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The context for this analysis was the national procurement of EHRs in English
hospitals by the government in 2002. Three commercial information system suppliers
were tasked with delivering these, driven by a vision to deliver a record that connected
disparate sources of information across care settings on a national scale. In 2011, the
ÂŁ12.7 billion NPfIT initiative was abandoned.
A pragmatic ANT-informed approach was used to explore how EHRs transformed
care, healthcare staff relationships, and wider macro-networks (including policy makers
and supplier relationships). Despite its limitations outlined above, the notion of the active
role of objects in shaping human relationships was a helpful lens to examine human
dynamics and technological changes over time. EHRs, other technology, and paper
records were viewed as non-human actors, whilst attempts were made to black-box the
hospital EHR and analyze its translations over time (see Figure 1).
ANT was used as a conceptual tool for focusing data collection efforts. This was
done through sampling those human actors that were connected to the EHR and tracing
their relationships (see Figure 1). These network connections were either direct by
interacting with or building the technology, or indirect by influencing its strategic
direction. Over time, it became clear that the network was not confined to the hospital
environment but included for instance policy makers that had procured national
technological systems, the media, and information system developers. These could be
viewed as intermediaries, as they had an indirect influence on how the technology was
used by healthcare professionals.
ANT also helped to conceptualize how care was organized around the record and
how the re-organization of the record (by making it electronic) in turn re-organized care
and healthcare professional roles (translation). Due to the electronic nature of the EHR,
this change was often done at a distance thereby connecting spatially disconnected areas
of care. Ultimately, the vision was to do this nationally. Such relational connections and
mechanisms are usually poorly described and mapping network components helped to
reveal these. Investigating these processes, however, can have practical implications and
helped to identify facilitators for adoption and implementation that may otherwise not
have been considered. The most helpful aspect here was that ANT facilitated viewing
the EHR as an active part of the social world. As in Berg’s examples outlined above, we
examined how the technology influenced the social relationships of healthcare staff using
it, information system developers, patients, policy makers and evaluators (see Figure 1).
We also explored how the introduction of technology resulted in the formation of new
networks and how these transformed over time (translation). Here, ANT helped to
conceptualize how individual and organizational practices were centered around the
record, and how its role of directing organizational activity changed when it became
electronic.
3. Explaining the “failure” of the nationally procured EHR drawing on ANT
ANT is not a theory in the traditional sense. It describes rather than explains and its
explanatory power is limited. Nevertheless, it provided a unique and in-depth insight into
the processes and the active role of the EHR in coordinating care and work practices of
healthcare staff and hospitals. Thus, it helped to draw a sophisticated picture surrounding
the implementation and adoption of nationally procured EHRs that went beyond the
simple dichotomy of “success” and “failure”. This is because new network formations
can be described without making value judgements. Accordingly, analytical focus shifted
K.Cresswell /UsingActor-NetworkTheory toStudyHealth InformationTechnology Interventions 93
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book Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Title
- Applied Interdisciplinary Theory in Health Informatics
- Subtitle
- Knowledge Base for Practitioners
- Authors
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Publisher
- IOS Press BV
- Location
- Amsterdam
- Date
- 2019
- Language
- English
- License
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Size
- 16.0 x 24.0 cm
- Pages
- 242
- Category
- Informatik