Fitness for purpose when there are many different purposes: who are electronic patient records for?

Electronic patient record systems serve many purposes for many different kinds of users. Four case studies are reported of the use made by health-care staff of electronic patient record systems that supported health-care pathways. The results demonstrate that the systems fit the purposes of strategic and managerial users of the record, but they are problematic as tools for use by the frontline staff delivering care. As a result, these staff frequently resort to workarounds to accomplish their work goals. An analysis of the design processes that created these systems shows that the specification of the systems was based on strategic and managerial requirements and there was no formal assessment of the needs of frontline users. Efforts to address the needs of frontline staff in the provisions of electronic systems were most often made after the main system was implemented.