Healthcare systems across the globe are riding a wave of clinical health IT investment, centered on electronic health records (EHR) systems. Supported by governmental incentives, this build-out has positioned the healthcare system for a period of transformation as EHR functionality has become ingrained in the work routines of healthcare providers and other system participants. We report on a field study of healthcare participants in the United States to explore the influence of EHR use 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 highlight the changes to both boundary spanning and field practices engendered by enterprise EHR use and propose the complementary mechanisms of reticulation and boundary molding by which those changes emerge. We conclude with a consideration of the positive and potentially negative consequences of EHR use for delivery of healthcare services.

全球医疗保健系统正在掀起以电子健康记录 (EHR) 系统为中心的临床健康 IT 投资浪潮。在政府激励措施的支持下，这种扩建使医疗保健系统处于转型期，因为 EHR 功能已成为医疗保健提供者和其他系统参与者的工作常规中根深蒂固的一部分。我们报告了对美国医疗保健参与者的一项实地研究，以探讨电子病历的使用对该领域的边界和实践的影响。我们的扎根理论分析揭示了各个社区的现场实践与将它们联合起来的跨界实践之间的相互作用。通过采用实践视角，这些变化是通过网状和边界成型产生的。最后，我们考虑了使用电子病历提供医疗保健服务的积极和潜在的消极影响。