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Local knowing and the use of electronic patient records: categories and continuity of health care

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Abstract

The electronic patient record (EPR) is a constitutive element of medical practice and can be conceived of as a multi-purpose tool that is intended to support a range of activities such as planning, decision-making and evaluation. Each of these activities is quite complex in its own right. The aim of the present study is to explore how the standardized format of EPRs intervenes in the work of sustaining continuity in patients’ care. In doing this we analyse how this standardized format contributes to structure the production and use of information concerning patients’ mundane problems in the context of rehabilitation. Data consists of observations, informal interviews and video-recordings from a ward for patients affected by stroke. The results show that there is a tension between the highly uniform structures and standards for documentation in EPRs, on the one hand, and, on the other, how information is designed and put into use by care providers. When staff members use EPRs, they constantly have to contextualize what is written in relation to what they know about patients and/or the current situation. On the local level, the increasing standardization that follows the introduction of EPRs will make it even more necessary for professionals to engage in such interpretative work to close the gap between the standardized categories of the EPR and contextually relevant health care interventions. In spite of requests for increasing standardization there will always be a need to adapt to specific needs for more flexible information structures. Otherwise, there may be the risk that non-standard features the initial standardization was intended to reduce may be re-introduced.

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Notes

  1. Participants’ talk is written in . When members of the staff produce talk that is reading from the text of the EPR, the transcript is italicised. Non-verbal activities are indicated within double brackets and (.) indicates audible pauses.

References

  1. Ackerman MS, Halverson C. Organizational memory as objects, processes, and trajectories: an examination of organizational memory in use. J Comput Support Coop Work. 2004;13(2):155–89.

    Article  Google Scholar 

  2. Agar MH. Speaking of ethnography. Beverly Hills: Sage; 1986.

    Google Scholar 

  3. Ball MJ, Lillis JC. Health information systems: challenges for the 21st century. AACN Clin Issues. 2000;11(3):386–95.

    Article  Google Scholar 

  4. Berg M. The construction of medical disposals: medical sociology and medical problem solving in clinical practice. Sociol Health Illn. 1992;14(2):151–79.

    Article  Google Scholar 

  5. Berg M. Practicies of reading and writing: the constitutive role of the patient record in medical work. Sociol Health Illn. 1996;18(4):499–524.

    Article  Google Scholar 

  6. Berg M. On distribution, drift and the electronic medical record: some tools for a sociology of the formal. In: Proceedings from The Fifth European Conference on Computer Supported Collaborative Work. Dordrecht: Kluwer; 1997. p. 141–56.

  7. Berg M. Health information management: integrating information technology in health care work. New York: Routledge; 2004.

    Google Scholar 

  8. Bos L, Kun L. Just another journal? No, a different one! Health Technol. 2011;1(1):1–4.

    Article  Google Scholar 

  9. Bossen C. The parameters of common information spaces: The heterogeneity of cooperative work at a hospital ward. In: Proceedings of the 2002 ACM Conference on Computer Supported Cooperative Work. New York: ACM Press; 2002. p. 176–85.

  10. Bowker G, Star LS. Sorting things out: classification and its consequences. Cambridge: MIT Press; 1999.

    Google Scholar 

  11. Bowker G. Memory practices in the sciences. Cambridge: MIT Press; 2006.

    Google Scholar 

  12. Clarke K, Rooksby J, Rouncefield M, Procter R, Slack R. Healthcare information giving services: technologies and everyday practicalities. Health Inform J. 2006;12(2):153–6.

    Article  Google Scholar 

  13. Douglas M. How institutions think. Syracuse: Syracuse University Press; 1986.

    Google Scholar 

  14. Ehnfors M, Ehrenberg A, Thorell-Ekstrand I. Vips-boken [The Vips-book]. Stockholm: Vårdförbundet; 2000.

    Google Scholar 

  15. Hammersly M, Atkinson P. Ethnography, principles in practice. New York: Routledge; 1995.

    Google Scholar 

  16. Hartswood M, Procter R, Rouncefield M, Slack R. Making a case in medical work: implications for the electronic medical record. J Comput Support Collab Work. 2003;12(3):241–66.

