The Digitalization of Health Care: Electronic Records and the Disruption of Moral OrdersElectronic health records are widely regarded as the 'connective tissue' of any modern healthcare system. For some they represent a 'dangerous enthusiasm' and for others a key enabler of 'disruptive innovation'. Many governments have made major policy and financial investments in digitalizing health records but their implementation has frequently run into opposition from doctors, had lukewarm responses from patients, and raised considerable concerns for privacy advocates and others worried by the security of sensitive health data and the risks of national data-bases. This book draws upon the concept of 'orders of worth' to reveal the moral dimensions of the medical division of labour and to delve deeper into understanding why electronic records have been so difficult to implement and the sources of opposition to them. The authors argue that digitalization disrupts the moral orders which define rights and responsibilities for the sharing and exchanging of patient medical data. This is illustrated through longitudinal studies of two of the most controversial attempts to introduce national systems - a patient controlled electronic record in Australia and a national summary care record that was part of the ill-fated NHS national program for IT in England. The authors conclude by using the lessons from these national experiences and insights from two regional projects in each country to suggest how the idea of electronic records might be re-thought. It is a must read for anyone concerned about health information and the implications of how it is shared and exchanged in a digital world. |
Contents
Introduction | 1 |
Digitalizing Healthcare Dangerous Enthusiasm or Disruptive Innovation? | 10 |
The Troubled History of Implementing EHRs | 23 |
Moral Orders and Justification in the Division of Medical Labour | 41 |
The Development of a National EHR in Australia I Trials Tribulations and Uncertainty | 58 |
The Development of a National EHR in Australia II The Struggle over Personal Control | 78 |
The Development of a National EHR in England The Summary Care Record | 98 |
Boundary Objects Building EHRs at National and Local Level | 119 |
Conclusion Moral ReOrdering and Rethinking the Electronic Record | 140 |
Research Design and Methods | 157 |
Other Sources Not Cited in Text | 161 |
References | 165 |
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Common terms and phrases
attempts Australia Card Australian Privacy Foundation Boston Consulting Group boundary objects Business Architecture Canberra challenges Chapter Christensen citizens Clayton Utz clinical clinicians Coiera Committee concerns consent models consultation consumer Controlled Electronic Health databases Department of Health digitalization of healthcare disruptive innovation doctors EHR projects electronic health record electronic records enable England etal federal feedback Greenhalgh groups health data health information health ministers healthcare providers healthcare systems HealthConnect hospitals implementation information systems infrastructure interviews involved issues Journal justify legislation Medical Informatics medical records Medicare Australia model of consent moral orders national EHR system National Health NEHTA NHHRC NPfIT OECD orders of worth organizations patient records PCEHR Personally Controlled Electronic policy-makers positions potential practice professional regional responsibilities roll-out shared smart card stakeholders strategy tension tion Tony Abbott trials uploaded users whilst wicked problems