Contextual influences on technology use mediation: a comparative analysis of electronic medical record systems

Developing, implementing and assimilating information technologies into organizational practices pose significant technical and social challenges. In this paper, we explore technology use mediation (TUM) processes in two cases of electronic medical record system use in two healthcare organizations. In our analysis, we examine contextual influences on mediation and consider TUM processes and outcomes in projects utilizing modern systems development methods. We found that crucial TUM actions occurred during systems development phases as well as during system use, that mediation was vitally important with these specialized IT artefacts, and that system configuration required changes to software infrastructure and code. Organizational size influenced the availability and the effectiveness of mediation resources; with adequate resources committed to the task, the institutional environment presented substantial, but not insurmountable, challenges to technology use mediation. We consider implications for practice and suggest future research directions.