title: National electronic health records and the digital disruption of moral orders.
abstract: The digitalisation of patient health data to provide national electronic health record systems (NEHRS) is a major objective of many governments. Proponents claim that NEHRS will streamline care, reduce mistakes and cut costs. However, building these systems has proved highly problematic. Using recent developments in Australia as an example, we argue that a hitherto unexamined source of difficulty concerns the way NEHRS disrupt the moral orders governing the production, ownership, use of and responsibility for health records. Policies that pursue digitalisation as a self-evident 'solution' to problems in healthcare without due regard to these disruptions risk alienating key stakeholders. We propose a more emergent approach to the development and implementation of NEHRS that supports moral re-ordering around rights and responsibilities appropriate to the intentions of those involved in healthcare relationships.
authors.affiliation: School of Management and Marketing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia. Electronic address: karin@uow.edu.au.
authors.forename: Karin
authors.initials: K
authors.lastname: Garrety
authors.affiliation: Department of Management, Monash University, Caulfield Campus, Melbourne, Victoria 3145, Australia. Electronic address: Ian.McLoughlin@monash.edu.
authors.forename: Ian
authors.initials: I
authors.lastname: McLoughlin
authors.affiliation: Newcastle University Business School, Newcastle University, Newcastle upon Tyne NE1 4JH, UK. Electronic address: Rob.Wilson@ncl.ac.uk.
authors.forename: Rob
authors.initials: R
authors.lastname: Wilson
authors.affiliation: School of Management and Marketing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia. Electronic address: gz742@uowmail.edu.au.
authors.forename: Gregor
authors.initials: G
authors.lastname: Zelle
authors.affiliation: Newcastle University Business School, Newcastle University, Newcastle upon Tyne NE1 4JH, UK. Electronic address: mike@ryton-associates.co.uk.
authors.forename: Mike
authors.initials: M
authors.lastname: Martin
mesh_terms: D001315:Australia; D003695:Delivery of Health Care / Q000941:ethics / Q000458:organization & administration*; D057286:Electronic Health Records; D006291:Health Policy; D006801:Humans; D009014:Morals; D028701:Patient Rights / Q000941:ethics; D012941:Social Responsibility
keywords: Australia; Digital disruption; Moral order; National electronic health record systems; Personal control; Policy; Responsibilities; Rights