Social Studies of Scienceand Technology: New ways to illuminate challenges in training for health information technologies utilisation.

Abstract

Electronic health records (EHRs) have transformed clinical practice. They are not simply replacements for paper records but integrated systems with the potential to improve patient safety and quality of care. Training physicians in the use of EHR is a highly complex intervention that occurs in a dynamic socio-technical health system. Training in this complex space is considered a wicked problem and would benefit from different analytic approaches to the traditional linear causal relationship analysis. Social Sciences theories see technological change in relation to complex social and institutional processes and provide a useful starting point. Our aim, therefore, is to introduce the medical education scholar to a selection of theoretical approaches from the Social Studies of Science and Technology (SSST) literatures, to inform educational efforts in training for EHR use. We suggest a body of theories and frameworks that can expand the epistemological repertoire of medical education scholarship to respond to this wicked problem. Drawing from our work on EHR implementation, we discuss current limitations in framing training for EHRs use as a research problem in medical education. We then present a selection of alternative theories. Unified Theory of Acceptance and Use of Technology (UTAUT) explains the individual adoption of new technologies in the workplace and has four key constructs: performance/effort expectancy, social influence and facilitating conditions. Social Practice Theory (SPT), rather than focusing on individuals or institutions, starts with the activity or practice. The socio-technical model (STM) is a comprehensive theory that offers a multidimensional framework for studying the innovation and application of EHRs. Practical examples are provided. We argue that education for effective utilisation of EHRs requires moving beyond the epistemological monism often present in the field. New theoretical lenses can illuminate the complexity of research to identify the best practices for educating and training physicians.