Introducing the electronic patient record (EPR) in a hospital setting: boundary work and shifting constructions of professional identities.

Today's healthcare sector is being transformed by several ongoing processes, among them the introduction of new technologies, new financial models and new ways of organising work. The introduction of the electronic patient record (EPR) is representative and part of these extensive changes. Based on interviews with health personnel and office staff in a regional hospital in Norway, and with health administrators and information technology service-centre staff in the region, the article examines how the introduction of the EPR, as experienced by the participants, affects the work practices and boundaries between various professional groups in the healthcare system and discusses the implications this has for the understanding of medical practice. The article shows how the EPR has become part of the professionals' boundary work; expressing shifting constructions of professional identities.

[1]  J. Allsop.  Medical dominance in a changing world: the UK case , 2006 .

[2]  G. Currie,et al.  Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce. , 2009, Social science & medicine.

[3]  Tiago Moreira,et al.  Technogovernance: evidence, subjectivity, and the clinical encounter in primary care medicine. , 2006, Social science & medicine.

[4]  E. Willis.  Introduction: taking stock of medical dominance , 2006 .

[5]  Martin Frischer,et al.  Barriers to the adoption of computerised decision support systems in general practice consultations: a qualitative study of GPs' perspectives , 2004, Int. J. Medical Informatics.

[6]  Signe Vikkelsø,et al.  In between Curing and Counting: Performative Effects of Experiments With Healthcare Information Infrastructure , 2007 .

[7]  Lorelei Jones,et al.  Shifting discourses of professionalism: a case study of general practitioners in the United Kingdom. , 2006, Sociology of health & illness.

[8]  D. Swinglehurst,et al.  Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. , 2009, The Milbank quarterly.

[9]  Marc Berg,et al.  Patient care information systems and health care work: a sociotechnical approach , 1999, Int. J. Medical Informatics.

[10]  David Watts,et al.  The doctor-nurse game revisited. , 1990, The New England journal of medicine.

[11]  S. Porter,et al.  A participant observation study of power relations between nurses and doctors in a general hospital. , 1991, Journal of advanced nursing.

[12]  G. Currie,et al.  Professional competition and modernizing the clinical workforce in the NHS , 2009 .

[13]  Jerry M Maniate,et al.  Sociological interpretations of professionalism , 2009, Medical education.

[14]  Mike Dent,et al.  Managing professional identities : knowledge, performativity and the 'new' professional , 2002 .

[15]  Carl May,et al.  Transforming general practice: the redistribution of medical work in primary care. , 2003, Sociology of health & illness.

[16]  S. Carmel,et al.  Boundaries obscured and boundaries reinforced: incorporation as a strategy of occupational enhancement for intensive care. , 2006, Sociology of health & illness.

[17]  Susan Leigh Star,et al.  Layers of Silence, Arenas of Voice: The Ecology of Visible and Invisible Work , 1999, Computer Supported Cooperative Work (CSCW).

[18]  Susan Halford,et al.  Beyond implementation and resistance: how the delivery of ICT policy is reshaping healthcare , 2009 .

[19]  Carl May,et al.  The Clinical Encounter and the Problem of Context , 2007 .

[20]  Roland Svensson.  The interplay between doctors and nurses—a negotiated order perspective , 1996 .

[21]  Simon Carmel.  Health care practices, professions and perspectives: a case study in intensive care. , 2006, Social science & medicine.

[22]  D. Allen,et al.  The nursing-medical boundary: a negotiated order? , 1997 .

[23]  John Germov,et al.  Managerialism in the Australian public health sector: towards the hyper-rationalisation of professional bureaucracies. , 2005, Sociology of health & illness.

[24]  D W Light,et al.  Professional dynamics and the changing nature of medical work. , 1995, Journal of health and social behavior.

[25]  R. Goffee,et al.  Segregated Occupations and Gender Stereotyping: A Study of Secretarial Work in Europe , 1995 .

[26]  Marcus Sanchez Svensson,et al.  Technology and medical practice. , 2003, Sociology of health & illness.

[27]  David P. Hughes,et al.  When nurse knows best: some aspects of nurse/doctor interaction in a casualty department , 1988 .

[28]  Marc Berg,et al.  Practices of reading and writing: the constitutive role of the patient record in medical work , 1996 .

[29]  Alan M Borthwick,et al.  Dynamic professional boundaries in the healthcare workforce. , 2005, Sociology of health & illness.

[30]  Andrew Webster,et al.  Rationalising Knowledge: IT Systems, Professional Identities and Power , 1998 .

[31]  D. Willems.  Balancing rationalities: gatekeeping in health care , 2001, Journal of medical ethics.

[32]  Mary L. Fennell,et al.  The Changing Organizational Context of Professional Work , 1997 .

[33]  S. Timmons,et al.  Resistance to Computerized Care Planning Systems by Qualified Nurses Working in the UK NHS , 2003, Methods of Information in Medicine.

[34]  J. Hindmarsh,et al.  Beyond 'doctor and patient': developments in the study of healthcare interactions. , 2009, Sociology of health & illness.

[35]  Julia Evetts,et al.  Short Note: The Sociology of Professional Groups , 2006 .

[36]  David Coburn.  Freidson Then and Now: An “Internalist” Critique of Freidson's Past and Present Views of the Medical Profession , 1992, International journal of health services : planning, administration, evaluation.

[37]  D. Coburn.  Medical dominance then and now: critical reflections , 2006 .