The Organizational, Professional and Legal Challenges of New Information Technologies in Healthcare

University Of Wisconsin-Madison, Madison WI

Investigators

Abstract

SES-0242033 Mark Suchman University of Wisconsin-Madison This is a study of the organizational, professional and legal factors that shape the adoption of clinical information technologies in American hospitals. Innovations such as electronic medical record-keeping and computerized physician order-entry promise to improve the accuracy, efficiency and rigor of clinical medical practice. At the same time, however, they also threaten to introduce new forms of coercion, surveillance and inequality into the healthcare sector. Employing theories from organizational sociology, the sociology of the professions, the sociology of technology and the sociology of law, this research examines the role of "social governance mechanisms" -- laws, rules and norms -- in determining when and how these new technologies are embraced or rejected. The project comprises two empirical components: (1) a broad-based quantitative survey of clinical information technology use and governance at 320 hospitals across 16 states, and (2) an intensive qualitative field observation of the technology implementation and legal-compliance process at a large teaching and research hospital in the Upper Midwest. The quantitative survey traces the macro-structure of technology governance nationwide, as the diverse sample of hospitals confronts new Federal regulations on electronic data interchange and patient privacy. Simultaneously, the qualitative fieldwork traces the micro-structure of technology governance in a single site, as the focal hospital brings its operations into compliance with the same regulatory initiative. By examining technology implementation in an environment of substantial legal activity, the research promises new insights into how social governance mechanisms channel and constrain innovation and organizational change. In addition, the research promises new insights into how various governance mechanisms interact with one another, as organizational cultures, professional ethics and legal strictures overlap to determine the fate of technology projects both within particular organizations and throughout the healthcare sector as a whole. This investigation will make fundamental contributions to social scientific knowledge about innovation and diffusion, technology governance (particularly standard-setting, trust and accountability), and organizational responses to law. The results should also assist policymakers in constructing appropriate governance mechanisms to realize the immense potential of clinical information technology whileavoiding the equally immense pitfalls.