Electronic patient records and nurses' work: rhetoric and reality

Abstract

The UK National Health Service (NHS) has been at the centre of a long-term effort by successive governments to modernise public services and create information-led, cost efficient institutions via the introduction of information and communication technologies (ICTs). One such initiative is Electronic Patient Records (EPR), which forms a major arm of the British government’s National Programme for Information Technology (NPfIT) aiming to connect doctors, nurses and health care professionals countrywide. The core ideology of NPfIT is based on the view that ICTs are means of providing better information to clinicians which in turn will enable them to provide better healthcare to patients. Connecting for Health, the coordinating agency for NPfIT, suggests that the programme will not only drive modernisation of the NHS but also support the NHS infrastructure by promoting knowledge management and technologyassisted decision making by clinicians, as well as providing training and development for all NHS staff.

Our research investigated the extent to which the premised potential has been realised. To that end, it examined the ways in which nurses enacted an EPR system in a London teaching hospital and the benefits they perceived in the three years since full rollout of the system. Our findings show that while nurses commented positively about the potential of EPR, and claimed to use it in support of their daily work practices, the reality was rather different. Furthermore, hospital managers tacitly challenged the deterministic logic of NPfIT since they made little effort to ensure that nurses used EPR for anything other than the most basic functions. We provide some explanations of these mismatches between rhetoric and reality using concepts from the social study of information technology, which examine ICTs and organizations in terms of individual actors’ behaviour embedded in social context, that is, enabled or constrained by institutionalised modes of practice.