National Telehealth Center, National Institutes of Health, University of the Philippines Manila, Padre Faura St., Ermita, Manila, 1000, Philippines.
Department of Family and Community Medicine, College of Medicine, University of the Philippines Manila, Pedro Gil Street, Taft Ave, Ermita, Manila, 1000, Philippines.
Soc Sci Med. 2022 Aug;307:115182. doi: 10.1016/j.socscimed.2022.115182. Epub 2022 Jul 1.
By drawing perspectives from the multi-level perspectives in sociotechnical transition and the normalisation process theory, this article explores how ongoing (i.e., incomplete) national level reforms in health information management (HIM) shape the normalisation of electronic medical records (EMRs) in Philippine rural health work. Based on document review, interviews, and observations, we argue that an ongoing HIM regime transition-transitioning from paper-based to an electronic HIM regime-may exert ambivalent institutional pressures on health workers through their institutions' implementation context. The ambivalence of the implementation context-one that accommodates both EMR and paper-based medical records-offers conflicting social, cognitive, and material resources for normalising EMRs. In such a context, we find that health workers performed selective participation and partial implementation in normalising EMRs in their routine healthcare work. In selective participation, select health workers-often, the technologically savvy-could actively participate in the EMR implementation while others focused on their clinical work. At the same time, since only a few could use the EMR in routine work, EMRs were implemented partially in particular instances where it is deemed more valuable and applicable. We emphasised in this article how complementing the idea of normalisation with sociotechnical transition may reveal the emergence of pressures from various institutions and stakeholders that advances (or impede) the normalisation of healthcare innovations.
本文从社会技术转型的多层次视角和正常化过程理论出发，探讨了正在进行的（即未完成的）国家层面的卫生信息管理（HIM）改革如何影响菲律宾农村卫生工作中电子病历（EMR）的正常化。通过文件审查、访谈和观察，我们认为，HIM 制度转型（从纸质 HIM 制度向电子 HIM 制度转型）可能会通过医疗机构的实施背景，对卫生工作者产生矛盾的制度压力。实施背景的矛盾性——既可以容纳 EMR，也可以容纳纸质病历——为 EMR 的正常化提供了相互冲突的社会、认知和物质资源。在这种情况下，我们发现卫生工作者在日常医疗保健工作中选择性地参与和部分实施 EMR 的正常化。在选择性参与中，一些技术熟练的卫生工作者可以积极参与 EMR 的实施，而其他人则专注于临床工作。同时，由于只有少数人可以在日常工作中使用 EMR，因此仅在认为 EMR 更有价值和适用的特定情况下部分实施 EMR。本文强调了如何将正常化与社会技术转型的理念相结合，揭示了来自各种机构和利益相关者的压力的出现，这些压力推动（或阻碍）了医疗创新的正常化。
