Autonomy Disrupted: Law, Technology, and its Impact on Professions’ Autonomy Following the Implementation of the Electronic Health Record

Brennan, Elizabeth Jayne

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Year:: 2022
Contributor:: Brennan, Elizabeth Jayne (creator); Suchman, Mark (Advisor); Hirschman, Daniel (Reader); Pacewicz, Joshua (Reader); Brown University. Department of Sociology (sponsor)
Genre:: theses
Subject:: Qualitative research; Autonomy; Physicians; Health Information Technology for Economic and Clinical Health Act (United States); medical sociology; electronic health record; Disruptive technologies; Professions; law on books law in action; Historical analysis; Organizational sociology
Extent:: 16, 230 p.

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Abstract:: Like the paper medical record, the electronic health record (EHR) contains a patient’s medical history, diagnoses, and treatment plan; however, the EHR is more than a data repository. Advances in data analytics facilitate the incorporation of evidence-based medicine, the generation of metrics, and streamline the billing process—all functionalities that promise to improve patient care while addressing the rising costs of healthcare. These are also all functionalities that make the EHR a disruptive technology that requires clinicians and administrators to develop new skills and alter the delivery of care. The rapid adoption of EHRs across the United States following the passage of a federal incentive program presents a fascinating case to examine the impact of a disruptive technology and law across an organizational field. I argue law plays a significant role in the innovation and adoption of disruptive technologies. To understand the implication of these legal processes – both for the materiality of the technology itself and for the experiences of its users, especially regarding a profession’s autonomy – I examine the codification of law on the books and the implementation of law in action via the case of the EHR. Usually, these two sides of law are analyzed separately. However, by employing a more holistic approach, I contribute to a more detailed understanding of the entanglement of law and technology, and show their iterative relationship has direct, yet varied, consequences for the professions who use the technology. Specifically, when law standardizes and supports the widespread adoption of a technology across an organizational field, the technology can positively or negatively impact a profession’s autonomy. I argue that in the case of the EHR, it impacts the medical profession’s autonomy across three dimensions: time, interaction, and cognition. But this impact varies by medical specialty, where generalists experience a negative impact to their autonomy across all three dimensions, while specialists experience negative autonomy on time but no effect on interaction and cognition. This dissertation is a multi-method qualitative project. First, I employed a historical analysis of federal EHR policy. Second, I conducted semi-structured interviews at a hospital system and observations at professionals’ association meetings.
Notes:: Thesis (Ph. D.)--Brown University, 2022

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Brennan, Elizabeth Jayne, "Autonomy Disrupted: Law, Technology, and its Impact on Professions’ Autonomy Following the Implementation of the Electronic Health Record" (2022). Sociology Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:9f5hg8rh/

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Sociology Theses and Dissertations

Theses and Dissertations for the Sociology department.
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