Resistance to Mandatory Technology Use-The Case of EMR in the United States Healthcare Industry

Organizations implement information systems (IS) to enable the capture, storage, and analysis of large datasets and inform decision-making. In the United States, government agencies are deploying IS-centric plans to remedy cost and quality issues in healthcare by aggregating and analyzing data on worker performance, patient outcomes, and administrative processes. Federal agencies hope that data-driven approaches will improve administrative decisions and the treatment of patients. A review of existing IS research suggests, however, that the goals of technological interventions often prove difficult to attain. One reason is that technologies do not always suit the context of use, so workers resist. When resistance is locally severe (i.e., many workers in the same organization resist), the organization can customize or replace the technology to satisfy its workers and generate desired outcomes. But when the technology and its uses are mandated, such as in healthcare, organizations have little flexibility in adoption and implementation decisions, and workers have few opportunities to act on their frustration via their use of the technology. How, then, might workers respond when traditional forms of resistance cannot escalate and derail implementation? I investigate this question through a qualitative study of healthcare workers’ responses to the electronic medical records (EMR) program. Under this program, organizations must adopt federally-certified EMR and comply with standards for use, or face financial penalties for noncompliance. Preliminary evidence suggests that when opportunities for localized resistance to change are limited, workers leverage political and social structures—such as professional organizations—to resist changes to their work. Continued study in contexts where technology use is mandated is essential for the development of theories that go beyond localized resistance and provide a comprehensive view resistance. Practically, a comprehensive understanding of resistance can inform policy and technology design, implementation, management, and evaluation in healthcare and elsewhere.