{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T21:45:28Z","timestamp":1776116728816,"version":"3.50.1"},"reference-count":57,"publisher":"Association for Computing Machinery (ACM)","issue":"1","license":[{"start":{"date-parts":[[2015,2,17]],"date-time":"2015-02-17T00:00:00Z","timestamp":1424131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.acm.org\/publications\/policies\/copyright_policy#Background"}],"content-domain":{"domain":["dl.acm.org"],"crossmark-restriction":true},"short-container-title":["ACM Trans. Comput.-Hum. Interact."],"published-print":{"date-parts":[[2015,3,4]]},"abstract":"<jats:p>Implementation of large Health Information Technology (HIT) systems is critical to healthcare organizations and has seen heavy investment. However, research has not fully explored the adaptation of HIT systems, particularly the tensions between individual flexibility and organizational needs in the adaptation process. This study analyzes how Emergency Department (ED) clinicians adapted to a new hospital-wide Electronic Medical Records (EMR) system. We present four adaptation cases revealing two interrelated types of adaptations\u2014technical and organizational\u2014as responses to the new system in use. First, individual clinicians respond to the immediate alteration in workflows caused by the EMR, while the organizational adaptations later mitigate the changes in healthcare quality control resulting from the clinicians\u2019 initial adaptation. Our analysis reflects the critical nature and value of both adaptation types, with an emphasis on the triggers and process of organizational adaptation, for the successful implementation of a socio-technical-political system in a healthcare organization.<\/jats:p>","DOI":"10.1145\/2656213","type":"journal-article","created":{"date-parts":[[2015,2,18]],"date-time":"2015-02-18T13:24:05Z","timestamp":1424265845000},"page":"1-24","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Technological and Organizational Adaptation of EMR Implementation in an Emergency Department"],"prefix":"10.1145","volume":"22","author":[{"given":"Sun Young","family":"Park","sequence":"first","affiliation":[{"name":"University of California, Irvine, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunan","family":"Chen","sequence":"additional","affiliation":[{"name":"University of California, Irvine, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Rudkin","sequence":"additional","affiliation":[{"name":"University of California, Irvine, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"320","published-online":{"date-parts":[[2015,2,17]]},"reference":[{"key":"e_1_2_1_1_1","volume-title":"Organizational Learning: A Theory of Action Perspective","author":"Argyris C.","year":"1978"},{"key":"e_1_2_1_2_1","unstructured":"D. Armijo C. McDonnell and K. Werner. 2009. Electronic health record usability: Evaluation and use case framework. Agency for Healthcare Research and Quality Rockville MD.  D. Armijo C. McDonnell and K. Werner. 2009. Electronic health record usability: Evaluation and use case framework. Agency for Healthcare Research and Quality Rockville MD."},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M1471"},{"key":"e_1_2_1_4_1","doi-asserted-by":"publisher","DOI":"10.1057\/ejis.2008.14"},{"issue":"1986","key":"e_1_2_1_5_1","first-page":"78","article-title":"Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments","volume":"31","author":"Barley S. R.","year":"1996","journal-title":"Admin. Sci. Quart. (JSTOR)"},{"key":"e_1_2_1_6_1","volume-title":"Contextual Design: Defining Customer-Centered Systems. Morgan Kaufmann","author":"Beyer H.","year":"1997"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000387"},{"key":"e_1_2_1_8_1","doi-asserted-by":"publisher","DOI":"10.1287\/orsc.1040.0103"},{"key":"e_1_2_1_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2008.06.008"},{"key":"e_1_2_1_10_1","doi-asserted-by":"publisher","DOI":"10.1145\/1240866.1241004"},{"key":"e_1_2_1_11_1","volume-title":"Prentice-Hall","author":"Cyert R. M.","year":"1963"},{"key":"e_1_2_1_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0802005"},{"key":"e_1_2_1_13_1","unstructured":"John M. Dutton and Annie Thomas. 