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Boundary-Object Trimming: On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures

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Abstract

As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (11 hours), interviews (three individual and one group) and survey data (31 of 250 respondents were medical secretaries). We depict medical secretaries’ core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments’ work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term ‘boundary-object trimming’ to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power.

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Acknowledgments

Our sincere thanks to the staff at Regional Hospital for their cooperating in connection with the EHR evaluation, and to the reviewers for constructive comments.

Notes

  1. i

    Of the 41 hits on medical secretaries 13 focused on work conditions broadly; 7 were handbooks, manuals or voice recognition tools; 5 point to medical secretaries as being undervalued; 4 focus on neck and shoulder pain; 3 deal with EPRs (Lærum et al. (2004), Bertelsen and Nøhr (2005), and Bossen et al. (2012)). The remaining 9 hits have various content (obituaries, letters to the editor, minutes of meetings) (Search performed 6th April 2012)

  2. ii

    Whereas such a search may not provide rigorous results upon scholarly work upon these professions, the tendency is clear. GoogleScholar was searched for [“medical secretary” OR “medical secretaries”] in the title from 1990 to 2012, and identical searches were made for [“nurse” OR “nurses”], and [“physician” OR “physicians”].

    Adding “electronic” to similar searches on these three professions with the words anywhere in papers between1990 and 2012 provides the same clear pictures. Results for medical secretaries, nurses and physicians are 1.700; 351.000; and 444.000 hits respectively (Searches performed 6th of April 2012).

    In the USA, there are no ‘medical secretaries’ as such since the tasks are divided between health information managers, transcriptionists, chart completion, and medical coders. However, search results are meager: 65, 59, 5, and 4 hits respectively (Search as above. For the latter, search was conducted for ‘diagnostic coder’, ‘medical coder’ or ‘medical records technician’ in singular and plural as for the other terms) (Searches performed 19th of April 2012). Adding ‘electronic’ to the searches, also from 1990 to 2012, as above resulted in 397 hits for health information manager; 2670 hits for transcriptionist; 137 hit for chart completion; 479 hits for medical coder (all in singular and plural).

  3. iii

    Searches were conducted for ‘medical secretary’, ‘medical coder’, ‘diagnostic coder’, ‘medical records technician’, ‘transcriptionist’, ‘health information manager’ in singular and plural.

  4. iv

    In Denmark 98 % (Chairperson of the Danish association of medical secretaries, personal communication); in the UK 99 % of members in the British Society of Medical Secretaries & Administrators are women (Special Projects Manager, BSMSA, personal communication).

  5. v

    See their newsletters (in Danish): http://www.hk.dk/kommunal/dit_fag/dl/nyhedsarkiv (accessed 10th of April 2012)

  6. vi

    http://www.hk.dk/kommunal/dit_fag/dl/nyhedsarkiv/2011/arbejdsgange_paa_hospitaler_traenger_til_fornyelse (accessed 10th of April 2012)

  7. vii

    http://www.bsmsa.org.uk/index.cfm?task=news&targetnewsid=57

  8. viii

    The number of medical secretaries is almost stable with a decrease of only 0.4 % from 2009–2011 (http://www.hk.dk/kommunal/dit_fag/dl/nyhedsarkiv/2012/laegesekretaerer_slipper_naadigt).

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  1. Information Studies, Aarhus University, Helsingforsgade 14, 8200, Aarhus N, Denmark

    Claus Bossen

  2. Department of Health Technology Assessment, Institute of Public Health, Aarhus University, Oluf Palmes Alle 15, 8200, Aarhus N, Denmark

    Lotte Groth Jensen

  3. Danish Center for Health Care Improvements, Faculty of Social Sciences & Faculty of Medicine, Aalborg University, Fibigerstræde 11, 9220, Aalborg Ø, Denmark

    Flemming Witt Udsen

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Bossen, C., Jensen, L.G. & Udsen, F.W. Boundary-Object Trimming: On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures. Comput Supported Coop Work 23, 75–110 (2014). https://doi.org/10.1007/s10606-013-9195-5

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