Right Information, Right Time, Right Place: Physical Alignment and Misalignment in Healthcare Practice

Implementation of new health information systems such as Electronic Health Records (EHR) is expected to reap many benefits. However, the transition from one information system to another is often associated with inefficiency, ineffectiveness, and patient safety hazards. These negative consequences are difficult to predict and avoid before system transitions take place. The changed physical form of information remains an unexamined facet of healthcare system transitions. Using ethnographic methods in two clinical sites, we discovered a recurrent set of problems that emerged due to physical disconnections between information and practice predicated on implementation of new information systems. "Physical misalignments" are instances where workers cannot bring information sources to hand in the precise time and place in which they are needed. We identify three types of physical misalignments, then discuss how physical misalignments can be proactively identified and corrected before, during, and after implementation of new health information systems.