The passage of the US Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the financial incentives provided by the Meaningful Use (MU) program stimulated healthcare providers in the United States to adopt electronic health records (EHRs). The digital turn that followed changed dramatically and unexpectedly the organisation and delivery of health services. Drawing upon long‐term ethnographic fieldwork, Barbara Cook Overton's book documents the profound and pervasive changes brought by the transition from paper charts to EHRs.

The study began as a multi‐sited ethnography conducted in the emergency rooms (ERs) of three hospitals. In the first chapter, which is devoted to the ER culture, Overton uses this preliminary research to set the stage for the analysis of technological change and its consequences. However, the remainder of the book builds upon data collected in only one setting, a Southern Louisiana suburban hospital (referred to as ‘Hospital H’) that was in the early stage of transitioning to electronic records at the beginning of fieldwork. By capturing the whole process of adopting a new technology, the book unravels the emergence of more or less subtle structural changes that alter for the worse the established medical practice at the ER.

Policymakers expected that EHR would improve practitioners' efficiency and productivity, drop costs, reduce medical errors, and ensure better care for patients. Overton's thorough analysis shows that the implementation of electronic records largely fell short of these expectations. In the ER under scrutiny, the hasty adoption of a poorly designed EHR system exacerbated existing problems and created additional ones. The electronic records changed not only the ways of documenting care but also the culture of the organisation and the relations among members. The interpersonal relations became weaker, and the sense of camaraderie began to vanish as computer‐mediated interaction replaced much of the face‐to‐face communication. Moreover, the decreased direct interaction also created a fertile ground for misunderstandings and medical errors. While EHR is more comprehensive than the paper charts that preceded it, this comprehensiveness came at the expense of simplicity. Learning the new software is a tedious endeavour, and using it as part of the day to day work is time‐consuming. For instance, due to the different sections of the EHR system being poorly integrated, the collection of relevant information, such as medical history, often needs to be duplicated, consequently extending the length of patients' stay and frustrating everyone involved (p. 108). Overton shows that the format of the electronic records also changes the organisation of clinical encounters, making them more fragmented and focused around issues of bureaucratic interest. The medical record itself shifts from privileging the patient story and the physician's interpretation of it to a decontextualised set of indicators that are difficult to read by practitioners. In other words, the abundance of information is undermined by the lack of coherence. At Hospital H, the EHR system also failed the promise of increasing overall revenues because of its poor integration with the billing system (pp. 176‐180).

The use of a complex theoretical framework that combines Giddens’ (1984) structuration theory with two extensions of it, the adaptive structuration theory and the modified adaptive structuration model, leads to a convincing demonstration of how technology change goes against its goals and compromises the functioning of the ER. However, the problems inherent to EHR are not set apart from those pertaining to the design of the system in place at Hospital H or to the transitioning process itself. It is, therefore, difficult to distinguish between the structural changes to the organisation of emergency care brought by the adoption of new technology and the local problems that originate in a multiplicity of factors, of which the selection of the EHR system is one.

In this respect, the book could have benefited from a comparative approach. Hospital H is not a typical case of a community hospital. By the time it introduced electronic records, it was in dire financial straits and had experienced significant turmoil, including a restructuring of the wage structure and high staff turnover. The EHR system it adopted was also considerably cheaper, but more cumbersome and less efficient than its competitors. The selection of a second research site different in terms of economic performance and EHR system could have led to a more complex and nuanced understanding of the phenomenon under scrutiny.

Notwithstanding these limits, the book makes a meaningful contribution to the study of healthcare organisation at a time of technological governance. As such, it can be relevant to a broad audience, including not only scholars of health systems, but also policymakers, hospital managers, providers of care, and health IT designers. The final chapter of the book provides useful practical suggestions on how to make the EHR system better serve the interests of the healthcare community.

2009年美国经济和临床健康信息技术（HITECH）法案的通过以及有意义使用（MU）计划提供的经济激励措施刺激了美国的医疗保健提供者采用电子健康记录（EHR）。随后发生的数字化转变极大地改变了医疗服务的组织和提供方式。芭芭拉·库克·奥弗顿（Barbara Cook Overton）的书借鉴了长期的民族志田野调查，记录了从纸质海图向电子病历的过渡带来的深刻而普遍的变化。

该研究始于在三所医院的急诊室（ER）中进行的多地点人种志研究。在致力于ER文化的第一章中，Overton使用此初步研究为分析技术变革及其后果奠定了基础。但是，本书的其余部分仅基于在一种情况下收集的数据，即路易斯安那州南部的郊区医院（称为“医院H”），该医院在实地调查开始时正处于向电子记录过渡的早期阶段。通过掌握采用新技术的整个过程，该书揭示了或多或少的细微结构变化的出现，这些变化使急诊室既定的医学实践变得更糟。

政策制定者期望EHR可以提高从业者的效率和生产率，降低成本，减少医疗错误，并确保为患者提供更好的护理。Overton的详尽分析表明，电子记录的实施大大低于这些期望。在接受审查的急诊室中，匆忙采用设计不良的电子病历系统加剧了现有问题并产生了其他问题。电子记录不仅改变了记录护理的方式，而且改变了组织的文化和成员之间的关系。人际关系变得越来越弱，随着计算机介导的互动取代了很多面对面的交流，友情意识开始消失。此外，减少的直接互动也为误解和医疗错误创造了沃土。尽管EHR比之前的纸质图表更为全面，但这种全面性是以牺牲简单性为代价的。学习新软件是一项乏味的工作，将其用作日常工作的一部分非常耗时。例如，由于电子病历系统的不同部分整合不善，经常需要重复收集相关信息（例如病史），从而延长了患者的住院时间，并使每个相关人员感到沮丧（第108页） 。Overton指出，电子记录的格式也改变了临床交流的组织，使其更加分散，并集中在官僚利益问题上。医疗记录本身从特权病人的故事和医生的特权转变 将其解释为脱上下文的一组指标，这些指标很难被从业人员阅读。换句话说，缺乏连贯性破坏了信息的丰富性。在H医院，EHR系统也未能实现增加总收入的承诺，原因是它与计费系统的集成不佳（第176-180页）。

使用复杂的理论框架，将Giddens（1984）的结构化理论与它的两个扩展相结合，即自适应结构化理论和改进的自适应结构化模型，可以令人信服地证明技术变革如何违背其目标并损害其功能。 ER。但是，EHR固有的问题并未与医院H的系统设计或过渡过程本身有关。因此，很难区分由于采用新技术而导致的紧急护理组织的结构性变化与由多种因素引起的局部问题，其中选择电子病历系统是其中之一。

在这方面，该书本可以从比较方法中受益。医院H不是社区医院的典型案例。当它引入电子记录时，它已经陷入严重的财务困境，经历了严重的动荡，包括工资结构的调整和人员流动率的提高。它采用的电子病历系统也比竞争对手便宜得多，但又麻烦又效率低下。在经济表现和电子病历系统方面选择不同的第二个研究地点可能会导致对这种现象进行更复杂和细微的了解。

尽管有这些限制，该书仍对技术治理时期的医疗保健组织研究做出了有意义的贡献。因此，它可能与广大受众相关，不仅包括卫生系统学者，而且还包括政策制定者，医院经理，护理提供者和卫生IT设计师。本书的最后一章就如何使EHR系统更好地服务于医疗界的利益提供了有用的实用建议。