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Boundary-Object Trimming: On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures

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Boundary-Object Trimming : On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures. / Bossen, Claus; Jensen, Lotte Groth; Udsen, Flemming Witt.

In: Computer Supported Cooperative Work, Vol. 23, No. 1, 2014, p. 75-110.

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Bossen, Claus ; Jensen, Lotte Groth ; Udsen, Flemming Witt. / Boundary-Object Trimming : On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures. In: Computer Supported Cooperative Work. 2014 ; Vol. 23, No. 1. pp. 75-110.

Bibtex

@article{2d18710775124a7abcf47a2959208ca3,
title = "Boundary-Object Trimming: On the Invisibility of Medical Secretaries{\textquoteright} Care of Records in Healthcare Infrastructures",
abstract = "As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (eleven hours), interviews (three individual and one group) and survey data (thirty one of two hundred and fifty respondents were medical secretaries). We depict medical secretaries{\textquoteright} core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments{\textquoteright} work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term {\textquoteleft}boundary-object trimming{\textquoteright} to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power. ",
keywords = "boundary object, elektroniske patientjournal, k{\o}n, sundhedsv{\ae}sen, l{\ae}gesekret{\ae}rer, usynligt arbejde, ikke-kliniske professioner, boundary objects, cooperative work , electronic health records, gender, health care, medical secretaries, invisible work, non-clinical occupations",
author = "Claus Bossen and Jensen, {Lotte Groth} and Udsen, {Flemming Witt}",
year = "2014",
doi = "10.1007/s10606-013-9195-5",
language = "English",
volume = "23",
pages = "75--110",
journal = "Computer Supported Cooperative Work",
issn = "0925-9724",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Boundary-Object Trimming

T2 - On the Invisibility of Medical Secretaries’ Care of Records in Healthcare Infrastructures

AU - Bossen, Claus

AU - Jensen, Lotte Groth

AU - Udsen, Flemming Witt

PY - 2014

Y1 - 2014

N2 - As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (eleven hours), interviews (three individual and one group) and survey data (thirty one of two hundred and fifty respondents were medical secretaries). We depict medical secretaries’ core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments’ work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term ‘boundary-object trimming’ to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power.

AB - As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (eleven hours), interviews (three individual and one group) and survey data (thirty one of two hundred and fifty respondents were medical secretaries). We depict medical secretaries’ core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments’ work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term ‘boundary-object trimming’ to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power.

KW - boundary object

KW - elektroniske patientjournal

KW - køn

KW - sundhedsvæsen

KW - lægesekretærer

KW - usynligt arbejde

KW - ikke-kliniske professioner

KW - boundary objects

KW - cooperative work

KW - electronic health records

KW - gender

KW - health care

KW - medical secretaries

KW - invisible work

KW - non-clinical occupations

U2 - 10.1007/s10606-013-9195-5

DO - 10.1007/s10606-013-9195-5

M3 - Journal article

VL - 23

SP - 75

EP - 110

JO - Computer Supported Cooperative Work

JF - Computer Supported Cooperative Work

SN - 0925-9724

IS - 1

ER -