Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method.
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 s...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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2009
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| _version_ | 1797086050094415872 |
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| author | Greenhalgh, T Potts, H Wong, G Bark, P Swinglehurst, D |
| author_facet | Greenhalgh, T Potts, H Wong, G Bark, P Swinglehurst, D |
| author_sort | Greenhalgh, T |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-07T02:16:30Z |
| format | Journal article |
| id | oxford-uuid:a26b0ffe-0e78-4ed4-a004-34996127a2ef |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:16:30Z |
| publishDate | 2009 |
| record_format | dspace |
| spelling | oxford-uuid:a26b0ffe-0e78-4ed4-a004-34996127a2ef2022-03-27T02:20:00ZTensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a26b0ffe-0e78-4ed4-a004-34996127a2efEnglishSymplectic Elements at Oxford2009Greenhalgh, TPotts, HWong, GBark, PSwinglehurst, DCONTEXT: 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. |
| spellingShingle | Greenhalgh, T Potts, H Wong, G Bark, P Swinglehurst, D Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. |
| title | Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. |
| title_full | Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. |
| title_fullStr | Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. |
| title_full_unstemmed | Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. |
| title_short | Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. |
| title_sort | tensions and paradoxes in electronic patient record research a systematic literature review using the meta narrative method |
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