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Normalisation of electronic medical records in routine healthcare work amidst ongoing digitalisation of the Philippine health system

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  • Macabasag, Romeo Luis A.
  • Mallari, Eunice U.
  • Pascual, Patrick Joshua C.
  • Fernandez-Marcelo, Portia Grace H.

Abstract

By drawing perspectives from the multi-level perspectives in sociotechnical transition and the normalisation process theory, this article explores how ongoing (i.e., incomplete) national level reforms in health information management (HIM) shape the normalisation of electronic medical records (EMRs) in Philippine rural health work. Based on document review, interviews, and observations, we argue that an ongoing HIM regime transition—transitioning from paper-based to an electronic HIM regime—may exert ambivalent institutional pressures on health workers through their institutions’ implementation context. The ambivalence of the implementation context—one that accommodates both EMR and paper-based medical records—offers conflicting social, cognitive, and material resources for normalising EMRs. In such a context, we find that health workers performed selective participation and partial implementation in normalising EMRs in their routine healthcare work. In selective participation, select health workers—often, the technologically savvy—could actively participate in the EMR implementation while others focused on their clinical work. At the same time, since only a few could use the EMR in routine work, EMRs were implemented partially in particular instances where it is deemed more valuable and applicable. We emphasised in this article how complementing the idea of normalisation with sociotechnical transition may reveal the emergence of pressures from various institutions and stakeholders that advances (or impede) the normalisation of healthcare innovations.

Suggested Citation

  • Macabasag, Romeo Luis A. & Mallari, Eunice U. & Pascual, Patrick Joshua C. & Fernandez-Marcelo, Portia Grace H., 2022. "Normalisation of electronic medical records in routine healthcare work amidst ongoing digitalisation of the Philippine health system," Social Science & Medicine, Elsevier, vol. 307(C).
    • Handle: RePEc:eee:socmed:v:307:y:2022:i:c:s0277953622004889
    DOI: 10.1016/j.socscimed.2022.115182
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    References listed on IDEAS

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    1. Heloise Agreli & Fiona Barry & Aileen Burton & Sile Creedon & Jonathan Drennan & Dinah Gould & Carl May & Mp Smiddy & Michael Murphy & Siobhan Murphy & Eileen Savage & Teresa Wills & Josephine Hegarty, 2019. "Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland," Post-Print hal-03188223, HAL.
    2. Geels, Frank W., 2002. "Technological transitions as evolutionary reconfiguration processes: a multi-level perspective and a case-study," Research Policy, Elsevier, vol. 31(8-9), pages 1257-1274, December.
    3. May, Carl, 2013. "Agency and implementation: Understanding the embedding of healthcare innovations in practice," Social Science & Medicine, Elsevier, vol. 78(C), pages 26-33.
    4. Geels, Frank W. & Schot, Johan, 2007. "Typology of sociotechnical transition pathways," Research Policy, Elsevier, vol. 36(3), pages 399-417, April.
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