Balancing Work Practices and Protocols in the Design of EMR Systems: The Case of Developing an EMR System for Antenatal Care Services in Malawi

Implementing ICTs in healthcare settings has proved to be very challenging such that progress towards widespread adoption and use of Electronic Medical Record (EMR) systems has been slow. The challenges of implementing these technologies have been described as complex, diverse, and locally situated. One of the challenging aspects of designing EMR systems is the need for inscribing standardised protocols whilst taking into account local work practices. Previous research has called for the need to balance work practices and protocols in the design of EMR systems. We present an attempt to balance the work practices and protocols in the development of an EMR system for antenatal care in a developing country, Malawi. This was done through implementing weak inscriptions of the protocols in some cases and strong inscriptions in other cases. The study highlights the important role that clients play in healthcare work and thus, influence the design of EMR systems.