Electronic Medical Record as a Trigger of Sociotechnical Controversies

• In Event: Rethinking Health Professions in the 21st Century: Innovations, Interruptions, and Regenerations

Abstract

This paper reflects on the digital quantification of medical practice through a case of study, namely, the process of implementation of an Electronic Medical Record (EMR) at the Public Pediatric Hospital Dr. Exequiel Gonzalez Cortes. This EMR is part of a deep organizational change, that includes moving to a new “smart” building, as well as the operationalization of a new “bio-psycho-social” health model, replacing "patients" with "persons-as-social-beings".

The main goal of the interdisciplinary team that developed the new EMR is to provide assistance to medical decisions through algorithmic systems that take into account bio-psycho-social considerations. But beyond the benefits, the organizational change in general and the new EMR, in particular, led to a series of resistances.

We have found three main sources of conflicts. Firstly, the unexpected transparency of doctor’s everyday practices. The new visibility has clashed with previous autonomy–or deregulation–of their work practices, such as how many hours they say they treat patients versus the hours that actually appear on the EMR.

Second, because one of the objectives of the new EMR is to optimize the time of attention, the practices of care and love–digitally incommensurables–are discouraged. Traditionally, pediatric health staff maintained a close relationship with “their kids”. The controversies between the two styles increase the tension between the old personnel–usually skeptic of Smart technologies– and the young ones.

Third, automation has been problematized as a source of medical decisions. In our interviews, some physicians described medicine as an “art” threatened by algorithms.

Authors

• Pablo Ignacio Hermansen, Pontificia Universidad Católica de Chile

• Matías Valderrama

• Martin Tironi