Patient care information systems and health care work: a sociotechnical approach
Those who face the difficulties of developing useful patient care information systems (PCISs) often stress the importance of organizational issues. Building upon recent sociological insights in the construction and use of information technologies for (health care) work, this paper underscores the importance of these insights for the development and evaluation of these systems. A sociotechnical approach to PCISs in health care is outlined, and two implications of this empirically grounded approach for the practices of developing and evaluating IT applications in health care practices are discussed. First, getting such technologies to work in concrete health care practices appears to be a politically textured process of organizational change, in which users have to be put at center-stage. This requires an iterative approach, in which the distinctions between analysis, design, implementation and evaluation blur. Second, a sociotechnical approach sheds new light on the potential roles of IT applications in health care practices. It is critical of approaches that denounce the messy and ad hoc nature of health care work, and that attempt to structure this work through the formal, standardized and rational nature of IT systems. Optimal utilization of IT applications, it is argued, is dependent on the meticulous interrelation of the systems functioning with the skilled and pragmatically oriented work of health care professionals.
patient care information systems health care work sociotechnical approach evaluation electronic patient record medical decision-making system development system implementation