    Article  Google Scholar 

  17. Heath C. Preserving the consultation: medical record cards and professional conduct. Sociol Health Illn. 1982;4(1):56–74.

    Article  Google Scholar 

  18. Heath C, Luff P. Documents and professional practice: ‘bad’ organisational reasons for ‘good’ clinical records. In: Heath C, Luff P, editors. Technology in action. Cambridge: Cambridge University Press; 2000. p. 31–60.

    Chapter  Google Scholar 

  19. Heath C, Hindmarsh J, Luff P. Video in qualitative research. Analysing social interaction in everyday life. Los Angeles: Sage; 2010.

    Google Scholar 

  20. Heath C, Luff P, Sanchez Svensson M. Technology and medical practice. Sociol Health Illn. 2003;25(3):75–96.

    Article  Google Scholar 

  21. Hindmarsh J, Jenkings N, Rapley T. Introduction to healthcare technologies in practice. Health Inform J. 2007;13(1):5–8.

    Article  Google Scholar 

  22. Jones A. Creating history: documents and patient participation in nurse-patient interviews. Sociol Health Illn. 2009;31(6):907–23.

    Article  Google Scholar 

  23. Karlsson D. Aspects of the use of medical decision-support systems—the role of the context in decision support. Linköping: Department of Health and Environment, Linköping University; 2001.

    Google Scholar 

  24. von Krogh G, Nåden D. A nursing-specific model of EPR documentation: organizational and professional requirements. J Nurs Scholarsh. 2008;40(1):68–75.

    Article  Google Scholar 

  25. May C, Finch T, Mair F, Mort M. Towards a wireless patient: chronical illness, scarse care and technological intervention in the United Kingdom. Social Sci Med. 2005;61(7):1485–94.

    Article  Google Scholar 

  26. Moen A. Nursing leadership when an Electronic Patient Record System is introduced in Norwegian hospitals. Oslo: Institute of Nursing Sciences, University of Oslo; 2001.

    Google Scholar 

  27. Moore RJ, Whalen J, Hankinson Gathman EC. The work of the work order: document practice in face-to-face service encounters. In: Llewellyn N, Hindmarch J, editors. Organisation, interaction and practice: studies in ethnomethodology and conversation analysis. Cambridge: Cambridge University Press; 2010. p. 172–97.

    Chapter  Google Scholar 

  28. Mäkitalo Å, Säljö R. Talk in institutional context and institutional context in talk. Categories as situated practices. Text. 2002;22(1):57–82.

    Article  Google Scholar 

  29. Nilsson G. Classification and reuse of clinical information in general practice. Linköping: Division of medical informatics, Linköping University; 2002.

    Google Scholar 

  30. Olson D. The world on paper. The conceptual and cognitive implications of writing and reading. Cambridge: Cambridge University Press; 1994.

    Google Scholar 

  31. Ruland C. Helse- og sykepleieinformatikk. Hvordan IKT kan bidra till utvikling av en bedre helsetjeneste [Health and nursing informatics. How ICT can contribute to the development of a better health service]. Oslo: Gyldendal Akademisk; 2000.

    Google Scholar 

  32. Socialstyrelsen (2006:131) SNOMED CT—ska vi gå med eller avvakta? [SNOMED CT—Should we join in or wait?] Stockholm, Sweden: Socialstyrelsen.

  33. Socialstyrelsen (2007:131) ICF—en grund för tvärprofessionell journaldokumentation. [ICF—a basis for interdisciplinary health record documentation] Stockholm, Sweden: Socialstyrelsen.

  34. Socialstyrelsen. An Interdisciplinary Terminology for Health and Social Care Final Report. Stockholm: Socialstyrelsen; 2011.

    Google Scholar 

  35. Suchman L. Centers of coordination. In: Resnick L, Säljö R, Pontecorvo C, Burge B, editors. Discourse, tools and reasoning. Essays on situated cognition. Berlin: Springer; 1997. p. 41–62.

    Google Scholar 

  36. Suchman L. Making a case: “knowledge” and “routine” work in document production. In: Luff P, Hindmarsh J, Heath C, editors. Workplace studies. Recovering work practice and information system design. Cambridge: Cambridge University Press; 2000. p. 29–45.

