Subtle Redistribution of Work, Attention and Risks: Electronic Patient Records and Organisational Consequences

Based on an actor-network study of the way in which medical work in a hospital has changed after the introduction of an electronic patient record system, the paper addresses the question of organisational consequences of ICT. It describes how the introduction of electronic patient records (EPR) has occasioned redistribution of work, of organisational attention, and of risks. By comparing these findings to the public expectations of EPR and to the literature on organisational effects of EPR, it is argued that we need to shift from a theory of improvement to a theory of distribution in order to understand the way in which ICT affects work practices. The paper further argues that this shift also has implications for the theoretical understanding and practical management of design, implementation, and evaluation of ICT.