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- Winman, Thomas, et al.
(författare)
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Electronic patient records in action : Transforming information into professionally relevant knowledge
- 2011
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Ingår i: Health Informatics Journal. - : SAGE Publications. - 1460-4582 .- 1741-2811. ; 17:1, s. 51-62
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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- Winman, Thomas, et al.
(författare)
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Electronic patient records in inter-professional decision making – Standardized categories and local hermeneutics
- 2008
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Ingår i: Paper presented at the Conference on Cultural and Activity Research, 2008, San Diego, USA..
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Konferensbidrag (refereegranskat)abstract
- The electronic patient record (EPR) is a constitutive element of medical practice and serves as tool for planning and implementing care for individual patients. Introducing EPRs is expected to improve inter-professional communication and to support decision-making. EPRs are based on several standardized categories and classifications, where the structure is thought to obstruct the input of unformatted free text and thereby become a time and location independent information-sharing-chart that provide reliable knowledge from different professionals’ perspectives. Much research, which examine digital technologies for storing and sharing information, claim that standardized sets of categories are controlling and precluding the knowledge of professionals. Those studies, however, do not inform us about how the EPR and its information structure interfere with the very process of decision-making. This study, in contrast, aims at understanding how the EPR feature into inter-professional decision-making in everyday activities. We are interest in to what extent the standardized terminology that it is built into the EPR contributes to how staff members reach an informed agreement on “what to do next”. Does the standardization of information determine the decisions made or is it a more open-ended affair? The data collection took place at a hospital ward where doctors, nurses, physiotherapists, assisting nurses and occupational therapists met every week in team-rounds with the purpose of planning individual patients’ care. Nine team-rounds were observed and audio recorded. The result show that decision-making in multi-professional team-rounds is a matter of pre-structuring a “pathological reality”. Information in the EPR is counteracted and recasted into already embodied patterns that conform to the pre-structure. Therefore, recasting patients’ problems involves knowing of how to make sense of information embedded in indexical categories, which simultaneous pre-structure the understanding of the problems at hand. Standardized categories contribute to stabilize items that simultaneously make expectations of knowledge and processes recognizable for actors, which in turn, make them constitutive and perspective setting. Moreover, categories have an indexical logic that is based on a knowing in and about the local work and the institution’s obligations. Hence, the logic of decision-making is not to be found in the technology itself. Instead, the logic can be seen as a locally shared knowing of the indexical meaning of standardized categories and their practical implications. One important methodological implication is that the implementation, design and use of information systems and the built-in conceptual structure need to account for the concrete work these systems are intended to support.
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- Winman, Thomas, 1967-, et al.
(författare)
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Electronic patient records in interprofessional decision making : Standardized categories and local use
- 2012
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Ingår i: Human Technology. - : Centre of Sociological Research, NGO. - 1795-6889. ; 8:1, s. 46-64
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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- Winman, Thomas, 1967-, et al.
(författare)
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Från journaler till digitala informationssystem
- 2009. - 1. uppl
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Ingår i: Omvårdnadens grunder. - Lund : Studentlitteratur. - 9789144049076 ; , s. 403-433
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Winman, Thomas, et al.
(författare)
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Från journaler till digitala informationssystem : From medical records to digital information systems
- 2009
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Ingår i: Omvårdnadens grunder: Ansvar och utveckling. - 9789144058719 ; , s. 403-433
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- I det här kapitlet beskrivs hur dokumentation kommit att bli en alltmer central del i modern vård och omsorg för att skapa och upprätthålla kunskap om vårdtagares hälsotillstånd och för att koordinera omvårdnadsarbetet. I takt med den ökade specialisering och den enorma kunskapstillväxten inom vård och omsorg har behoven av mer standardiserad och tillgänglig information ökat explosionsartat. I kapitlet beskrivs hur dokumentation utvecklats från privata och osystematiska anteckningar till dagens system baserade på modern informations- och kommunikationsteknik (IKT) där ett stort antal användare kan bidra till och ta del av innehållet. Syftet är att ge en inblick i vilka krav de framväxande informationssystemen ställer på sjuksköterskors kunskaper, dels med avseende på vad som krävs för att kunna använda systemen på ett relevant sätt, dels vad som krävs för att skapa information så att den kan användas både i den direkta omvårdnaden och för kvalitetsutveckling, ledning och forskning.
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| 8. |
- Winman, Thomas, 1967-, et al.
(författare)
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Local knowing and the use of electronic patientrecords : categories and continuity of health care
- 2012
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Ingår i: Health and Technology. - : Springer Science and Business Media LLC. - 2190-7188 .- 2190-7196. ; 2:3, s. 185-196
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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