TABLE 2.
Nine Meta-narratives That Have Driven Research on the EPR in Organizations
| Research Tradition | Disciplinary and Philosophical Roots | Definition and Scope | General Format of Research Question | EPR Conceptualized as | EPR User Conceptualized as | Context Conceptualized as | Key Empirical Studies or Systematic Reviews |
|---|---|---|---|---|---|---|---|
| 1 Health information systems | (Evidence-based) medicine, computer science. | Study of the storage, computation, and transmission of clinical data. Until recently, focus was on benefits of EPRs and how to achieve them. | What is the impact of technology X (e.g., EPR, CDSS, CPOE) on process Y (e.g., clinician performance) and outcome Z (e.g., patient health status)? | Container for information about the patient; tool for aggregating clinical data for secondary uses. | Rational decision maker whose cognitive ability limits what can be achieved without computers. | Potential confounder that can be “controlled for” if the right study design is used. | See review of 37 previous reviews (Car et al. 2008), plus one later publication (Shekelle and Goldzweig 2009). |
| 2 Change management (within health services research) | (Evidence-based) medicine, social psychology, management. | Study of how to achieve organizational-level change in health care. | How can we improve the delivery of health care and sustain that improvement? | Innovation that, if implemented widely and consistently, will improve process and outcome of care. | “Resistant” agent who must be trained and given incentives to adopt new technologies and ways of working. | External milieu of interacting variables that serve as barriers or facilitators to change efforts. | See note a. |
| 3 Information systems (positivist) | Business studies, psychology, computer science. | Study of how organizations adopt and assimilate (or why they fail to adopt and assimilate) information systems. | What factors (independent variables) account for the success or failure (dependent variable) of information system X in organization Y? | Unwelcome change that is likely to be resisted by individuals and interest groups and that may fit poorly with organizational structures and systems. | Potential adopter who may be actively engaged in the change or resist it; member of group whose power base may be enhanced or threatened. | External milieu of interacting variables that mediate or moderate the relationship between input and output variables. | Lapointe and Rivard 2005; Spil, Schuring, and Michel-Verkerke 2005; Wainwright and Waring 2007. |
| 4 Information systems (interpretivist) | Management, sociology, social psychology, anthropology. | Study of how organizational members make sense of information systems and thereby assimilate them. | What meanings does information system X hold for the members of organization Y? How can different views be accommodated? | Sociotechnical change that holds different meanings for different individuals and groups. | Stakeholder whose “framing” of the EPR is crucial to its effective assimilation. Agent whose creativity and energy can be drawn on in this effort. | Scene and setting for an unfolding story; webs of meaning in which organizational actors are suspended. | See note b. |
| 5 Information systems (technology-in-practice) | Organizational sociology, social psychology, philosophy. | Study of how social structures recursively shape and are shaped by human agency, and the role of technology in this process, with a focus on the meso-level of organizational life. | What is the relationship among organizational actors, technology X, and the organization, and how does this change over time? | Itinerary and organizer whose physical and technical properties structure and support collaborative clinical work. | Knowledgeable, creative agent for whom social structures both create possibilities and limit the possible. | Generated and regenerated through the interplay of action and structure. Researchers do not study “technologies” and “contexts” separately but study technologies-in-use. | See note c. |
| 6 Computer-supported cooperative work | Computer science, software engineering, psychology, sociology. | Study of how groups of people work collaboratively, supported by information technology. | How can technologies support the work of multiple interacting people? | Contextualized artifact. | Agent who seeks to achieve local goals in collaboration with others and creatively overcomes limitations of formal tools. | Either external milieu or an emergent property of action (constituted by, and inextricable from, an activity involving people and technologies). | See note d. |
