Keeping Distributed Care Together: Medical Summaries Reconsidered

  • Troels MønstedEmail author
Conference paper


Summaries in the medical record have traditionally offered health professionals good cognitive support by guiding reading of the medical record and supporting communication and collaboration in clinical teams. However, because of increased distribution of chronic care and fragmentation of the medical record, summaries are becoming increasingly incomplete and have lost some of their ability to mediate collaboration in clinical teams and support situated sensemaking. Based on findings from a project aimed at studying and designing IT to support collaboration among health professionals in distributed, chronic care, this article present a detail study of current use of summaries and discusses how a new type of summary can be designed to offer better support for distributed, chronic care. Overall I argue that we must maintain an appropriate balance between structure and flexibility, while reconsidering the readership, the authorship, and the maintenance of summaries.


Health Professional Implantable Cardioverter Defibrillator Chronic Care Chronic Care Model Medical Work 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The research was supported by the Danish Council for Strategic Research as part of the CITH project (2008–13). I thank physicians and patients at the local hospital and ICD center for allowing us to observe and interview them, in particular physicians Helen Høgh Petersen, Jesper Hastrup Svendsen, Olav Wendelboe Nielsen, René Husted Worck, and Steen Abildstrøm. I also thank all other researchers affiliated to the CITH project who have contributed to this study: Pernille Bjørn, Finn Kensing, Kjeld Schmidt, Erling Havn, Tariq Andersen, and Jonas Moll. A special dedication goes to Professor Jørgen Bansler for his great contribution to the ideas presented in this article, through discussions and feedback on the manuscript.


