Linking macro-level goals to micro-level routines: EHR-enabled transformation of primary care services

Information and communication technologies are known to be instrumental in the enhancement of healthcare management capabilities in developing countries. Turkey – a developing country – has undergone a major healthcare transformation marked by the redesign of primary care delivery and the implementation of a nation-wide Electronic Health Records (EHR) system. In this research, presenting Turkey’s case, we investigate the consequences of EHR implementation in developing countries. We argue that to better understand the consequences, we need to link macro-level healthcare goals with micro-level system usage behaviors that actualize the macro-level goals or alternatively result in unintended negative health outcomes. We posit that this linkage is achieved through the meso-level structures, namely the EHR and the organizational context, in which it is embedded. Hence, we examine the EHR’s role in this relationship. Our findings indicate that EHR usage both enables and constrains the achievement of clinicians’ professional goals in the context of primary care delivery. Moreover, goal alignment between the government agency as the designer of the system and the clinicians influence the outcomes of the EHR-enabled transformation. When the healthcare goals are aligned, the system enables the clinicians to achieve their professional goals and their system usage behaviors converge, contributing to improvements in health outcomes. Contrarily, when the goals are misaligned, the system constrains goal achievement and the clinicians show divergent usage behaviors, including goal abandonment. In turn, goal abandonment may lead to negative consequences and even adversely affect the achievement of population-level healthcare goals in the long run.