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Unintended Consequences of Electronic Medical Records

An Emergency Room Ethnography
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Unintended Consequences of Electronic Medical Records: An Emergency Room Ethnography argues that, while electronic medical records (EMRs) were supposed to improve health care delivery, EMRs' unintended consequences have affected emergency medicine providers and patients in alarming ways. Higher health care costs, decreased physician productivity, increased provider burnout, lower levels of patient satisfaction, and more medical mistakes are just a few of the unintended consequences Barbara Cook Overton observes while studying one emergency room's EMR adoption. With data collected over six years, Cook Overton demonstrates how EMRs harm health care organizations and thrust providers into the midst of incompatible rule systems without appropriate strategies for coping with these challenges, thus robbing them of agency. Using structuration theory and its derivatives to frame her analysis, Cook Overton explores ways providers communicatively and performatively receive and manage EMRs in emergency rooms. Scholars of communication and medicine will find this book particularly useful.
Introduction: "Inventions of the Devil" Chapter 1: "Computers Destroy Personal Communication" Chapter 2: "If EMRs are Not Ready for Prime Time, Why are We Using Them?" Chapter 3: Theoretical Frameworks Chapter 4: Forced Learning Amid Organizational Change: Ways Dissonance and Reactance Hinder EMR Training Chapter 5: An Appropriation Analysis of Speech Acts and Relating Moves: Ways a "Frustrating" EMR Altered Providers' Everyday Habits Chapter 6: An Appropriation Analysis of Constraining and Judging Moves: Ways an EMR's Incoherent Spirit Impinged Providers' Agency and Changed Workflow Chapter 7: Stuck Between a Rock and Hard Place: How Structurational Divergence in the Emergency Room was Made Worse by an EMR Chapter 8: An EMR's Unintended and Perverse Consequences: "I Don't Think This is What They had in Mind." Chapter 9: Implications and Suggestions Conclusion: Goodbye. Farewell. Amen.
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