Variations in the use of electronic medical records in obstetrics and gynecology consultation: role of sociocultural aspects

Abstract

The use of electronic medical records (EMRs) in providing quality care for patients is spreading across countries including India. A systematic review of the literature reveals that EMR systems are designed as the database of medical records, and document health needs in biomedical terms. With potential implications for women’s health care, the biomedical framing of health discounts pre-existing sociocultural dispositions that inform meanings of health, illness, and healthcare practices. This thesis explores how women’s sexual and reproductive health needs are socially and culturally situated which potentially lead to variations in the use of EMR. The fieldwork comprised direct observations and conversations with eight obstetrics and gynecology doctors working in four kinds of hospitals and their teams and more than forty women who were consulting the doctors. Data collection spanned eight months and involved more than two weeks of on-site interactions with each doctor, which were analysed using grounded theory. While incorporating reflexivity and culture-centered approach to health for fieldwork and data analysis, the study emphasizes the nuances of researcher-researched relationship. EMR systems are designed considering doctors with biomedical training as primary users. However, the study finds that patients also use EMRs for managing not only medical risks but also social risks. Beyond doctors’ biomedical reasoning, the latter usage influences the use of EMR by doctors as they decide whether to record or not depending on their evaluation of the day-to-day appropriateness of the data in accordance with gender norms, familial responsibilities, folk knowledge, and stigmatization of certain health conditions in the immediate society. Yet, the biomedical design approach of EMR reduces the likelihood of fostering a dignified life for women. Hence, this thesis argues for a woman-centered design approach joining the conversations on patient-centric health IT designs within the domain of human-computer interaction (HCI). Accordingly, this work recommends design justice principles to explore opportunities for advancing health needs of women and to engage with research in HCI’s design-in-use paradigm. The findings are important in the contemporary context as the digitalization of health records is being encouraged by the Indian government and more intensely after the Covid-19 outbreak.