| 7 Critical sociology | Sociology, philosophy. | Study of the relationship between people and the social order and how this changes over time, and the role of technologies in this process. | What social structures and inherent power imbalances are embedded in technology X, and what impact does this have on social roles and relationships? | Implicated in micro- and macropower dynamics, both within the organization and more widely (because of the link between knowledge and power). | Constrained by dominant social structures or discourses; imagined user, stereotypes of which may be built into technologies by designers. | Social and material conditions into which the (inherently unequal) social order is inscribed; a more or less stable structure of macrosocial relations. | Bloomfield 1995; Bloomfield and McLean 1995; Darbyshire 2004; Doolin 2004; Goorman and Berg 2000; Harris 1990; Henwood and Hart 2003; Sharman 2007; Timmons 2003a, 2003b; Wagner 1993. |
| 8 Empirical philosophy (actor-network case studies) | Philosophy, sociology, linguistics. | Study of sociotechnical networks and what emerges from these. Considers how relationships and power shift within the network. | How has the network, with its various relationships, work practices, and risks, changed as a result of introducing technology X? | Actor in a network. | Actor in a network. | The EPR and its context together form the network; the one cannot be studied without the other (since the EPR becomes “the EPR” only as part of the network). | See note e. |
| 9 Systems approaches to risk management and integration | Systems and management research, drawing on cognitive psychology, CSCW, and ANT. | The study, from a systems perspective, of how to promote safety and reduce risk in health care. | What role in both protecting against and producing error does the EPR play in a complex health care system? | Component of complex sociotechnical system whose structural features and operational properties, even when designed to protect against error, may come together in unpredictable ways to produce error. | Component of complex sociotechnical system whose structural features and operational properties, even when designed to protect against error, may come together in unpredictable ways to produce error. | Complex, changing environment that poses potential risks to patient safety. | See note f. |
Notes:aBadger, Bosch, and Toteja 2005; Boddy et al. 2009; Doolan, Bates, and James 2003; Granlein and Simonsen 2007; Greenhalgh et al. 2008; Hendy et al. 2005, 2007; Jones 2003; Littlejohns, Wyatt, and Garvican 2003; Miller and Sim 2004; Nemeth et al. 2008; Ovretveit et al. 2007a, 2007b; Pagliari 2005; Pagliari et al. 2005; Pagliari, Gilmour, and Sullivan 2004; Sanchez, Savin, and Vasileva 2005; Scott et al. 2005; Southon, Sauer, and Dampney 1997.
bBrown and Jones 1998; Checkland and Holwell 1998; Chiasson and Dexter 2001; Currie and Brown 1997; Currie and Guah 2007; Davidson and Heslinga 2007; Davidson and Reardon 2005; Desjardins, Lapointe, and Pozzebon 2006; Eason 2007, 2009; Jensen and Aanestad 2007; Prasad 1993.
cDavidson 2000; Davidson and Chiasson 2005; Mogard, Bunch, and Moen 2006; Østerlund 2002, 2003, 2004a, 2004b, 2006; Rodriguez and Pozzebon 2006; Sicotte, Denis, and Lehoux 1998; Sicotte et al.1998.
dBardram and Bossen 2005; Clarke et al. 2001, 2003; Engestrom, Engestrom, and Saarelma 1988; Greatbatch et al. 1995; Hartswood and Procter 2000; Hartswood et al. 2002; Hartswood, Procter, Rouncefield, and Slack 2003; Hartswood, Procter, Rouncefield, Slack, and Voss 2003; Heath, Knoblauch, and Luff 2000; Heath and Luff 1996, 2000; Heath, Luff, and Svensson 2003; Kuhn 1962; Luff, Heath, and Greatbatch 1992; Reddy, Dourish, and Pratt 2001; Schneider and Wagner 1993; Symon, Long, and Ellis 1996; Tellioglu and Wagner 2001.
eAarts and Berg 2004; Aarts, Doorewaard, and Berg 2004; Aderibigbe, Brooks, and McGrath 2007; Berg 1997, 1998, 1999; Berg et al. 1998; Berg and Bowker 1997; Bruni 2005; Constantinides and Barrett 2006; Iedema 2003; Moser and Law 2006; Pirnejad et al. 2007; Pouloudi et al. 2004; Stoop, Bal, and Berg 2006; Winthereik 2003; Winthereik and Langstrup 2009; Winthereik, van der Ploeg, and Berg 2007.
fAarts, Ash, and Berg 2007; Ash et al. 2006; Ash, Sittig, Campbell, et al. 2007; Ash, Sittig, Dykstra, Campbell, et al. 2007; Ash, Sittig, Dykstra, Guappone, et al. 2007; Ash, Sittig, Poon, et al. 2007; Ash et al. 2009; Braa et al. 2006; Braa, Monteiro, and Sahay 2004; Campbell et al. 2006, 2007; Ellingsen 2003; Ellingsen and Monteiro 2003b, 2003c, 2006; Ellingsen and Munkvold 2007; Ellingsen and Obstfelder 2007; Han et al. 2005; Hanseth et al. 2006; Hanseth and Monteiro 1997, 1998; Hasan and Padman 2006; Jaeger and Monteiro 2005; Koppel et al. 2006; Obstfelder and Moen 2006; Tamuz and Harrison 2006.