    Chapter  Google Scholar 

  37. Svenningsen S. Electronic patient records and medical practice: reorganization of roles, responibilities and risks. Copenhagen: Copenhagen Business School; 2003.

    Google Scholar 

  38. Säljö R. Mental and physical artifacts in cognitive practices. In: Reimann P, Spada H, editors. Learning in humans and machines: towards an interdisciplinary learning science. Oxford: Pergamon; 1996. p. 83–96.

    Google Scholar 

  39. Säljö R. Lärande och kulturella redskap. Om lärprocesser och det kollektiva minnet [Learning and cultural tools. On processes of learning and the collective memory]. Stockholm: Norstedts; 2005.

    Google Scholar 

  40. Taneva S, Law E, Higgins J, Easty A, Plattner B. Operating room coordination with the eWhiteboard: the fine line between successful and challenged technology adoption. Health Technol. 2011;1(2–4):81–92.

    Article  Google Scholar 

  41. Tang C, Carpendale S. An observational study on information flow during nurses’ shift change. In: Proceedings of the 1st ACM International Health Informatics Symposium. San Jose: ACM Press; 2007. p. 219–28.

  42. Timmermans S, Berg M. The gold standard. The challenge of evidence-based medicine in health care. Philadelphia: Temple University Press; 2003.

    Google Scholar 

  43. Timmermans S, Bowker G, Star LS. The architecture of difference: visibility, control and comparability in building a nursing interventions classification. In: Berg M, Mol A, editors. Differences in medicine: unraveling practices, techniques, and bodies. London: Duke University Press; 1998. p. 202–25.

    Google Scholar 

  44. Törnvall E. Carrying out electronic nursing documentation—use and development in primary health care. Linköping: Faculty of Health Science, Linköping University; 2008.

    Google Scholar 

  45. Winman T, Rystedt H. Electronic patient records in action: transforming information into professionally relevant knowledge. Health Inform J. 2011;17(1):51–62.

    Article  Google Scholar 

  46. Wintherreik BR, Vikkelsø S. ICT and integrated care: some dilemmas of standardising inter-organisational communication. J Comput Support Coop Work. 2005;14(1):43–67.

    Article  Google Scholar 

  47. Wittgenstein L. Zettel. Oxford: Blackwell; 1981.

    Google Scholar 

  48. Zhou X, Ackerman MS, Zheng K. I just don’t know why it’s gone: maintaining informal information use in in-patient care. In: Proceedings of the ACM Conference on Human Factors in Computing Systems. Boston: ACM Press; 2009. p. 2061–70.

  49. Zhou X, Ackerman MS, Zheng K. Computerization and information assembling process: nursing work and CPOE adoption. In: Proceedings of the 1st ACM International Health Informatics Symposium. Virginia: ACM Press; 2010. p. 36–45.

  50. Østerlund CS. Documents in place: demarcating places for collaboration in healthcare settings. J Comput Support Coop Work. 2008;17(2–3):195–225.

    Article  Google Scholar 

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Acknowledgments

The work reported here has been supported by The Knowledge Foundation in Sweden; University West; The Linnaeus Centre for Research on Learning, Interaction and Mediated Communication in Contemporary Society (LinCS); and The University of Gothenburg Learning and Media Technology Studio (LETStudio), a cross-disciplinary research collaboration at University of Gothenburg, Sweden.

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Authors and Affiliations

  1. Department of Education, Communication and Learning, University of Gothenburg, 405 30, Gothenburg, Sweden

    Thomas Winman, Roger Säljö & Hans Rystedt

  2. Department for Social and Behavioural Studies, University West, 46186, Trollhättan, Sweden

    Thomas Winman

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  1. Thomas Winman
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  2. Roger Säljö
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Correspondence to Thomas Winman.

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Winman, T., Säljö, R. & Rystedt, H. Local knowing and the use of electronic patient records: categories and continuity of health care. Health Technol. 2, 185–196 (2012). https://doi.org/10.1007/s12553-012-0029-0

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