Hospital. Computer Supported Cooperative Work, 14(2), 131--160.

Digital Library

[5]

Berg, M., Bowker, G. The Multiple Bodies of the Medical Record: toward a Sociology of an Artifact. The Sociological Quarterly, (1997). 38(3), 513--537.

[6]

Berg, M. Implementing Information Systems in Health Care Organizations: Myths and Challenges. International Journal of Medical Informatics, 64, 2-3 (2001), 143--156.

[7]

Boonstra, A., and Broekhuis, M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research, 10, (2010), 231.

[8]

Campbell, E. M., Sittig, D. F., Ash J. S. Types of Unintended Consequences Related to Computerized Provider Order Entry. J Am Med Inform Assoc. 2006;13(5):547--556.

[9]

Chen, Y. Documenting Transitional Information in EMR. In Proc. CHI 2010, ACM Press (2010), 1787--1796.

Digital Library

[10]

Corbin, J., Strauss, A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. (2008). Los Angeles: Sage.

[11]

Cyert, R. M., March, J. G. A Behavioral Theory of the Firm. Prentice-Hall, Englewood Cliffs, NJ, USA, 1963.

[12]

Dykstra, R. H., Ash, J. S., Campbell, E., Sittig, D. F., Guappone, K., Carpenter, J., Richardson, J., Wright, A., McMullen, C., Persistent Paper: the Myth of Going Paperless, in: AMIA Annual Symposium Proceedings, 2009, pp. 158--162.

[13]

Embi, P. J., Yackel, T. R., Logan, J. R., Bowen, J. L., Cooney, T. G., Gorman, P. N. Impacts of Computerized Physician Documentation in a Teaching Hospital: Perceptions of Faculty and Resident Physicians, Journal of American Medical Informatics Association 11 (2004) 300--309.

[14]

Feldman, M., Pentland, B. Reconceptualizing Organizational Routines as a Source of Flexibility and Change. Administrative Science Quarterly (2003). 48(1), 94--118.

[15]

Fitzpatrick, G. Integrated Care and the Working Record. Health Informatics Journal 10 (2004) 291--302.

[16]

Hardey, M., Payne, S., and Coleman, P. (2000). 'Scraps': Hidden nursing information and its influence on the delivery of care. Journal of Advanced Nursing, 32(1), p. 208--214.

[17]

Harrison, M. I., Koppel, R., and Bar-Lev, S. Unintended Consequences of Information Technologies in Health Care - An Interactive Sociotechnical Analysis. JAMIA, 14, 5 (2007), 542--549.

[18]

Heath, C., Luff, P. Documents and Professional Practice: 'Bad' Organizational Reasons for 'Good' Clinical Records. In Proc. CSCW 1996, ACM Press (1996), 354- 363.

Digital Library

[19]

Han, Y. Y., Carcillo, J. A., Venkataraman, S. T., Clark, R. S. B., Watson, S., Nguyen, T. C., Bayir, H., Orr, R. A. Unexpected Increased Mortality after Implementation of a Commercially Sold Computerized Physician Order Entry System. Pediatrics 116 (2005), 1506--1512.

[20]

Hardstone, G., Hartswood, M., Procter, R., Slack, R., Voss, A., Rees, G. Supporting Informality: Team Working and Integrated Care Records. In Proc. CSCW 2004, ACM Press, 142--151.

Digital Library

[21]

Hartswood, M., Procter, R., Rouncefield, M., Slack, R. (2003). Making a Case in Medical Work: Implications for the Electronic Medical Record. Computer Supported Cooperative Work, 12(3), 241--266.

Digital Library

[22]

Hayes, G., Lee, C., Dourish, P. Organizational routines, innovation, and flexibility: The application of narrative networks to dynamic workflow. International Journal of Medical Informatics, (2011). 80(8), 161--177.

[23]

Hersh, W. R. The Electronic Medical Record: Promises and Problems. Journal of the American Society for Information Science, 46, 10 (1999), 772--776.

[24]

Hillestead, R. et al. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs. Health Affairs, 24, (2005), 1103--1117.

[25]

Klein, H., Myers, M. A set of principles for conducting and evaluating interpretive field studies in information systems. MIS Quarterly, (1999). 23(1), 67--93.

Digital Library

[26]

Park, S. Y. and Chen, Y. Adaptation as Design: Learning from an EMR deployment Study. In Proc. CHI 2012, ACM Press, 2097--2106.

Digital Library

[27]

Park, S. Y., Lee, S. Y., Chen, Y. The Effects of EMR Deployment on Doctors' Work Practices: A qualitative Study in the Emergency Department of a Teaching Hospital, International Journal of Medical Informatics, Vol 81, Issue 3 (2012), 204--217.

[28]

Pentland, B., and Feldman, M. Designing routines: On the folly of designing artifacts, while hoping for patterns of action. Information & Organization, 18 (2008), 235--250.

Digital Library

[29]

Pine, K. P. Fragmentation and Choreography: Caring for a Patient and a Chart during Childbirth. In Proc. CSCW 2012, ACM Press, 887--896.

Digital Library

[30]

Pipek, V., and Wulf, V. Infrastructuring: Toward an Integrated Perspective on the Design and Use of Information Technology. JAIS, 10, 6 (2009), 447--473.

[31]

Poissant, L., Pereira, J., Tamblyn, R., Kawasumi, Y. The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review. J Am Med Inform Assoc, 12 (2005), 505--516.

[32]

Reddy, M. 2002. A Finger on the pulse. Temporal Rhythms and Information Seeking in Medical Work. In Proc. CSCW'08, 344--353.

Digital Library

[33]

Steinbrook, R. Health Care and the American Recovery and Reinvestment Act. New England Journal of Medicine, 360 (2009), 1057--1060.

[34]

Strauss, A., Fagerhaugh, S., Suczek, B., Wiener, C. The Social Organization of Medical Work. Chicago: The University of Chicago Press. (1997).

[35]

Timmermans, S., Berg, M. Standardization in Action: Achieving Local Universality through Medical Protocols. Social Studies of Science, 27(2) (1997), 273--305.

[36]

Timmermans, S., Berg, M. The Gold Standard: The Challenge of Evidence Based Medicine and Standardization in Health Care. Philadelphia: Temple University Press (2003).

[37]

Wilcox, L., Lu, J., Lai, J., Feiner, S., Jordan, D. Physician-driven Management of Patient Progress Notes in an Intensive Care Unit. In Proc. CHI 2010, ACM Press, 1879--1888.

Digital Library

[38]

Zhou, X., Ackerman, M. S., and Zheng, K. (2009) I just don't know why it's gone: Maintaining Informal Information Use in Inpatient Care. In Proc. CHI 2009, ACM Press, 2061--2070.

Digital Library

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Local-universality: designing EMR to support localized informal documentation practices

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cover image ACM Conferences

CSCW '13: Proceedings of the 2013 conference on Computer supported cooperative work

February 2013

1594 pages

ISBN:9781450313315

DOI:10.1145/2441776

General Chairs:
Amy Bruckman
Georgia Institute of Technology, USA
,
Scott Counts
Microsoft Research, USA
,
Program Chairs:
Cliff Lampe
University of Michigan, USA
,
Loren Terveen
University of Minnesota, USA

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Published: 23 February 2013

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Jin XServant F(2023)HybridCISave: A Combined Build and Test Selection Approach in Continuous IntegrationACM Transactions on Software Engineering and Methodology10.1145/357603832:4(1-39)Online publication date: 26-May-2023
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