Going paperless at the emergency department: a socio-technical study of an information system for patient tracking.

Purpose: The purpose of this study was to examine nurses' attitudes and reflection on the transformation of their workpractices after the implementation of an Emergency Department Information System (EDIS).
Methods: A qualitative study using interviews, mainly with nurses, conducted four years after the implementation of an EDIS at the emergency department (ED) of a large university hospital in Midlands, UK.
Results: The introduction of waiting time targets for patients attending EDs and the spatial expansion of these clinical settings so as to support increasing numbers of attendances challenged the viability of paper records and whiteboards in the management of patient flows within the department. They also fostered the use of an information system for accumulating information and coordinating the activities of the multidisciplinary team. While whiteboards were abolished, paper still plays a role in nursing practice in response to issues of confidentiality, personal safety, ergonomics, computer literacy, interoperability, relationship with patients and overdependence on EDIS.
Conclusions: ED information systems can have a major impact on organisational practices particularly as new service models of care are gradually introduced in EDs. Considering their spatio-temporal implications while treating the technology as an artifact with transformative, rather than supportive or substitutive, power enhances our understanding of the implementation challenges that need to be addressed during the reshaping of the sociotechnical network.
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