Enacting computer workaround practices within a medication dispensing system

Computer workarounds in health information systems (HIS) threaten the potential for gains in efficiency through computerization aimed at reducing process variability. Eliminating such workarounds is desirable, but information system (IS) researchers tend to treat computer workarounds as black-boxes, whereas HIS researchers are primarily concerned with descriptive or prescriptive remedies. We propose to open the black-box of computer workarounds and study them as situated practices that consist of adjustments to existing computer-based procedures, which are enabled by the negotiated order of a hospital. This negotiative property of a hospital's organizational environment allows for interpretive flexibility, in which physicians stretch certain rules in practice, while inducing others to cooperate. We illustrate this conceptual framework with a non-participant observer case study of a medication dispensing system used in a teaching hospital to support a prior-approval policy for anti-microbial drugs. Within these enacted workaround practices, we found significant variety in roles, timing and interactions, which boil down to a pattern of four practices revolving around one function of an HIS. Our research extends the literature on computer workarounds in IS and HIS by proposing a theoretical understanding of workaround practices based on a contextual healthcare study.