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.

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.

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.