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The U.S. healthcare system is riding a wave of clinical health IT investment, centered on electronic health records (EHR) systems adoption. Supported by governmental incentives, this build-out has positioned the healthcare system for a period of transformation as EHR functionality becomes ingrained in the work routines of healthcare providers and other system participants. We report on a field study of healthcare participants to explore the influence of EHR adoption on the boundaries and practices of the field. Our grounded theory analysis reveals the interplay between the field practices of individual communities and the boundary spanning practices that unite them. Through the adoption of a practice perspective, we assess the varied boundary object aspects of EHR systems and their influence on boundary spanning and field practices alike. We conclude with a consideration of the positive and potentially negative consequences of widespread EHR use for delivery of healthcare services.

ABSTRACTOrganizational decision making is dominated by teams. When an important decision is required, a team is often formed to make it or to advise the individual decision maker, because a team has more resources, knowledge, and political insight than any one individual working alone. As teams have become geographically distributed, collaboration technology has come to play an important role in such collective decision making efforts. Instant messaging (IM) is an increasingly prevalent workplace collaboration technology that enables near‐synchronous text exchanges on a variety of devices. We examined the use of IM during face‐to‐face, telephone, and computer‐mediated team meetings, a practice we call "invisible whispering." We introduce Goffman's characterization of social interaction as dramatic performance, differentiable into "front stage" and "backstage" exchanges, to analyze how invisible whispering alters the socio‐spatial and temporal boundaries of team decision making. Using IM, workers were able to influence front stage decision making through backstage conversations, often participating in multiple backstage conversations simultaneously. This type of interaction would be either physically impossible or socially constrained without the use of IM. We examine how invisible whispering changes the processes of collaborative decision making and how these new processes may affect the efficiency and effectiveness of collaborative decision making, as well as participation, satisfaction, relationships among team members, and individual attention.

Organizational decision making is dominated by teams. When an important decision is required, a team is often formed to make it or to advise the individual decision maker, because a team has more resources, knowledge, and political insight than any one individual working alone. As teams have become geographically distributed, collaboration technology has come to play an important role in such collective decision making efforts. Instant messaging (IM) is an increasingly prevalent workplace collaboration technology that enables near-synchronous text exchanges on a variety of devices. We examined the use of IMduring face-to-face, telephone, and computer-mediated team meetings, a practice we call "invisible whispering." We introduce Goffman's characterization of social interaction as dramatic performance, differentiable into "front stage" and "backstage" exchanges, to analyze how invisible whispering alters the socio-spatial and temporal boundaries of team decision making. Using IM, workers were able to influence front stage decision making through backstage conversations, often participating in multiple backstage conversations simultaneously. This type of interaction would be either physically impossible or socially constrained without the use of IM. We examine how invisible whispering changes the processes of collaborative decision making and how these new processes may affect the efficiency and effectiveness of collaborative decision making, as well as participation, satisfaction, relationships among team members, and individual attention.