Enacting computer workaround practices within a medication dispensing system

Computer workarounds in health information systems ( HIS) threaten the potential for gains in efficiency through computerization aimed at reducing process variability. Eliminating such workarounds is desirable, but information system ( IS) researchers tend to treat computer workarounds as black-boxes, whereas HIS researchers are primarily concerned with descriptive or prescriptive remedies. We propose to open the black-box of computer workarounds and study them as situated practices that consist of adjustments to existing computer-based procedures, which are enabled by the negotiated order of a hospital. This negotiative property of a hospital's organizational environment allows for interpretive flexibility, in which physicians stretch certain rules in practice, while inducing others to cooperate. We illustrate this conceptual framework with a non-participant observer case study of a medication dispensing system used in a teaching hospital to support a prior-approval policy for anti-microbial drugs. Within these enacted workaround practices, we found significant variety in roles, timing and interactions, which boil down to a pattern of four practices revolving around one function of an HIS. Our research extends the literature on computer workarounds in IS and HIS by proposing a theoretical understanding of workaround practices based on a contextual healthcare study.