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Transforming information into practical actions: A study of professional knowledge in the use of electronic patient records
University West, Department of Social and Behavioural Studies, Division of Social Pedagogy and Sociology. (LINA)ORCID iD: 0000-0002-1908-4940
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 [en]
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: urn:nbn:se:hv:diva-4779ISBN: 978-91-977943-3-6 (print)OAI: oai:DiVA.org:hv-4779DiVA: diva2:564025
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
List of papers
1. Local knowing and the use of electronic patientrecords: categories and continuity of health care
Open this publication in new window or tab >>Local knowing and the use of electronic patientrecords: categories and continuity of health care
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
Keyword
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:nbn:se:hv:diva-4776 (URN)10.1007/s12553-012-0029-0 (DOI)
Available from: 2012-11-01 Created: 2012-11-01 Last updated: 2015-03-30Bibliographically approved
2. Electronic patient records in action: Transforming information into professionally relevant knowledge
Open this publication in new window or tab >>Electronic patient records in action: Transforming information into professionally relevant knowledge
2011 (English)In: Health Informatics Journal, ISSN 1460-4582, Vol. 17, no 1, 51-62 p.Article in journal (Refereed) Published
Abstract [en]

The implementation of generic models for organizing information in complex institutions like those in healthcare creates a gap between standardization and the need for locally relevant knowledge. The present study addresses how this gap can be bridged by focusing on the practical work of healthcare staff in transforming information in EPRs into knowledge that is useful for everyday work. Video recording of shift handovers on a rehabilitation ward serves as the empirical case. The results show how extensive selections and reorganizations of information in EPRs are carried out in order to transform information into professionally relevant accounts. We argue that knowledge about the institutional obligations and professional ways of construing information are fundamental for these transitions. The findings point to the need to consider the role of professional knowledge inherent in unpacking information in efforts to develop information systems intended to bridge between institutional and professional boundaries in healthcare.

Keyword
communication, electronic patient records, professional knowledge, shift handovers, workplace studies
National Category
Pedagogy
Research subject
SOCIAL SCIENCE, Pedagogics
Identifiers
urn:nbn:se:hv:diva-3342 (URN)10.1177/1460458210396330 (DOI)
Available from: 2011-05-21 Created: 2011-05-21 Last updated: 2015-01-16Bibliographically approved
3. Electronic patient records in interprofessional decision making: Standardized categories and local use
Open this publication in new window or tab >>Electronic patient records in interprofessional decision making: Standardized categories and local use
2012 (English)In: Human Technology, ISSN 1795-6889, Vol. 8, no 1, 46-64 p.Article in journal (Refereed) Published
Abstract [en]

Electronic patient records (EPRs) are a constitutive element of medical practice and are expected to improve interprofessional communication and support decision making. The aim of the current study is to explore the ways in which access to structured information from multiple professions within EPRs enters into the phases involved in arriving at final agreements about patients' future care. The results show that decision making in interprofessional team rounds involves a prestructuring of a pathological reality. Further, the results demonstrate how information in EPRs is deconstructed and recast into patterns that presuppose knowledge about the EPR's structural organization. This means that EPRs are highly flexible technologies and that their design does not determine their usefulness. A major conclusion is that the members' knowledge on how to bridge between standardized categories in EPRs and their local meanings is decisive for understanding the basic conditions necessary for how EPRs could support interprofessional collaboration.

Place, publisher, year, edition, pages
Finland: Agora Center, University of Jyväskylä, 2012
Keyword
Electronic patient records, decision making, categories, standardization, communication, information technologies
National Category
Pedagogy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
SOCIAL SCIENCE, Pedagogics; Work Integrated Learning
Identifiers
urn:nbn:se:hv:diva-4777 (URN)
Available from: 2012-11-01 Created: 2012-11-01 Last updated: 2015-03-26Bibliographically approved

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