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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 £12.7 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