title: Square pegs in round holes: information systems, hospitals and the significance of contextual awareness.
abstract: The considerable emphasis in the development and implementation of clinical information systems in hospitals internationally seems to have had a limited effect. In particular, the implementation of electronic patient record (EPR) systems has been slower and more difficult than anticipated and with little change in efficiency and security. This paper suggests why this might be the case. Well established research findings within the field of computer supported cooperative work (CSCW--an interdisciplinary research field between informatics and the social sciences) are cited to construct a case for greater awareness of (1) inter- and intra-professional interests, and (2) broader social and health policy contexts. We draw on Gouldner's work [(1957). Cosmopolitans and locals: toward an analysis of latent social roles--I. Administrative Science Quarterly, 2(3), 281-306; (1958). Cosmopolitans and locals: toward an analysis of latent social roles--II. Administrative Science Quarterly, 2 (4), 444-480] on organisational roles to develop a discussion of professional awareness; a pivotal notion is also the interactionist one of the hospital as a 'negotiated order'. Drawing for illustrative purposes on the Norwegian experience (that is, reviewing research on hospital information systems in Norway), we contend that enhanced awareness of the hospital itself as a social system may be a precondition of cost-effective hospital information and communication technologies.
authors.affiliation: Department of Sociology and Political Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway. aksel@tjora.net
authors.forename: Aksel Hagen
authors.initials: AH
authors.lastname: Tjora
authors.forename: Graham
authors.initials: G
authors.lastname: Scambler
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D001364:Awareness; D016494:Computer Security; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D006751:Hospital Information Systems / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008490:Medical Informatics; D016347:Medical Records Systems, Computerized / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D008962:Models, Theoretical; D009664:Norway; D019982:Organizational Case Studies; D015279:Organizational Culture; D012942:Social Sciences; D012962:Sociology, Medical; D018511:Systems Integration