A cross-case analysis of technology-in-use practices: EPR-adaptation in Canada and Norway

Purpose: To identify and characterize enabling factors that support a continuous adaptation of technology and work practices in the health care sector. Methods: Cross-case analysis of two longitudinal ethnographic studies of managing the gradual adaptation of electronic patient records, one in Canada and one Norway. Results: The cross-case analysis revealed that technology-in-use practices developed more rapidly in one of the cases, and one of the major driving forces was the establishment of a special committee and the associated project meetings. Based on the literature and grounded in the empirical observations, we complement and expand the notion of project meetings as composed of continuous reflection-on-practice activities to construct technology-in-use practices. Conclusion: We characterize reflection-on-practice activities as frequent encounters of negotiations of work practices and technology use, providing internal actors a space for systematic evaluation of suggested changes. Further we argue that representatives of the affected professions should not only participate, but also have a mandate to make and evaluate decisions of the technology-in-use practices of the particular group. (C) 2008 Elsevier Ireland Ltd. All rights reserved.