Introduced in 1994 [1], technology use mediation (TUM) has become an important approach to managing the large number of currently available software packages and computer-mediated communication technologies, and to integrating them into an efficient information system, based on the organization’s particularities and changing supporting contexts.

After reviewing the literature on TUM, the authors present their experiences concerning TUM processes. The implementation of an electronic medical record system (EMRS) is considered, both for a large organization (a hospital in the US) and for a small outpatient clinic (a cardiology clinic in Canada). Two different paths are identified and discussed, from the TUM viewpoint, for the resulting EMRS. The comparison is made in accord with the TUM phases (establishment, reinforcement, adjustment, and episodic change), and considers not only TUM resources and TUM outcomes, but also the contextual influences on TUM.

The obtained results suggest “that implementing specialized software technologies entails TUM processes,” and that it is necessary for TUM actions to “begin before the system goes into operational use and continue during system use.” The analysis shows that “TUM processes and outcomes are influenced by contextual factors such as the nature of the [information technology (IT)] artefact, malleability of the software, institutional influences from the organizational environment and organization size.” The material is organized into six sections, references, and one appendix. In my opinion, the paper is long, but the material is presented well.