Beyond the boundaries of care: Electronic health records and the changing practices of healthcare

Abstract

Healthcare systems across the globe are riding a wave of clinical health IT investment, centered on electronic health records (EHR) systems. Supported by governmental incentives, this build-out has positioned the healthcare system for a period of transformation as EHR functionality has become ingrained in the work routines of healthcare providers and other system participants. We report on a field study of healthcare participants in the United States to explore the influence of EHR use on the boundaries and practices of the field. Our grounded theory analysis reveals the interplay between the field practices of individual communities and the boundary spanning practices that unite them. Through the adoption of a practice perspective, we highlight the changes to both boundary spanning and field practices engendered by enterprise EHR use and propose the complementary mechanisms of reticulation and boundary molding by which those changes emerge. We conclude with a consideration of the positive and potentially negative consequences of EHR use for delivery of healthcare services.