Technology Readiness through Collaborative Reflection: A Qualitative Case Study of an Under-Resourced Nurse-Managed Clinic

This paper reports how a nurse-managed primary care clinic (NMPCC) prepared for the implementation of an Electronic Health Record (EHR) system with limited resources. EHR adoption is a complex task that requires not only implementing a system but also an integration of the system into the existing sociotechnical environments. In this study, we identified three stages of the process improvement meetings conducted at the clinic: (1) understanding routines, roles, and practices, (2) identifying problems and deficiencies, and (3) iterating interventions by optimizing resources through reconfiguring artifacts and work practices. Importantly, we found the staff jointly reflecting on one another's experiences and practices by making sense of the collaborative work. We regarded this sense-making process as collaborative reflection, and argued that it enhanced technology readiness of the NMPCC through creating a more technology-compatible and collaborative sociotechnical environment for the impending EHR implementation.