1985. Relating technological change and learning by doing. In Research on Technological Innovation Management and Policy Richard S. Rosenbloom (Ed.) 2 187--224.  John M. Dutton and Annie Thomas. 1985. Relating technological change and learning by doing. In Research on Technological Innovation Management and Policy Richard S. Rosenbloom (Ed.) 2 187--224."},{"key":"e_1_2_1_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10606-012-9168-0"},{"key":"e_1_2_1_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2012-000982"},{"key":"e_1_2_1_16_1","volume-title":"The Discovery of Grounded Theory: Strategies for Qualitative Research","author":"Glaser B. G.","year":"1967"},{"key":"e_1_2_1_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm047"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1287\/isre.1110.0365"},{"key":"e_1_2_1_19_1","doi-asserted-by":"crossref","unstructured":"E. Goorman and M. Berg. 2000. Modeling nursing activities: Electronic patient recrods and their discontents. Nurs. Inq. 7 (March 2000) 3--9.  E. Goorman and M. Berg. 2000. Modeling nursing activities: Electronic patient recrods and their discontents. Nurs. Inq. 7 (March 2000) 3--9.","DOI":"10.1046\/j.1440-1800.2000.00053.x"},{"key":"e_1_2_1_20_1","doi-asserted-by":"crossref","unstructured":"J.\n       \n      Grudin\n     and \n      \n      \n      L.\n       \n      Palen\n      \n  \n  . \n  1997\n  . Emerging groupware successes in major corporations: Studies of adoption and adaptation. Worldwide Computing and Its Applications Lecture Notes in Computer Science Volume 1274\n  . \n  Springer-Verlag New York 142--153.   J. Grudin and L. Palen. 1997. Emerging groupware successes in major corporations: Studies of adoption and adaptation. Worldwide Computing and Its Applications Lecture Notes in Computer Science Volume 1274. Springer-Verlag New York 142--153.","DOI":"10.1007\/3-540-63343-X_44"},{"key":"e_1_2_1_21_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1287"},{"key":"e_1_2_1_22_1","first-page":"124","article-title":"Rework and workarounds in nurse medication administration process: Implications for work processes and patient safety. Health Care Manage","volume":"35","author":"Halbesleben J. R. B.","year":"2010","journal-title":"Rev."},{"key":"e_1_2_1_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4571(199512)46:10<772::AID-ASI9>3.0.CO;2-0"},{"key":"e_1_2_1_24_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.24.5.1103"},{"key":"e_1_2_1_25_1","doi-asserted-by":"publisher","DOI":"10.5465\/amr.1990.4308227"},{"key":"e_1_2_1_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0900592"},{"key":"e_1_2_1_27_1","unstructured":"J. M. Juran A. B. Godfrey R. E. Hoogstoel and E. G. Schilling. 1999. Juran's Quality Handbook (5th ed.). McGraw-Hill New York NY.  J. M. Juran A. B. Godfrey R. E. Hoogstoel and E. G. Schilling. 1999. Juran's Quality Handbook (5th ed.). McGraw-Hill New York NY."},{"key":"e_1_2_1_28_1","volume-title":"Technology: Activity Theory and Interaction Design","author":"Kaptelinin V.","year":"2006"},{"key":"e_1_2_1_29_1","unstructured":"C. H. Kepner and B. B. Tregoe. 1976. The Rational Manager: A Systematic Approach to Problem Solving and Decision Making (2nd ed.). Kepner-Tregoe Inc. Princeton NJ.  C. H. Kepner and B. B. Tregoe. 1976. The Rational Manager: A Systematic Approach to Problem Solving and Decision Making (2nd ed.). Kepner-Tregoe Inc. Princeton NJ."},{"key":"e_1_2_1_30_1","doi-asserted-by":"publisher","DOI":"10.2307\/249410"},{"key":"e_1_2_1_31_1","doi-asserted-by":"publisher","DOI":"10.1145\/1056808.1056966"},{"key":"e_1_2_1_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.10.1197"},{"key":"e_1_2_1_33_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M2616"},{"key":"e_1_2_1_34_1","unstructured":"B. Latour. 2004. Nonhumans. In Patterned Ground: Entanglements of Nature and Culture. 224--227.  B. Latour. 2004. Nonhumans. In Patterned Ground: Entanglements of Nature and Culture. 224--227."},{"key":"e_1_2_1_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/0048-7333(88)90006-6"},{"key":"e_1_2_1_36_1","doi-asserted-by":"crossref","unstructured":"P. M. Leonardi. 