Electronic Health Records and the Logics of Care: Complementarity and Conflict in the U.S. Healthcare System

The U.S. healthcare system has experienced rapid growth in the adoption and use of clinical health information technology, such as electronic health record (EHR) systems. In a field as complex and pluralistic as healthcare, the introduction of these sweeping information technology platforms is transforming the practices, roles, interdependencies, and communication mechanisms that connect a heterogeneous mix of stakeholders. In this study, we assess the impact of EHR adoption and use on the practices in the U.S. healthcare system and the diverse ways of thinking and acting that those practices reflect. Building on our field study of diverse healthcare stakeholders, we propose a mechanism for how information system (IS) use can influence the institutional dynamics of the healthcare system. We argue that this theoretical framework may be fruitfully applied to other national healthcare systems and other classes of enterprise IS. In addition, the study offers a number of practical insights for IS designers and policy makers as EHR system use expands and evolves in the coming years. The U.S. healthcare system has experienced rapid growth in the adoption and use of clinical health information technology, such as electronic health record (EHR) systems. In a field as complex and pluralistic as healthcare, the introduction of these sweeping information technology platforms is transforming the practices, roles, interdependencies, and communication mechanisms that connect a heterogeneous mix of stakeholders. In this study, we assess the impact of EHR adoption and use on the practices of U.S. healthcare stakeholders and the institutional logics that they instantiate. We identify four prominent logics around the adoption and use of EHR systems—medical professionalism, private sector managerialism, technical design, and regulatory oversight. Our analysis reveals the ways in which practices enacted through EHR systems interact to engender a confluence of the institutional logics that mark the field. Specifically, we theorize a mechanism by which the reticulation, or intertwining, of practices mediated by an EHR system variously fosters complementarity and conflict between institutional logics based on the commensurability of the organizing principles invoked. This proposed framework offers a novel approach to the role of information system use in the institutional dynamics of the healthcare system. In addition, this research offers a range of practical insights regarding