Journal Article

Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method

GREENHALGH, TRISHA, POTTS, HENRY W.W., WONG, GEOFF, BARK, PIPPA, SWINGLEHURST, DEBORAH

2009

Overview

Context: The extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Methods: Using the meta-narrative method and searching beyond the Medline-indexed literature, this review used \"conflicting\" findings to address higher-order questions about how researchers had differently conceptualized and studied the EPR and its implementation. Findings: Twenty-four previous systematic reviews and ninety-four further primary studies were considered. Key tensions in the literature centered on (1) the EPR (\"container\" or \"itinerary\"); (2) the EPR user (\"information-processer\" or \"member of socio-technical network\"); (3) organizational context (\"the setting within which the EPR is implemented\" or \"the EPR-in-use\"); (4) clinical work (\"decision making\" or \"situated practice\"); (5) the process of change (\"the logic of determinism\" or \"the logic of opposition\"); (6) implementation success (\"objectively defined\" or \"socially negotiated\"); and (7) complexity and scale (\"the bigger the better\" or \"small is beautiful\"). Conclusions: The findings suggest that EPR use will always require human input to recontextualize knowledge; that even though secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper may offer a unique degree of ecological flexibility; and that smaller EPR systems may sometimes be more efficient and effective than larger ones. We suggest an agenda for further research.

• Publisher: Blackwell Publishing Inc,Wiley Subscription Services, Inc,Blackwell Publishing Ltd
• Subject: Access to Information / Antipositivism / Biomedical technology / Charges / Computerized medical records / Decision making / Determinism / Diffusion of Innovation / Electronic health records / electronic patient records / England / Flexibility / Health care / Health services / Health Services Research / Hospital Information Systems - organization & administration / Humans / Information storage and retrieval systems / Information technology / innovation / Knowledge / Literature reviews / Medical decision making / Medical informatics / Medical practice / Medical records / Medical Records Systems, Computerized - organization & administration / Medical sociology / MEDLINE / Meta-analysis / Metanarratives / Narratives / Organization / Original / Paradoxes / Patients / Positivism / Research methodology / Research methods / Risk Factors / Social structures / Systematic review / Technology / Traditions