As electronic health records grow in popularity, the microcosmic networks they form in every medical practice and hospital become increasingly membranous. Since this framework constantly evolves per the degree of user involvement, there is no rigidity to these networks’ structure, and some thinkers would argue this is both a gift and a curse.
Professor Trish Greenhalgh spearheaded a meta-narrative take on various interpretations of EHRs to make sense of conflicting research on these systems. The most compelling is perhaps the Actor-Network Theory (ANT), which we’ve profiled below.
EHRs and the Actor-Network Theory
There are a number of meta-narrative approaches highlighted by Trish Greenhalgh and her team at University College London, including positivist, interpretivist and critical sociological approaches.
However, her actor-network meta-narrative approach has perhaps received the most attention. Actor-Network Theory (ANT) sees people and technology as linked via networks, with most research in the field focusing on the networks’ changing relationships and what results from them.
The view that emerges from the ANT perspective is that EHRs fail when efforts in translation within the network fail. Studies show the networks that EHRs form are highly dynamic and often inherently unstable. Whenever actors input codes and standards, the system is irreversibly shaped and, to a certain degree, constrained.
Stabilizing the actor-network requires aligning people, technologies, roles, routines, training, and incentives via translation, which involves defining all problems for which EHRs can provide a solution, getting people to ascribe to the EHR as a solution, and mobilizing others to fulfill roles, undertaking practices, implementing EHRs and linking with others in the network.
The ANT perspective is complex and is regarded highly in science and technology studies, but these concepts are sometimes too dense for some EHR thinkers and have been more or less ignored in HIT, despite bringing up very relevant points regarding the physician-patient flow of EHR networks and interoperability.
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