Professional facing coercive work formalization: vicious circle of the Electronic Medical Record (EMR) implementation and appropriation

This paper shows that, according to many studies, the implementation of the Electronic Medical Record (EMR) does not cause efficient uses as expected in hospitals. Authors suggest explanatory factors, including both generic factors related to the implementation of ERP and specific factors related to health sector, in particular to professional bureaucracies (professional autonomy, divergence of goals, lack of coordination). The paper highlights the risk of a vicious circle of clinical process computerization, similar to bureaucratic vicious circle described by Crozier (Crozier 1965). Specifically, the convergence of two information systems, the clinical one and the administrative one inside the EMR, is a source of conflict between two logics, one focused on the professional to manage the care of a given patient, and the other focused on the resources management for all patients. The dominance of the administrative logic, consisting in monitoring and promoting coercive formalization, is likely to reduce the professional adjustment and autonomy, to cause their resistance and, consequently, the absence of effective uses, which lead back a strengthening of the control logic. The author shows interest to consider this conflict to reverse the situation by enabling approach, using professional autonomy as lever.