"Where Does the Blood Go?": Constructing an Electronic Medical Records System in the United States, 1960-1990

Abstract

Electronic medical record systems are complex technologies that reflect the decisions of both its developers and its users. The construction of a new electronic record system in 1960-1990 Massachusetts and Vermont is an opportunity to explore these decisions and the specific ways in which technologies have values, priorities, and demands embedded within the artifacts. The two cases examined in this analysis act as contrasting foils to each other, demonstrating how the same type of technology can be constructed in distinctly different ways that shape the artifact's place within the workplace. One case is the Laboratory of Computer Science at the Massachusetts General Hospital, developing the Hospital Computer Project in the 1960s, the programming language MUMPS in the 1960s-1970s, and the publicly available system COSTAR in the 1970s-1980s. The second case is the problem-oriented medical record and its computerized version, PROMIS, from Lawrence Weed at the University of Vermont, 1964-1990. The cases are analyzed through the lens of Andrew Abbott's The System of Professions in order to explore the social, professional, and work components of these technical artifacts. The dissertation falls into the science and technology studies traditions of studying sociotechnical systems, boundary objects, controversies, and histories of technology.