  1. Albolino, S., Cook, R., & O’Connor, M. (2007). Sensemaking, safety, and cooperative work in the intensive care unit. Cognition, Technology and Work, 9(3), 131–137.CrossRefGoogle Scholar
  2. Bansler, J., Havn, E., Mønsted, T., & Schmidt, K. (2013). Physicians progress notes—The integrative core of the medical record. In European Conference on Computer-Supported Collaborative Work ECSCW’13, September 21–25, 2013 (pp. 123–142).Google Scholar
  3. Bardram, J. E., & Bossen, C. (2005). Mobility work: The spatial dimension of collaboration at a hospital. Computer Supported Cooperative Work, 14(2), 131–160.Google Scholar
  4. Battles, J. B., Dixon, N. M., Borotkanics, R. J.,Rabin-Fastmen, Kaplan, H. (2006). Sensemaking of patient safety risks and hazards. Health Research and Educational Trust, 41(4), 1555–1575.Google Scholar
  5. Berg, M. (1996). Practices of reading and writing: the constitutive role of the patient record in medical work. Sociology of Health and Illness, 18(4), 499–524.CrossRefGoogle Scholar
  6. Berg, M. (1997). Rationalizing medical work: Decision-support techniques and medical practices. Cambridge: MIT Press.Google Scholar
  7. Berg, M., & Bowker, G. C. (1997). The multiple bodies of the medical record: Toward a sociology of an artifact. The Sociological Quarterly, 38(3), 513–537.CrossRefGoogle Scholar
  8. Bjørn, P., & Markussen, R. (2013). Cyborg heart: The affect apparatus of bodily production of ICD patients. Science and Technology Studies, 2, 14–28.Google Scholar
  9. Bossen, C., & Jensen, L. G. (2014). How physicians ‘Achieve Overview’—a case-based study in a hospital ward. In Proceedings of CSCW’14 (pp. 257–268).Google Scholar
  10. Boyd, C. M., & Kent, D. M. (2013). Evidence-based medicine and the hard problem of multimorbidity. Journal of General Internal Medicine, 29(4), 552–553.CrossRefzbMATHGoogle Scholar
  11. Bruner, J. (1991). The narrative construction of reality. Critical Inquiry, 18(1), 1–21.CrossRefGoogle Scholar
  12. Car, J., Black, A., Anandan, C., Cresswell, K., Pagliari, C., McKinstry, B. et al. (2008). The impact of health on the quality and safety of healthcare. University of Edinburgh and Imperial College London.Google Scholar
  13. Cramer-Petersen, C. (2013). Between generative prototyping and work of synthesis in design: Interplay and adding value in the early concept development. In Proceedings of Co-Create 2013 Conference.Google Scholar
  14. Ehn, P., & Kyng, M. (1991). Cardboard computers: Mocking-it-up or Hands-on the future. In J. Greenbaum & M. Kyng (Eds.), Design at work: Cooperative design of computer systems. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  15. Feldman, M. S., Sköldberg, K., Brown, R. N., & Horner, D. (2004). Making sense of stories: A rhetorical approach to narrative analysis. Journal of Public Administration Research and Theory, 14(2), 147–170.CrossRefGoogle Scholar
  16. Fitzpatrick, G. (2004). Integrated care and the working record. Health Informatics Journal, 10(4), 291–304.CrossRefzbMATHGoogle Scholar
  17. Flesch, M., & Erdmann, E. (2006). The problem of polypharmacy in heart failure. Current Cardiology Reports, 8(3), 217–225.CrossRefGoogle Scholar
  18. Greenhalgh, T., Potts, H. W. W., Wong, G., Bark, P., & Swinglehurst, D. (2009). Tensions and paradoxes in electronic patient record research: A systematic literature review using the meta-narrative method. Milbank Quarterly, 87(4), 729–788.CrossRefGoogle Scholar
  19. Greenhalgh, T., Stramer, K., Bratan, T., Byrne, E., Russell, J., & Potts, H. W. W. (2010). Adoption and non-adoption of a shared electronic summary record in England: A mixed-method case study. BMJ, 340, c3111.Google Scholar
  20. Halskov, K., & Dalsgård, P. (2006). Inspiration card workshops. In Proceedings of the ACM Conference on Designing Interactive System DIS (pp. 2–11).Google Scholar
  21. Houde, S., & Hill, C. (1997). What do prototypes prototype? In M. Helander, T. Landauer & P. Prabhu (Eds.), Handbook of human-computer interaction (2nd ed.). Amsterdam: Elsevier Science B.V.Google Scholar
  22. Hunter, K. (1996). “Don’t think zebras”: Uncertainty, interpretation, and the place of paradox in clinical education. Theoretical Medicine and Bioethics, 17(3), 225–241.CrossRefGoogle Scholar
  23. Jensen, T. B., & Aanestad, M. (2006). How healthcare professionals make sense of an electronic patient record, adoption. Information Systems Management Information Systems Management, 24(1), 29–42.CrossRefGoogle Scholar
  24. Jordan, M. E., Lanham, H. J., Crabtree, B. F., Nutting, P. A., Miller, W. L., Stange, K. C., & McDaniel, R. R, Jr. (2009). The role of conversation in health care interventions: enabling sensemaking and learning. Implementation Science, 4(15), 1–13.Google Scholar
  25. Kodner, D. L., & Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications—a discussion paper. International Journal of Integrated Care, 12(2), 791–806.Google Scholar
  26. Mattingly, C. (1998). Healing dramas and clinical plots: The narrative structure of experience. Cambridge: Cambridge University Press.Google Scholar
  27. Montgomery, K. (2006). How Doctors think. Clinical judgment and the practice of medicine. Oxford: Oxford University Press.Google Scholar
  28. Moth, G., Vestergaard, M., & Vedsted, P. (2012). Chronic care management in Danish general practice—a cross-sectional study of workload and multimorbidity, BMC Fam .Pract, 13, 52.Google Scholar
  29. Reddy, M. C., Dourish, P., & Pratt, W. (2001). Coordinating heterogeneous work: Information and representation in medical care. In Proceedings of European Conference on Computer-Supported Cooperative Work 2001 (pp. 239–258).Google Scholar
  30. Roland, M. (2013). Better management of patients with multimorbidity. BMJ, 346, 2510.CrossRefGoogle Scholar
  31. Rosenbloom, S. T., Denny, J. C., Xu, H., Lorenzi, N., & Stead, W. W. (2010). Data from clinical notes: A perspective on the tension between structure and flexible documentation. JAMIA, 18, 181–186.Google Scholar
  32. Sackett, D. L., Rosenberg, W. M. C., Muir, J. A., Haynes, B. R., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312, 71.Google Scholar
  33. Schneider, K., & Wagner, I. (1993). Constructing the ‘Dossier Représentatif’. Computer Supported Cooperative Work (CSCW), 1(4), 229–253.CrossRefGoogle Scholar
  34. Singer, G. M., Izhar, M., & Black, H. R. (2002). Goal-oriented hypertension management: Translating clinical trials to practice, hypertension. Journal of the American Heart Association, 40, 464–469.Google Scholar
  35. Stead, W. W., & Lin, H. S. (2009). Computational technology for effective healthcare. Washington, D.C.: The National Academies Press.Google Scholar
  36. Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Organizing care for patients with chronic illness. The Milbank Quarterly, 74(4), 511–544.CrossRefGoogle Scholar
  37. Weick, K. E. (1995). Sensemaking in organizations. New York: Sage Publications.Google Scholar
  38. Winthereik, B. (2003). “We fill in our working understanding”: On codes, classifiations and the production of accurate data. Methods of Information in Medicine, 4, 489–496.Google Scholar
  39. Winthereik, B. R., & Vikkelsø, S. (2005). ICT and integrated care: Some dilemmas of standardising inter-organisational communication. Computer Supported Cooperative Work CSCW, 14(1), 43–67.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.University of CopenhagenCopenhagenDenmark

Personalised recommendations