Autonomy and Electronic Health Records: Can We Have Both?

Physicians, as highly-trained professionals, have a sense of autonomy about how they perform their work. Electronic health record (EHR) systems can be constraining and thus may affect physicians' sense of autonomy. Such effects have been reported in the literature, but they may be due to managers using the EHR to exercise more control. We are studying an EHR implementation in an organization known for the autonomy it allows affiliated primary care practices. We are collecting longitudinal, qualitative data and using grounded theory methods. We found that healthcare professionals think broadly about autonomy and want control over how their practices operate. After the implementation of the basic EHR, few autonomy effects were observed, but more functionality is being implemented, including physician order entry and a patient portal, that may have stronger effects on autonomy. To test these possibilities, we will be collecting a second round of data after physician order entry is implemented.