EMR Design as Socio-Technical Mosaic


I conducted research in a large suburban emergency department for a paper for my “Social Analysis of Computing” class in Fall 2010. The following paper, “EMR Design as Socio-Technical Mosaic: A Multi-Lens Approach to Emergency Department System Design” is a result of that work. The full paper is embedded below.


Socio-technical studies of Health Information Technology (HIT) and Electronic Medical Record (EMR) systems have received a growing amount of attention in recent years. The International Journal of Medical Informatics notes that papers focusing on socio-technical approaches to HIT  doubled between 2004-2006 and 2007-2009. [1] Despite the expanding interest, those who actually develop information systems for the healthcare sector have done little to incorporate the crucial insights that derive from this type of work. With government reimbursement plans meant to encourage implementation of EMR systems nationwide by 2014, hospitals are racing to make the transition. Unfortunately, most of these systems focus more on the technical aspects, such as synchronization, interoperability integration, and productivity, and less on the social, organizational, and human aspects of the work done through systems.

The purpose of this paper is to draw focus to how HIT systems design, and particularly systems for the emergency department (ED) can benefit from socio-technical thinking. This paper presents research conducted in the ED of a large urban hospital that is currently in the process of implementing a new $100 million system. I chose a variety of frameworks through which to analyze the system and ED work to see what each can elucidate and how insights derived from each can be translated into recommendations for system design or organizational structuring. The lenses I used include action theory, distributed cognition, situated action, structuration theory, boundary objects, articulation work, genre repertoire, remediation and multitasking. 

Through the research, I found that almost every theory or perspective gave new insight. The challenge was to also see how these insights could potentially fit into the development of real systems. This paper is meant to merely be a survey of what a variety of socio-technical perspectives can add to our understanding of the work done in ED’s. These theories span a broad landscape of socio-technical approaches, and, combined together form a mosaic to view the various and overlapping ways a system can account for social and organizational practices. It was out of the scope of this paper to go into depth with any one framework, but this exploration reveals a brief overview of what each can add to EMR design in practice, not just in theory.