Materialising the electronic patient record : Reshaping medical practices on NHS wards

Electronic patient records (EPRs) are replacing paper notes in hospitals across the National Health Service (NHS). Digital records have been promised to provide increased accessibility, legibility, safety, and efficiency, but despite costly national programmes, adoption of EPRs in hospitals, as replacements for paper, has been slow. In addition, research has shown that removal of paper records as a central communication and collaboration device appears to have unintended consequences for the ways that clinicians work together. This project, based in an NHS hospital, used ethnographic methods to observe an EPR in use on paperlight inpatient medical wards. Informed by actor-network theory, this thesis gives an account of how the relocation of information, from paper records to the EPR devices, is changing the ways that medicine is practiced. Through following the use of computers on wheels and handheld digital devices, the findings of this research emphasise the role that the materiality of the medical record has in both the evolution and holding together of clinical practices. These findings form the central contribution of this thesis, which is the development of the concept of the materialised EPR and how the physical housing of the electronic record has effects in collaborative and communicative healthcare settings. The findings emphasise the ways in which mobile digital devices lack the material and tangible properties of paper records, which functioned as a sophisticated network of physical coordination tools in the support of medical practices. This research provides novel insights on the utilisation of medical records, and how their materiality participates in shaping medical practice. This reconfigured work has consequences, not only in the way that communication and collaboration are changing between professionals, but also in influencing care