research-article

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

Authors:

Kathleen H. Pine,

Melissa MazmanianAuthors Info & Claims

CSCW '14: Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing

Pages 283 - 294

https://doi.org/10.1145/2531602.2531652

Published: 15 February 2014 Publication History

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.

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Cited By

Lee SDourish P(2024)Reconfiguring Data Relations: Institutional Dynamics around Data in Local GovernanceProceedings of the ACM on Human-Computer Interaction10.1145/36869598:CSCW2(1-28)Online publication date: 8-Nov-2024
https://dl.acm.org/doi/10.1145/3686959
Pedersen ABossen C(2024)Data Work Between the Local and the Global: An Ethnography of a Healthcare Business Intelligence UnitProceedings of the ACM on Human-Computer Interaction10.1145/36373178:CSCW1(1-28)Online publication date: 26-Apr-2024
https://dl.acm.org/doi/10.1145/3637317
Sun YMa XLindtner SHe L(2023)Care Workers' Wellbeing in Data-Driven Healthcare Workplace: Identity, Agency, and Social JusticeProceedings of the ACM on Human-Computer Interaction10.1145/36101787:CSCW2(1-29)Online publication date: 4-Oct-2023
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Index Terms

Institutional logics of the EMR and the problem of 'perfect' but inaccurate accounts
1. Human-centered computing
  1. Collaborative and social computing

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cover image ACM Conferences

CSCW '14: Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing

February 2014

1600 pages

ISBN:9781450325400

DOI:10.1145/2531602

General Chairs:
Susan Fussell
Cornell University
,
Wayne Lutters
University of Maryland, Baltimore County
,
Program Chairs:
Meredith Ringel Morris
Microsoft Research
,
Madhu Reddy
Penn State University

Copyright © 2014 ACM.

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Published: 15 February 2014

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February 15 - 19, 2014

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CSCW '14 Paper Acceptance Rate 134 of 497 submissions, 27%;

Overall Acceptance Rate 2,235 of 8,521 submissions, 26%

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Cited By

Lee SDourish P(2024)Reconfiguring Data Relations: Institutional Dynamics around Data in Local GovernanceProceedings of the ACM on Human-Computer Interaction10.1145/36869598:CSCW2(1-28)Online publication date: 8-Nov-2024
https://dl.acm.org/doi/10.1145/3686959
Pedersen ABossen C(2024)Data Work Between the Local and the Global: An Ethnography of a Healthcare Business Intelligence UnitProceedings of the ACM on Human-Computer Interaction10.1145/36373178:CSCW1(1-28)Online publication date: 26-Apr-2024
https://dl.acm.org/doi/10.1145/3637317
Sun YMa XLindtner SHe L(2023)Care Workers' Wellbeing in Data-Driven Healthcare Workplace: Identity, Agency, and Social JusticeProceedings of the ACM on Human-Computer Interaction10.1145/36101787:CSCW2(1-29)Online publication date: 4-Oct-2023
https://dl.acm.org/doi/10.1145/3610178
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Tandon A(2020)Practical Affordance: EMR Use Within Outpatient Consulting on Women’s HealthThe Future of Digital Work: The Challenge of Inequality10.1007/978-3-030-64697-4_14(180-193)Online publication date: 3-Dec-2020
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Kulp LSarcevic ACheng MZheng YBurd RBrewster SFitzpatrick GCox AKostakos V(2019)Comparing the Effects of Paper and Digital Checklists on Team Performance in Time-Critical WorkProceedings of the 2019 CHI Conference on Human Factors in Computing Systems10.1145/3290605.3300777(1-13)Online publication date: 2-May-2019
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