Brit Ross Winthereik

ICT and Integrated Care: Some Dilemmas of Standardising Inter-Organisational Communication

There is a growing interest in the issues of how to organise healthcare work along individual patient cases rather than along the demarcation lines of healthcare organisations. Health information systems, such as electronic patient records, are seen as important change agents, since they are asserted to help the coordination of care across organisations through fast and accurate exchange of clinical data. The paper explores how a semi-standardised discharge letter is employed to communicate about the patient between two organisational settings, the hospital and the general practitioner. It is shown that the discharge letter plays a double role as informational tool and accounting device. And it is argued that further standardisation of the discharge letter content – in order to facilitate electronic exchange – is likely to strengthen the letter’s role as a tool for organisational accountability and weaken it as a clinical tool. The paper concludes that this finding adds to the theoretical understanding of how computers support cooperative work, and that understanding how healthcare professionals present themselves as accountable and trustworthy should be of major concern when designing healthcare ICTs.

Talking about distributed communication and medicine: on bringing together remote and local actors

In this commentary we reflect on the articles in this special issue on computer-mediated communication (CMC) about things. We do this from our perspective as researchers of the sociotechnical practices of developing, using, and evaluating information technologies for health care work. The relevance of the articles for a medical setting is evaluated, and we also indicate that the material embeddedness of CMC should be unpacked. By focusing on the materiality of CMC in its working practice, we can see the otherwise invisible work that performs the ecology needed to make a CMC work. Only when seeing these activities, and when realizing the risks of possible miscommunications, can we assess the desirability and feasibility of (telemedicine) CMC projects.

Political and moralising moments: on visions of IT in Danish health care

In this paper, we discuss the production of visions for IT in Danish health care. Visions are not propagated “from above” but are produced through translation processes, in which contents change as they are inscribed in ministerial reports, leaflets or recommendations. This is illustrated by two cases: the electronic patient record at Hvidovre Hospital (HVEPS) and the Digital Doctor Project (DDP). Following STS‐studies we propose to analyse such reports as material agents with distinctive capacities and features. Prominent among those is the ability of such reports to carry “contradictory” messages. We analyse this capacity as a strength as it enables reports to bind together various people in various contexts, rather than as a weakness. We propose the concept of political moment as a tool that can capture the material heterogeneity and the unexpectedness of translations. The concept of moralising moment is introduced to identify accounts in which such processes are glossed or covered.