Examining the organizational implications of IT use in hospital-based health care: a case study of computerized order entry

The paper reports on the preliminary findings of an in-depth case study of the implementation of a computerized order entry (COE) system at a medium sized, acute care hospital. We propose a theoretically grounded framework, based on work by S.R. Barley (1986; 1990), for analyzing organizational changes that may result from COE introduction and use the framework to analyze findings at the research site. The hospital studied was largely successful in implementing and utilizing the system. However, use of the COE has altered the content and structure of order related information that passes between key participants in clinical care, affecting how these occupational groups and departments communicate and interact by creating ambiguity and uncertainty about order information. Use of the system may also be enabling increased organizational control over clinical care practices, exercised through professional norms and the clinical administrative hierarchy. Findings were consistent with other studies of COE use, suggesting that future research could focus on the consequences of structuring the content of order related communications on interactions between clinical and ancillary departments and the need to integrate the COE with other clinical systems to minimize disruptions.