The Organizational, Professional and Legal Challenges of New Information Technologies in Healthcare

mark suchman威斯康星大学麦迪逊分校这是一项关于美国医院采用临床信息技术的组织、专业和法律因素的研究。电子病历保存和计算机化医嘱输入等创新有望提高临床医疗实践的准确性、效率和严谨性。然而，与此同时，它们也有可能在医疗保健部门引入新的胁迫、监视和不平等形式。运用组织社会学、专业社会学、技术社会学和法律社会学的理论，本研究考察了“社会治理机制”——法律、规则和规范——在决定何时以及如何接受或拒绝这些新技术方面的作用。该项目包括两个实证组成部分：(1)对16个州320家医院的临床信息技术使用和治理进行广泛的定量调查，以及(2)对中西部上游一家大型教学和研究医院的技术实施和法律合规过程进行深入的定性实地观察。这项定量调查追踪了全国范围内技术治理的宏观结构，因为不同样本的医院面临着联邦政府关于电子数据交换和患者隐私的新规定。同时，定性实地考察追踪了单个地点的技术治理微观结构，因为重点医院将其运营纳入相同的监管倡议。通过在实体法律活动的环境中考察技术实施，该研究有望对社会治理机制如何引导和约束创新和组织变革提供新的见解。此外，随着组织文化、职业道德和法律限制的重叠决定了特定组织和整个医疗保健行业内技术项目的命运，该研究有望对各种治理机制如何相互作用提供新的见解。这项调查将对有关创新和扩散、技术治理（特别是标准制定、信任和问责制）以及组织对法律的反应的社会科学知识作出根本性贡献。研究结果还应有助于决策者构建适当的治理机制，以实现临床信息技术的巨大潜力，同时避免同样巨大的陷阱。

SES-0242033Mark SuchmanUniversity of Wisconsin-MadisonThis is a study of the organizational, professional and legal factors that shape the adoption of clinical information technologies in American hospitals. Innovations such as electronic medical record-keeping and computerized physician order-entry promise to improve the accuracy, efficiency and rigor of clinical medical practice. At the same time, however, they also threaten to introduce new forms of coercion, surveillance and inequality into the healthcare sector. Employing theories from organizational sociology, the sociology of the professions, the sociology of technology and the sociology of law, this research examines the role of "social governance mechanisms" -- laws, rules and norms -- in determining when and how these new technologies are embraced or rejected. The project comprises two empirical components: (1) a broad-based quantitative survey of clinical information technology use and governance at 320 hospitals across 16 states, and (2) an intensive qualitative field observation of the technology implementation and legal-compliance process at a large teaching and research hospital in the Upper Midwest. The quantitative survey traces the macro-structure of technology governance nationwide, as the diverse sample of hospitals confronts new Federal regulations on electronic data interchange and patient privacy. Simultaneously, the qualitative fieldwork traces the micro-structure of technology governance in a single site, as the focal hospital brings its operations into compliance with the same regulatory initiative. By examining technology implementation in an environment of substantial legal activity, the research promises new insights into how social governance mechanisms channel and constrain innovation and organizational change. In addition, the research promises new insights into how various governance mechanisms interact with one another, as organizational cultures, professional ethics and legal strictures overlap to determine the fate of technology projects both within particular organizations and throughout the healthcare sector as a whole. This investigation will make fundamental contributions to social scientific knowledge about innovation and diffusion, technology governance (particularly standard-setting, trust and accountability), and organizational responses to law. The results should also assist policymakers in constructing appropriate governance mechanisms to realize the immense potential of clinical information technology whileavoiding the equally immense pitfalls.