• electronic prescribing
• digital infrastructure

Digitalization:  ‘The encoding of analogue information into a digital format and the possible subsequent reconfigurations of the socio-technical context of production and consumption of the associated products and services’.1

This edition includes two papers reporting research from a 5-year study of electronic prescribing in English hospitals.2 3 The papers each address a significant safety and quality issue drawing data from the wider study. These issues are the level of coordination and integration that electronic prescribing systems achieve,3 and the emergence of ‘workarounds’ as managers and clinical users adapt electronic prescribing systems’ capabilities to their needs and working environment.2 The risks to patient safety posed by these systems, their implementation and use are further explored in a third associated paper published elsewhere.4

Workarounds were found to be either ‘informal’ or ‘formalised’ practices, the former derived from user innovations, the latter promoted and endorsed by management. Both types involved the use of other ‘intermediary systems’, such as paper or other software.2 While workarounds can create new risks and are an opportunity for safety issues to emerge, the study does acknowledge the positive role of workarounds in permitting poor usability of systems to be addressed, as ‘intentional strategies to help users gradually get used to a new system’, and as a means to support local innovation and tailoring.

The issue of integration of information is a common theme that crosses both studies. Workarounds, arguably, serve to better integrate information into work practices while the interfacing of multiple digital systems can provide a more coherent and timely flow of information. The research reports that even integrated hospital-wide systems were found not to interface well with external systems.3 It is important to note that the systems considered for integration with electronic prescribing in these studies are not …