The electronic patient record in community health services--paradoxes and adjustments in clinical work

This case study explores the consequences of the introduction of an electronic patient record (EPR) system to support community health services in a Norwegian municipality. The EPR was envisaged as a key tool for developing integration between a nursing home and a home care organization to meet quality care goals and to increase the time available for patient care. This investigation takes a socio-technical approach, particularly drawing on "actor-network" theory and insights from "articulation work". The empirical data comes from structured interviews, participant observation and document review. The findings of the case study indicated reluctance by staff to use the EPR system. The management had eliminated traditional information and communication routines, such as oral handover and informal nursing notes, in a reorganization of duties associated with the EPR implementation. To prevent fragmentation of nursing work, and to maintain continuity of care, the nurses reintroduced these routines spontaneously and ad hoc. The reluctance to use the system and the reintroduction of abandoned routines can be understood by exploring the interaction between the EPR system's user interface, its ability to support nursing work, and the workflow in the new merged health service. So far, the introduction of the EPR has not led to the benefits expected from it.