e-Journal of Health Informatics

In this paper the use of an electronic medical record (EMR) system in a general practice setting is analyzed. The concept of infrastructure helps shed light on its supposed role of invisibly supporting the work practices of medical and administrative personnel. An ethnographic case study at a Canadian Community Health Center has been conducted following an action research approach. The researcher assumed the role of IT support in a situation where the EMR system was displaying technical problems after an update of the software. Her role developed from troubleshooting IT issues to EMR training and IT education, and finally she was also increasingly involved in EMR optimization. Our research provides in depth insights into the researcher’s role as a mediator between the medical work and the technical tool within the larger context of system design, which, we suggest, has implications for design of programs to support the introduction of EMRs. Although these trained in health and medical informatics are aware of this need, research findings presented here suggest that this is often overlooked in funding programs and project implementation.

Medical Records Systems, Computerized; Community Health Centers; Action Research; Workplace Ethnography; Infrastructure; IT Support