Impediments to change: the case of implementing an electronic patient record in three oncology clinics

The aim of this paper is to provide a deeper understanding of the complexities of IT implementation processes in health care by studying the introduction of an electronic patient record (EPR) system at three oncology clinics belonging to an association of hospitals in Austria. It examines the larger political and organizational context, the role of different stakeholders, the impact of arenas of influence and participation, and gives an in-depth analysis of the case dynamics. It argues that in order to better understand large scale IT implementation in health care a profound understanding of the complexities and interdependencies of clinical work is needed as well as the inclusion of other involved social arenas and their agendas. Careful planning and a powerful agenda in all these arenas are essential for the alignment of the different perspectives and the resulting demands.