IMPLEMENTATION OF AN ELECTRONIC MEDICAL RECORD IN LIGHT OF THE ACTOR-NETWORK THEORY

Antônio Sávio De Macedo,Ricardo Bezerra Cavalcante,Tarcisio Laerte Gontijo,Cleyane Jovelina Da Cruz Januario Brito,Nádia Fontoura Sanhudo,Luciane Ribeiro De Faria

doi:10.1590/1980-265x-tce-2020-0123

Abstract

ABSTRACT Objective: to describe the human and non-human actors network involved in the implementation of an electronic medical record in Primary Health Care in Minas Gerais. Method: this is a study with a qualitative approach, with the Actor-Network Theory as a theoretical framework and Controversy Cartography as a methodological framework. We interviewed 20 health professionals, managers and other spokespersons involved with the implementation of an electronic medical record in a city in Minas Gerais State. We conducted observation and collection of 30 documents when following the participants from September 2018 to August 2019. For analysis, we used the following scales to visualize the mapped social dynamics: Minor Scale (brief and chronological description of the main events); Intermediate Scale (identification of humans and non-humans, their relationships and controversies); Major Scale (detailed description of the main controversies). Results: the network of actants involved in the electronic medical record implementation is woven from controversies: multiple actants and their translations influencing the electronic medical record implementation; contributions and weaknesses shaping the electronic medical record as an open controversy. Such controversies emerged from the mobilization of actors from various spheres of government, in addition to the place of implementation. Despite the weaknesses found, the electronic medical record contributed to: support decision-making; monitor patients’ health history; integrate information between the assistance network points. Conclusion: the success of the technology implementation was influenced by the relationships established between humans and non-humans from different management spheres, which, by mobilizing, strengthen or weaken computerization.

Highlights

In Brazil, the computerization of Primary Health Care (PHC) is sought based on e-SUS Primary Care Strategy (e-SUS AB - Estratégia e-SUS Atenção Básica).[1]
We realized the first controversy: deciding to implement the PEC made available by the Ministry of Health (MoH), implementing its own Electronic Health Record, already made available through its own Information System (IS), developed by the municipality, or acquiring another electronic medical record (ER) used in some municipality
The passage clarifies the controversy: [...] the Department technicians made visits to other municipalities to learn about other realities and, from there, decide whether to implant a new one, to use the electronic medical record already inserted in the municipal system itself, or the electronic health record of the Ministry of Health would be implemented [...] (RESP2)

Summary

Introduction

In Brazil, the computerization of Primary Health Care (PHC) is sought based on e-SUS Primary Care Strategy (e-SUS AB - Estratégia e-SUS Atenção Básica).[1]. PEC was developed to organize professionals’ service agenda, systematize patients’ clinical history and generate reports aimed at local planning.[2] The Brazilian Ministry of Health (MoH) allowed its own electronic medical records (those developed by Municipal Health Departments or acquired through the private sector) to be implemented. The condition is that such records disseminate information to the Health Information System for Primary Care (Sistema de Informação em Saúde para a Atenção Básica -SISAB) of e-SUS AB strategy.[2] The electronic medical record (ER) (object of this research) was developed by the Municipal Health Department (Secretaria Municipal de Saúde SEMUSA), disseminating information on SISAB

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Discussion

Conclusion