Epic disappointment: Physicians’ experiences of steerability in data-driven healthcare

This paper examines discrepancies between expectations and actual data management practices in healthcare. It develops the concept of steerability to demonstrate how guidance provided by integrated, multipurpose patient data management systems functions as a sociotechnical feature and a core value in emerging data-driven healthcare, and what happens when the promises of an all-encompassing data infrastructure fail. The paper analyses physician’s accounts and criticisms over an Epic-based patient data management system, Apotti, implemented in a public healthcare organization in Finland’s capital region. Apotti aimed to standardize care and enhance oversight of the entire healthcare organization through data, following the idea that steerable healthcare functions better. While physicians did not oppose the datafication reform itself, their experiences reveal a stark misalignment between Apotti’s steerability and their wants and needs, as it paradoxically both over- and understeered them. Clinicians felt the system fundamentally disrupted the core practices and values of their work, limiting their abilities in providing care. The paper shows how this deep mismatch was related to Apotti’s poor fit with the Finnish healthcare system and the healthcare organization’s more radical steerability objectives. Given the unfounded promises and misaligned effects, it raises the question of what role steerability plays in driving forward data-driven healthcare. • Steerability is a sociotechnical feature and a value of data-driven healthcare • Physicians accepted steerability but found the new system’s steering misaligned • The system disrupted physicians’ practices, failing its organizational goals • Poor fit with Finnish healthcare and huge managerial goals caused the misalignment • The findings question how much steerability should drive data-driven healthcare