The Electronic Patient Records System as Technology-in-Practice: The Impact of the Implementation of New Technology on the Routines and Structures in a Health Care Setting.

Adopting new technologies, such as electronic patient records (EPR) systems, is essential for improving inefficient practices and increasing productivity while reducing costs. However, studies show that many organizations fail to adopt technologies with demonstrable advantages. The relationship between technology and work transformation in complex organizations is poorly understood and further theoretical development is needed to advance our knowledge. This research draws on Orlikowski’s (2000) model of technology-in-practice, which suggests that the use of technology depends on how people interact with the technology and with each other over time and enact structures in social contexts. This study looks at how routines change when an EPR is implemented in a private hospital in Greece and how the technology is changed by the routines surrounding its use, aiming to explore the role of agents in implementing and using technologies in health organizations. It is conducted in two stages and is based on interpretive epistemology. Twenty-two semi-structured interviews and over twenty hours of onsite observation were conducted and analysed using a thematic approach. The findings show that the uptake of the EPR improved the performance of particular routines, the communication within the hospital, the productivity and service quality. However, in some departments different individuals introduced variations in the use of the technology and the surrounding routines. This study highlights the role of agents in implementing, using and changing a technology and refers to the technological, organizational and interpretive conditions influencing their actions. It helps researchers to understand that when a technology is integrated in complex networks, its use is less malleable than in contexts where individual actions are independent and users can shape it to fit their needs. It also emphasizes the need for designing technologies that fit the needs of end users, adequate training, strong leadership and clinician engagement in the change process