A journey into the hidden lives of electronic medical records (EMRS): action research in the making

Drawing upon a three and a half year long research project, this dissertation examines the adaptation process of an electronic medical record (EMR) in a primary healthcare setting, with emphasis on methodological reflections on doing action research with a community partner. This dissertation thus comprises two components: the first focuses on the implementations of EMRs, and the second focuses on action research as a method used for studying the EMRs, thus giving a glimpse of the research process. Drawing upon concepts from the fields of Computer-Supported Cooperative Work (CSCW) and Information Systems (IS), I analyze how health care practitioners adapt technology to their situated work practices. Investigating the factors promoting the adaptation process showed that reflective activities were essential for constructing emergent work practices. I therefore provide a conceptualization of the essential aspects of these reflective activities. I analyze how the technology transforms the medical practice, and identify two types of sociotechnical changes and their implications. Introducing insights from Actor-Network Theory (ANT), I argue that the EMR is more than just a tool that simply enables/constrains the medical practice. Rather, it is an active actor that has come to play an increasingly central role in the delivery and organization of care, and it is gradually transforming the medical profession. Following a self-reflective and critical epistemological stance, I shed light on methodological complexities faced when conducting action research. I investigate the norms that are enacted within IS action research, and I argue that these are built upon a rigid and standardized platform, similar to the one that traditional action research was originally opposed to. I also argue that these norms fail to critically address ways of discussing and managing empirical uncertainties and dilemmas. Drawing upon reflexive research methodologies, first-person action research and confessionals, I illustrate how empirical uncertainties can be transformed into fruitful practical interventions and utilized as knowledge providers. Finally, I propose conceptualizing action research as an actor-network with different sociomaterial connections which configure and produce particular roles in diverse settings. A network model enables us to see how future roles and interventions can be interpreted through past connections.