Abstract
Reengineering of the workplace through Information Technology is an important strategic issue for today's hospitals. The computer-based patient record (CPR) is one technology that has the potential to profoundly modify the work routines of the care unit. This study investigates a CPR project aimed at allowing physicians and nurses to work in a completely electronic environment. The focus of our analysis was the patient nursing care process. The rationale behind the introduction of this technology was based on its alleged capability to both enhance quality of care and control costs. This is done by better managing the flow of information within the organization and by introducing mechanisms such as the timeless and spaceless organization of the work place, de-localization, and automation of work processes. The present case study analyzed the implementation of a large CPR project ($45 million U.S.) conducted in four hospitals in joint venture with two computer firms. The computerized system had to be withdrawn because of boycotts from both the medical and nursing personnel. User-resistance was not the problem. Despite its failure, this project was a good opportunity to understand better the intricate complexity of introducing technology in professional work where the usefulness of information is short lived and where it is difficult to predetermine the relevancy of information. Profound misconceptions in achieving a tighter fit (synchronization) between care processes and information processes were the main problems.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Davenport, T.H. Process Innovation. Reengineering Work Through Information Technology, Harvard Business School Press, Boston, 1993.
IOM, The Computer-Based Patient Record, Institute of Medicine, National Academy Press, Washington, 1991.
Ball, M.J., and Collen, M.F. Aspects of the Computer-Based Patient Record, Springer-Verlag, New York, 1992.
Kaplan, B., Development and acceptance of medical information systems: An historical overview. J. Health Hum. Res. Admin. Summer:9–29, 1988.
Drazen, E.L., Metzger, J.B., Ritter, J.L., and Schneider, M.K. Patient Care Information Systems, Springer-Verlag, New York, 1995.
Yin, R.K., Case Study Research (revised edition), Sage Publications, Beverly Hills, 1989.
Einsenhardt, K.M., Building theories from case-study research. Acad. Manag. Rev. 14:532–550, 1989.
Bourke, M.D., Strategy and Architecture of Health Care Information Systems, Springer-Verlag, New York, 1994.
Preuss, G.A., Labor, skills, and information in service delivery: An examination of hospital care. Acad. Manag. Proc. 97:282–286, 1997.
Barley, S.R. Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments. Admin. Sci. Quart. 31:78–108, 1986.
DeSanctis, G., and Scott Poole, M., Capturing the complexity in advanced technology use: Adaptative Structuration Theory. Organ. Sci. 5(2):121–147, 1994.
Ettlie, J.D., and Reza. M., Organizational integration and process innovation. Acad. Manag. J. 35(4):795–827, 1992.
Orlikowski, W.J., The duality of technology: rethinking the concept of technology in organizations. Organ. Sci. 3(3):398–427, 1992.
Zuboff, S., In the Age of the Smart Machine, Basic Books, New York, 1988.
Rights and permissions
About this article
Cite this article
Sicotte, C., Denis, J.L. & Lehoux, P. The Computer Based Patient Record: A Strategic Issue in Process Innovation. Journal of Medical Systems 22, 431–443 (1998). https://doi.org/10.1023/A:1020674527409
Issue Date:
DOI: https://doi.org/10.1023/A:1020674527409