Localization of health it: How users "repair" Electronic Medical Record systems

Implementation of Health Information Technologies (HIT) in hospitals encounters difficulties and leads to unintended consequences when there is poor fit between the practices, standards, and assumptions of clinical work and those embedded within HIT. This paper explores ways in which nurses and physicians sought to "repair" an Electronic Medical Record (EMR) system and improve its fit with their everyday practice. The paper is based on a case study of the introduction of an EMR in an academic hospital in Israel. The research was guided by Orlikowski's work on the social construction of technology. We show that repair work by clinical practitioners flowed from pragmatic efforts to incorporate HIT into their practices, rather than from arbitrary resistance to HIT. By negotiating changes in the EMR, the practitioners succeeded in overcoming gaps between the designers' assumptions and realities of clinical work. In this way the EMR became localized. This study supports Orlikowski's argument that the features of a technology are not built in but emerge though negotiations among its stakeholders. Moreover, the study supports previous research findings showing that localization is inherent to implementation of new technologies. Moreover, we argue that localization of HIT implementation may actually contribute to its capacity to improve clinical work. Recognition of gaps between assumptions built into HIT software and the realities of clinical practice may help managers and designers learn to work more effectively with practitioners to develop HIT systems that are flexible and well aligned with the needs and concerns of users.