title: Using a sociotechnical framework to understand adaptations in health IT implementation.
abstract: OBJECTIVE
  When barcode medication administration (BCMA) is implemented nurses are required to integrate not only a new set of procedures or artifacts into everyday work, but also an orientation to medication safety itself that is sometimes at odds with their own. This paper describes how the nurses' orientation (the Practice Frame) can collide with the orientation that is represented by the technology and its implementation (the System Frame), resulting in adaptations at the individual and organization levels.
  
  
  METHODS
  The paper draws on two qualitative research studies that examined the implementation of BCMA in inpatient settings using observation and ethnographic fieldwork, content analysis of email communications, and interviews with healthcare professionals.
  
  
  RESULTS
  Two frames of reference are described: the System Frame and the Practice Frame. We found collisions of these frames that prompted adaptations at the individual and organization levels. The System Frame was less integrated and flexible than the Practice Frame, less able to account for all of the dimensions of everyday patient care to which medication administration is tied.
  
  
  CONCLUSIONS
  Collisions in frames during implementation of new technology result in adaptations at the individual and organization level that can have a variety of effects. We found adaptations to be a means of evolving both the work routines and the technology. Understanding the frames of clinical workers when new technology is being designed and implemented can inform changes to technology or organizational structure and policy that can preclude unproductive or unsafe adaptations.
authors.affiliation: Department of Biomedical Informatics, Implementation Sciences Laboratory, Center for Research and Innovation in Systems Safety, Vanderbilt University School of Medicine, United States. Electronic address: laurie.l.novak@vanderbilt.edu.
authors.forename: Laurie Lovett
authors.initials: LL
authors.lastname: Novak
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
authors.forename: Shilo H
authors.initials: SH
authors.lastname: Anders
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Hong
authors.forename: Ben-Tzion
authors.initials: BT
authors.lastname: Karsh
mesh_terms: D000223:Adaptation, Psychological; D057286:Electronic Health Records; D006284:Health Plan Implementation / Q000458:organization & administration*; D006751:Hospital Information Systems / Q000458:organization & administration*; D006801:Humans; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital; D009936:Organizational Innovation; D012984:Software; D013647:Task Performance and Analysis
keywords: Adaptations; Barcode medication administration; Orienting frames; Unintended consequences; Workarounds
references.citation: Int J Med Inform. 2011 Jul;80(7):466-79
references.pmid: 21530383
references.citation: Am J Health Syst Pharm. 2005 Dec 15;62(24):2619-25
references.pmid: 16333060
references.citation: Int J Med Inform. 2009 Sep;78(9):618-28
references.pmid: 19464231
references.citation: Cogn Technol Work. 2013 Aug 1;15(3):283-296
references.pmid: 24443642
references.citation: J Am Med Inform Assoc. 2010 Nov-Dec;17(6):617-23
references.pmid: 20962121
references.citation: Int J Med Inform. 1998 Oct-Dec;52(1-3):243-51
references.pmid: 9848421
references.citation: J Am Med Inform Assoc. 1996 Nov-Dec;3(6):399-409
references.pmid: 8930856
references.citation: J Healthc Inf Manag. 2002 Winter;16(1):46-51
references.pmid: 11813523
references.citation: Int J Med Inform. 2007 Jun;76 Suppl 1:S1-3
references.pmid: 17466251
references.citation: J Am Med Inform Assoc. 2007 Sep-Oct;14(5):542-9
references.pmid: 17600093
references.citation: Int J Med Inform. 2001 Dec;64(2-3):143-56
references.pmid: 11734382
references.citation: Int J Med Inform. 2001 Nov;64(1):39-56
references.pmid: 11673101
references.citation: Methods Inf Med. 2006;45(1):53-61
references.pmid: 16482371
references.citation: Pediatrics. 2003 Sep;112(3 Pt 1):506-9
references.pmid: 12949274
references.citation: Int J Med Inform. 2010 Feb;79(2):71-80
references.pmid: 20071219
references.citation: J Am Med Inform Assoc. 2004 May-Jun;11(3):207-16
references.pmid: 14764612
references.citation: J Am Med Inform Assoc. 2012 Nov-Dec;19(6):1043-9
references.pmid: 22634157
references.citation: J Am Med Inform Assoc. 2006 Sep-Oct;13(5):547-56
references.pmid: 16799128
references.citation: Int J Med Inform. 2007 Jun;76 Suppl 1:S129-35
references.pmid: 16875873
references.citation: Health Care Manage Rev. 2010 Apr-Jun;35(2):124-33
references.pmid: 20234219
references.citation: Pediatrics. 2004 Jan;113(1 Pt 1):59-63
references.pmid: 14702449
references.citation: J Am Med Inform Assoc. 2008 Jul-Aug;15(4):408-23
references.pmid: 18436903
references.citation: J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21
references.pmid: 10428004
references.citation: J Am Med Inform Assoc. 2012 May-Jun;19(3):392-400
references.pmid: 22003156
references.citation: Int J Med Inform. 2011 Jul;80(7):490-506
references.pmid: 21555237
references.citation: Methods Inf Med. 2003;42(4):297-301
references.pmid: 14534625
references.citation: J Am Med Inform Assoc. 2002 Sep-Oct;9(5):529-39
references.pmid: 12223505
references.citation: Nurse Educ Today. 2004 Aug;24(6):420-7
references.pmid: 15312950
references.citation: J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12
references.pmid: 14633936
references.citation: Int J Med Inform. 2003 Mar;69(2-3):235-50
references.pmid: 12810127
references.citation: Int J Med Inform. 1999 Aug;55(2):87-101
references.pmid: 10530825
references.citation: Int J Med Inform. 2007 Jun;76 Suppl 1:S136-40
references.pmid: 16798067
references.citation: Cogn Technol Work. 2011 Mar;13(1):11-29
references.pmid: 21479125
references.citation: J Am Med Inform Assoc. 2002 Sep-Oct;9(5):540-53
references.pmid: 12223506
references.citation: J Am Med Inform Assoc. 2010 Jan-Feb;17(1):78-84
references.pmid: 20064806
references.citation: Int J Med Inform. 2007 Jun;76 Suppl 1:S4-13
references.pmid: 16798068
references.citation: Pediatrics. 2005 Dec;116(6):1506-12
references.pmid: 16322178
references.citation: Ann Intern Med. 2003 Jul 1;139(1):31-9
references.pmid: 12834316
references.citation: Eur J Inf Syst. 2012 Sep 1;21(5):
references.pmid: 24357898
references.citation: Int J Med Inform. 2005 Aug;74(7-8):623-8
references.pmid: 15964780
references.citation: Int J Med Inform. 1998 Oct-Dec;52(1-3):235-42
references.pmid: 9848420
references.citation: Nurs Inq. 2000 Mar;7(1):3-9
references.pmid: 11022530
references.citation: Int J Med Inform. 2007 Jun;76 Suppl 1:S21-7
references.pmid: 16793330
references.citation: Arch Intern Med. 2003 Jun 23;163(12):1409-16
references.pmid: 12824090
references.citation: Int J Med Inform. 2011 Dec;80(12):863-71
references.pmid: 22019280
references.citation: Int J Ind Ergon. 2011 Jul 1;41(4):370-379
references.pmid: 21686318
references.citation: Hum Factors. 2006 Spring;48(1):15-22
references.pmid: 16696253