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Electronic prescription (EP) systems are supported by health authorities worldwide, and most European countries have started implementing or have fully implemented such systems. However, few studies have explored how EP systems affect the work of health care professionals (HCPs) across institutions and levels in health and care services. This study aims to explore changes in HCPs' roles, tasks, and responsibilities related to medication management by following a national EP system through different contexts and levels in health and care services. Through a qualitative study with an ethnographic approach, including participant observations and individual interviews, this study followed an EP technology in an intermediate unit, an emergency unit at a hospital, and a municipal home care service in Norway. Participant observations were conducted for 6 weeks in the intermediate unit, the emergency unit at the hospital, and the home care service. During the observations, 20 individual interviews with HCPs were conducted. For the analysis, we leaned on a stepwise-deductive inductive approach, using the concepts of delegation and enabler as theoretical tools to explore how roles, tasks, and responsibilities were being distributed within the sociotechnical system of which EP formed part. The results showed that physicians were overall satisfied with the Norwegian EP system and expressed satisfaction that some of their previous tasks were now delegated to the EP system, allowing a more efficient workflow on their side. In contrast, the home care service managing medication on their patients' behalf described several challenges and reported an increased workload related to medication management. Home care nurses often became mediators between the general practitioners and the pharmacies to ensure patient safety. The home care nurses also developed EP-based work-arounds to enable the Norwegian EP system to work. This study revealed that Norwegian the EP systems altered daily medication management routines, removing tasks from physicians and creating and delegating new roles, tasks, and responsibilities to home care nurses. Drawing on theoretical concepts (delegation and enabler), this study offers insights into the changing distribution of roles, tasks, and responsibilities following in the wake of implementing national EP systems.

BackgroundIn Norway, as in other countries, national eHealth systems, such as the Summary Care Record (SCR), have been implemented to improve the collaboration around patients by sharing patient information between health professionals across healthcare institutions and administrative levels. Although widely implemented across the health and care services in Norway, evaluations of the SCR indicate less use than expected. There is a need for analysis that lays out the visions and expectations of the SCR and contrasts these with detailed observations of use in everyday health professional work. This study adds to the eHealth research field by exploring this reality.MethodThis paper has a qualitative design with an ethnographic approach, including participant observation, qualitative interviews, and a document review. Qualitative individual interviews with 22 health professionals and six weeks of participant observation were conducted, and eight documents were reviewed. The field notes and the interview-transcriptions were analyzed following a stepwise-deductive induction analysis.ResultsThe document review identified the expectations and visions of the SCR, including an underlying assumption of trust in shared patient information. However, this assumption is implicit and not recognized as a crucial element for success in the documents. In our observation and interview data, we found that health professionals do not necessarily trust information in the SCR. In fact, several procedures and routines to assess the trustworthiness of SCR information were identified that complicate and disturb the expected use. In our analysis, two main themes characterize the health professionals' handling of the SCR: adapting to workflow and dealing with uncertainty.ConclusionOur study illustrates that unconditional trust in shared patient information is an implicit assumption in SCR policy documents, but in their everyday work health professionals do not necessarily unconditionally trust shared patient information. Rather, sharing patient information through technology, such as the SCR, requires of health professionals to critically assess the digital information. The information in the SCR, as all sources of information presented to health professionals, becomes an item for their constant trust-work. Our study is of value to policymakers, health information systems developers, and the field of practice both nationally and internationally.