Paper Versus Electronic Medical Records: The Effects of Access on Physicians' Decisions to Use Complex Information Technologies*

This study examines physicians' responses to complex information technologies (IT) in the health care supply chain. We extend individual‐level IT adoption models by incorporating a new construct: system accessibility. The main premise of the study is, when faced with a decision between alternate IT systems, individual users tend to select and make use of the technology or system that is most readily accessible. We discuss both physical and logical dimensions of accessibility as they relate to adoption of electronic medical records (EMR). Physical accessibility refers to the availability of computers that can be used to access EMR, while logical accessibility refers to the ease or difficulty of logging into the system. Using data from a survey of 199 physicians practicing in a large U.S. hospital, we show that, when deciding between the paper chart and EMR, accessibility is an important consideration in a physician's decision to use the system. Both dimensions of accessibility act as barriers to EMR use intentions through their indirect effect on physicians' perceptions of EMR usefulness and ease of use. Logical access also has a direct effect on EMR use intentions. We conclude that accessibility is an important factor that limits acceptance of complex IT such as EMR.     

Clinical clues in the breathing behaviors of patient and therapist

Verbal communications have dominated treatment theories and will remain a privileged source of communication. This paper directs the therapist's attention to some of the possible breathing behaviors in treatment which may, like verbal language, convey an unconscious or conscious message that is possibly interpretable. Breathing has meaning in the transference—countertransference intersubjective world. Behavior symbolized by breathing may be included in the earliest somatic, dyadic interaction and may therefore go with one through life and reappear in every new relationship. This paper directs the clinician's attention to some of the possible meanings and interpretations of breathing behavior during treatment. It calls attention to techniques for exploring the rich connection between breathing, body, object and somatization.     

Sociology and value neutrality: Limiting sociology to the empirical level

The scientific objectivity of sociology depends upon adherence to value neutrality, an adherence that strengthens the social power of sociologists. Yet all disciplines, including science, are motivated by values. This article argues that value neutrality is both possible and desirable for sociology, even though a number of values appear to be necessary to the sociological project. Among those values, some are necessary to the project of science as such, while others guide research interests. I argue that value consensus among sociologists regarding any extrascientific (research guiding) value raises questions of scientific integrity: Critical rationalism and humanitarianism are considered in this context. The scientific status of sociology is also compromised by nonempirical pronouncements, including the advocacy of certain values (such as egalitarianism) and of positions regarding the status of values (e.g., cultural relativism). I propose that the role of social scientist be kept distinct from the roles of moral philosopher and of theologian, and that this division of labor be accomplished by a scientific adherence to value neutrality. An earlier version of this paper was first presented at the 1990 Annual Meeting of the American Sociological Association.     

Sexual functioning and practices in a multi-ethnic study of midlife women: baseline results from SWAN

This study examined the sexual practices and function of midlife women by ethnicity (African American, Caucasian, Chinese, Hispanic, Japanese) and menopausal status. Sexual behavior was compared in 3,262 women in the baseline cohort of SWAN. Participants were 42 to 52 years old, premenopausal or early perimenopausal, and not hysterectomized or using hormones. Analysis used multivariate proportional odds regression. In our sample, 79% had engaged in sex with a partner in the last 6 months, and a third considered sex to be very important. Common reasons for no sex (n = 676) were lack of partner (67%), lack of interest (33%), and fatigue (16%). Compared with Caucasians, Japanese and Chinese women were less likely, and African Americans more likely, to report sex as very important (p < 0.005). Significant ethnic differences were found for frequency of all practices. Perimenopause status was associated only with higher frequencies of masturbation and pain during intercourse.