National electronic health records and the digital disruption of moral orders

Soc Sci Med. 2014 Jan;101:70-7. doi: 10.1016/j.socscimed.2013.11.029. Epub 2013 Nov 23.


The digitalisation of patient health data to provide national electronic health record systems (NEHRS) is a major objective of many governments. Proponents claim that NEHRS will streamline care, reduce mistakes and cut costs. However, building these systems has proved highly problematic. Using recent developments in Australia as an example, we argue that a hitherto unexamined source of difficulty concerns the way NEHRS disrupt the moral orders governing the production, ownership, use of and responsibility for health records. Policies that pursue digitalisation as a self-evident 'solution' to problems in healthcare without due regard to these disruptions risk alienating key stakeholders. We propose a more emergent approach to the development and implementation of NEHRS that supports moral re-ordering around rights and responsibilities appropriate to the intentions of those involved in healthcare relationships.

Keywords: Australia; Digital disruption; Moral order; National electronic health record systems; Personal control; Policy; Responsibilities; Rights.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Delivery of Health Care / ethics
  • Delivery of Health Care / organization & administration*
  • Electronic Health Records*
  • Health Policy
  • Humans
  • Morals*
  • Patient Rights / ethics
  • Social Responsibility