Tjora Aksel Hagen, Scambler Graham
Department of Sociology and Political Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
Soc Sci Med. 2009 Feb;68(3):519-25. doi: 10.1016/j.socscimed.2008.11.005. Epub 2008 Dec 4.
The considerable emphasis in the development and implementation of clinical information systems in hospitals internationally seems to have had a limited effect. In particular, the implementation of electronic patient record (EPR) systems has been slower and more difficult than anticipated and with little change in efficiency and security. This paper suggests why this might be the case. Well established research findings within the field of computer supported cooperative work (CSCW--an interdisciplinary research field between informatics and the social sciences) are cited to construct a case for greater awareness of (1) inter- and intra-professional interests, and (2) broader social and health policy contexts. We draw on Gouldner's work [(1957). Cosmopolitans and locals: toward an analysis of latent social roles--I. Administrative Science Quarterly, 2(3), 281-306; (1958). Cosmopolitans and locals: toward an analysis of latent social roles--II. Administrative Science Quarterly, 2 (4), 444-480] on organisational roles to develop a discussion of professional awareness; a pivotal notion is also the interactionist one of the hospital as a 'negotiated order'. Drawing for illustrative purposes on the Norwegian experience (that is, reviewing research on hospital information systems in Norway), we contend that enhanced awareness of the hospital itself as a social system may be a precondition of cost-effective hospital information and communication technologies.
国际上，医院临床信息系统的开发与实施受到了相当大的重视，但其效果似乎有限。特别是，电子病历（EPR）系统的实施比预期的要缓慢且困难，效率和安全性方面变化甚微。本文探讨了出现这种情况的原因。文中引用了计算机支持的协同工作领域（CSCW——信息学与社会科学之间的跨学科研究领域）已有的研究成果，以论证提高对以下两点的认识的必要性：（1）专业内和专业间的利益；（2）更广泛的社会和卫生政策背景。我们借鉴古尔德纳的著作[（1957年）。世界主义者与地方主义者：迈向对潜在社会角色的分析——I。《行政科学季刊》，2(3)，281 - 306；（1958年）。世界主义者与地方主义者：迈向对潜在社会角色的分析——II。《行政科学季刊》，2(4)，444 - 480]中关于组织角色的内容，来展开对专业意识的讨论；一个关键概念是将医院视为“协商秩序”的互动主义观点。为了说明问题，我们以挪威的经验为例（即回顾挪威医院信息系统的研究），认为提高对医院本身作为一个社会系统的认识，可能是实现具有成本效益的医院信息和通信技术的前提条件。
