Seite - 94 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

from dichotomizing towards stakeholder sense making activities, to negotiation and aligning differing actor perspectives/behaviors. A range of perspectives reflected different views surrounding “success” and “failure” resulting from different positions within the network at different points in time. For instance, the new software resulted in increased workloads for nurses, who may have viewed the implementation as a “failure” at least in the short- to medium-term. Policy makers, in turn, focused on the progress of developing the infrastructural components underlying the EHR technology. They therefore viewed this aspect of the national implementation as a “success”. The introduction of the new EHR also affected stakeholders in many different ways and revealing these simplifications was a key analytical task. The level of influence depended on their role (healthcare professionals, managers, policy makers, information system suppliers, patients), their local setting (existing relationships, physical environments), and the technology adoption time (short-, medium-, long-term). Common to all contexts and individuals, however, was that the technology adopted was an immature solution that lacked usability and had mostly negative effects. It for instance, increased workloads of users and negatively affected reputations of managers and suppliers. Over time, as the solution matured, some networks began to stabilize with the record gradually fulfilling its purpose of coordinating care effectively and stakeholders acclimatizing to these changes. However, these changes were only visible on a very small scale and in settings that had invested a significant amount of time and resources. The new information system was procured nationally, so policy makers and system vendors were initially in a relative position of power. Over time, clinical users became more powerful, as they refused to use a technology that was viewed to lack usability. This changed power dynamic led to changes in the national procurement model. It is not to say that other sociotechnical dimensions (including other social, political and organizational factors) are not important in determining “success”, but this work has illustrated that the most important pre-requisite for “success” from all perspectives is a usable technology. When mapping out the larger network and tracing the technology, we ensured that all human actors were either directly or indirectly (i.e. through another actor) related to the EHR. ANT-informed analysis indicated that there were two different networks that were not effectively connected through strong associations (e.g. aligned interests) beyond the technology itself (see Figure 1). These were the users of the technology (i.e. healthcare professionals and organizations) and the national implementers (i.e. policy makers and information system suppliers). Both groups had different views of and intentions for the technology: Policy makers wanted to make or save money/lives on a large scale through improving organizational processes. Users wanted to improve immediate patient care in their own micro-environments. There was thus a tension between the micro and the macro networks in the following ways: 1. Policy makers and suppliers foregrounded the vision of the technology as an integrated national EHR, whilst users had to cope with its manifestations and its lack of usability in everyday life. 2. New technology was designed to structure care to make it more effective (including the imposing of rules, categories and regulations). This was at odds with the nature of clinical reality as these rules inhibited the timely provision of care and also increased individual workloads. K.Cresswell /UsingActor-NetworkTheory toStudyHealth InformationTechnology Interventions94