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Local knowing and the use of electronic patientrecords: categories and continuity of health care
University West, Department of Social and Behavioural Studies, Division of Social Pedagogy and Sociology. (LINA)ORCID iD: 0000-0002-1908-4940
Department of Education, University of Gothenburg.
Department of Education, University of Gothenburg.
2012 (English)In: Health and technology, ISSN 2190-7196, Vol. 2, no 3, 185-196 p.Article in journal (Refereed) Published
Abstract [en]

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 ow 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.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2012. Vol. 2, no 3, 185-196 p.
Keyword [en]
Electronic patient records, Professional knowledge, Coordination, Categories
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
SOCIAL SCIENCE, Pedagogics; Work Integrated Learning
Identifiers
URN: urn:nbn:se:hv:diva-4776DOI: 10.1007/s12553-012-0029-0OAI: oai:DiVA.org:hv-4776DiVA: diva2:563982
Available from: 2012-11-01 Created: 2012-11-01 Last updated: 2015-03-30Bibliographically approved
In thesis
1. Transforming information into practical actions: A study of professional knowledge in the use of electronic patient records
Open this publication in new window or tab >>Transforming information into practical actions: A study of professional knowledge in the use of electronic patient records
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Today, technologies are being introduced into historically established settings, which change the conditions for work as well as for work-integrated learning. In health care, electronic patient records (EPRs) has been implemented during the last decades to serve as a tool for planning, decision making and evaluation of care work. The overall aim of the research presented in this thesis is to analyse the complex actions and interactions that occur when EPRs are used in health care practice. Analytically, such an interest is pursued employing a socio-cultural perspective on workplace studies, where the use of technology is studied in action. Through three separate studies, practical actions and practical use of EPRs have been examined and the empirical data draws on observations, video-recordings, audio-recordings and documents from a hospital ward in Sweden. The result shows that technologies such as EPRs both offer and presuppose standardization of terminologies and information structures. This, however, does not mean that EPRs completely format and structure information, or that it is driven by its own logic. When staffs comply with a set of standards, transformations of those standards will gradually occur. Those transformations are collective achievements and since each professional involved act in a conscious and active manner, this affects the use of standards as well as the development of collective proficiency. The results also demonstrate that meaning making in(through) the use of EPRs presupposes extensive knowledge of the indexicality of categories, something that originates in the participants‘ shared institutional history. It is in the process of reliving, creating and exposing the meaning of information, that health care professionals actually bring information in EPRs to life. In further development of EPRs that exceeds institutional and even national boundaries it is important to see this development not as solely technical or organizational questions. To develop systems that enhance the possibilities for professionals in different institutions with different professional domains to make sense of standardized information may be a much more  demanding task than it seems to be. Such boundary-crossing systems are nevertheless of great importance for the further development of health care practice.

Place, publisher, year, edition, pages
Trollhättan: University West, 2012. 207 p.
Series
PhD Thesis: University West, 2012:1
Keyword
Electronic patient records, professional knowledge, decision making, work integrated learning, standardization
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pedagogy
Research subject
SOCIAL SCIENCE, Pedagogics; Work Integrated Learning
Identifiers
urn:nbn:se:hv:diva-4779 (URN)978-91-977943-3-6 (ISBN)
Public defence
2012-09-21, Albertsalen, Högskolan Väst, Trollhättan, 13:00
Opponent
Supervisors
Available from: 2012-11-01 Created: 2012-11-01 Last updated: 2015-03-26Bibliographically approved

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