2011. When flexible routines meet flexible technologies: Affordance constraint and the imbrication of human and material agencies. MIS Quart. 35 1 (2011).   P. M. Leonardi. 2011. When flexible routines meet flexible technologies: Affordance constraint and the imbrication of human and material agencies. MIS Quart. 35 1 (2011).","DOI":"10.2307\/23043493"},{"key":"e_1_2_1_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1350508407082263"},{"key":"e_1_2_1_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.HMR.0000296785.29718.5d"},{"key":"e_1_2_1_39_1","doi-asserted-by":"publisher","DOI":"10.2307\/3250948"},{"key":"e_1_2_1_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2011.03.009"},{"key":"e_1_2_1_41_1","doi-asserted-by":"publisher","DOI":"10.1057\/ejis.2012.2"},{"key":"e_1_2_1_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2013.01.009"},{"key":"e_1_2_1_43_1","article-title":"An improvisational model for change management: The case of groupware technologies","volume":"38","author":"Orlikowski W. J.","year":"1997","journal-title":"Sloan Manag. Rev."},{"key":"e_1_2_1_44_1","doi-asserted-by":"publisher","DOI":"10.5465\/19416520802211644"},{"key":"e_1_2_1_45_1","doi-asserted-by":"crossref","unstructured":"W. J. Orlikowski. 2009. The sociomateriality of organisational life: Considering technology in management research. Cambridge Journal of Economics.  W. J. Orlikowski. 2009. The sociomateriality of organisational life: Considering technology in management research. Cambridge Journal of Economics.","DOI":"10.1093\/cje\/bep058"},{"key":"e_1_2_1_46_1","doi-asserted-by":"publisher","DOI":"10.1145\/2207676.2208361"},{"key":"e_1_2_1_47_1","doi-asserted-by":"publisher","DOI":"10.1518\/001872006776412234"},{"key":"e_1_2_1_48_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M1700"},{"key":"e_1_2_1_49_1","volume-title":"Proc. AMIA Annual Symposium","author":"Richardson J."},{"key":"e_1_2_1_50_1","unstructured":"N. Rosenberg. 1982. Inside the Black Box. Cambridge University Press Cambridge UK.  N. Rosenberg. 1982. Inside the Black Box. Cambridge University Press Cambridge UK."},{"key":"e_1_2_1_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2011.03.016"},{"key":"e_1_2_1_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-8231(02)03007-0"},{"key":"e_1_2_1_53_1","doi-asserted-by":"crossref","unstructured":"M. J. Tyre and W. J. Orlikowski. 1994. Windows of opportunity: Temporal patterns of technological adaptation in organizations. Organ. Sci. (1994) 5 1 (1994) 98--118.  M. J. Tyre and W. J. Orlikowski. 1994. Windows of opportunity: Temporal patterns of technological adaptation in organizations. Organ. Sci. (1994) 5 1 (1994) 98--118.","DOI":"10.1287\/orsc.5.1.98"},{"key":"e_1_2_1_54_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M2378"},{"key":"e_1_2_1_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(03)00057-3"},{"key":"e_1_2_1_56_1","first-page":"491","article-title":"Promoting clinical involvement in hospital quality improvement efforts: The effects of top management, board, and physician leadership","volume":"32","author":"Weiner B. J.","year":"1997","journal-title":"Health Serv. Res."},{"key":"e_1_2_1_57_1","doi-asserted-by":"publisher","DOI":"10.1145\/1978942.1979439"}],"container-title":["ACM Transactions on Computer-Human Interaction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dl.acm.org\/doi\/10.1145\/2656213","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dl.acm.org\/doi\/pdf\/10.1145\/2656213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T07:19:37Z","timestamp":1750231177000},"score":1,"resource":{"primary":{"URL":"https:\/\/dl.acm.org\/doi\/10.1145\/2656213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,17]]},"references-count":57,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2015,3,4]]}},"alternative-id":["10.1145\/2656213"],"URL":"https:\/\/doi.org\/10.1145\/2656213","relation":{},"ISSN":["1073-0516","1557-7325"],"issn-type":[{"value":"1073-0516","type":"print"},{"value":"1557-7325","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,17]]},"assertion":[{"value":"2013-09-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-09-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-02-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}