Accounting and Co-Constructing: The Development of a Standard for Electronic Health Records
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Patient records are central, constitutive parts of health care and hospitals. Currently, substantial sums are being invested in making patient records electronic, in order to take advantage of IT’s ability to quickly accumulate, compute, and propagate data to multiple sites, to enhance coordination of health care services and cooperation among staff, and make patient records immediately accessible to distributed actors. Investors also aim to increase health care services’ accountability and integration, and improve quality and efficiency. This paper analyses a Danish national standard for electronic health records, on the basis of an application prototype test designed to that standard. The analysis shows that, inscribed in the standard is an ambition to increase the accountability of staff and health care services at the cost of increased work, loss of overview, and fragmentation of patient cases. Significantly, despite the standard having been conceived and developed in a process of co-construction involving clinicians, clinicians did not find it adequate for their work. This analysis argues this was the result of the model of work embedded in the standard coming from a stance external to practice. Subsequently, a flip-over effect occurred, in which the model of work became a model for work. Hence, this paper argues that co-construction processes should not only include users as representatives of a profession, but strive to produce experiences and knowledge intrinsic to practice.
Key wordsaccountability clinical work co-construction electronic health records health care hospitals participatory design representations user involvement
Sincere thanks to the staff at the Endocrinology Department, and the three anonymous reviewers.
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