Collective expectations--individual action implementing electronic booking systems in Norwegian health care.
ABSTRACT We draw on an ongoing study of an electronic booking project at the University Hospital North Norway where general practitioners are given the opportunity to book appointments at the hospital for their patients. Electronic booking offers well-defined and standardised services as well as standardised procedures for preparing the patient for the appointment at the hospital. We examine how the standards inscribed in the booking system shape medical work and how they bring to the surface a social dilemma between collective and individual interests in how the key actors reflect on the consequences of the system. We combine two social theories, namely Actor Network Theory and the theory of collective action. As a conclusion, we argue that simple and well-defined cases of patients' problems and willingness among the general practitioners to undertake work traditionally conducted at the hospital are conditions for making electronic booking successful. However, when the patients' problems are unclear the booking system needs to be combined with traditional referrals. We also point to how the general practitioners' attitude towards the system is time-dependent. Their initial positive attitude towards the potential public goods produced by booking transforms into putting more weight on the individual interests.
- SourceAvailable from: Trisha Greenhalgh[show abstract] [hide abstract]
ABSTRACT: The extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Using the meta-narrative method and searching beyond the Medline-indexed literature, this review used "conflicting" findings to address higher-order questions about how researchers had differently conceptualized and studied the EPR and its implementation. Twenty-four previous systematic reviews and ninety-four further primary studies were considered. Key tensions in the literature centered on (1) the EPR ("container" or "itinerary"); (2) the EPR user ("information-processer" or "member of socio-technical network"); (3) organizational context ("the setting within which the EPR is implemented" or "the EPR-in-use"); (4) clinical work ("decision making" or "situated practice"); (5) the process of change ("the logic of determinism" or "the logic of opposition"); (6) implementation success ("objectively defined" or "socially negotiated"); and (7) complexity and scale ("the bigger the better" or "small is beautiful"). The findings suggest that EPR use will always require human input to recontextualize knowledge; that even though secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper may offer a unique degree of ecological flexibility; and that smaller EPR systems may sometimes be more efficient and effective than larger ones. We suggest an agenda for further research.Milbank Quarterly 12/2009; 87(4):729-88. · 4.64 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: This paper gives an overview of projects completed on the topic of electronic referral in healthcare. The first referral projects were based on standardized EDI-communication. The same basis is still used in many projects, but these are slowly being replaced by web-based solutions with possibilities for decision support and booking. The time from initiation of the first services to high volume use seems to be very much related to how well the new solutions fit with the general practitioners and specialists work practices, and if there are obvious benefits for the communication partners. High volume national services seem to require both political support and pressure. Some of the projects have not paid enough attention to sociotechnical approaches.Studies in health technology and informatics 02/2009; 150:327-31.
- [show abstract] [hide abstract]
ABSTRACT: The main idea behind the paper is to try to find out what the main socio-technical obstacles and enablers for high volume use of collaboration systems in the health sector are. The paper also focuses how the results can be used in design, implementation and deployment of collaborative systems in health care, with electronic referrals used as a case.Collaborative Technologies and Systems (CTS), 2010 International Symposium on; 06/2010