Judicious design of electronic health records: Case from public health system in India

Introducing EHR systems on a large scale is a complex undertaking. Based on empirical material from a project where we have developed and implemented an open source Electronic Health Record in a challenging context of a district hospital in India, we articulate an approach we term “judicious design”. This metaphor points to an incremental, modular and flexibly scalable approach which is fundamentally context-sensitive to the paper–computer hybrid as well as the work practices of the hospital staff. A key focus of this approach is to reduce the complexity of an undertaking before starting it, and scale with an evolutionary rather than revolutionary approach. Our empirical research helps to identify three sets of “judicious design principles”: 1. Managing the installed base with selective automation; 2. Structuring of interdependencies; and, 3. Proactive participation. While these principles have been developed based on an Indian case study, we argue that these could also be relevant in other contexts, including in the West.