Fluids or flows? Information and qualculation in medical practice

Purpose ? Seeks to explore the assumptions and limitations of current programmes for the creation of electronic patient records by comparing ICT programme statements with hospital uses of information. Design/methodology/approach ? Compares qualitative data from medical ICT programmes statements with data from ethnographic studies of hospital decision making. Uses actor-network theory to develop a performative definition of information as that which secures a decision or ?qualculation?, whether in the form of calculation or judgement. Findings ? Shows that decision making depends on a mix of formal and informal considerations that are, however, always restricted in scope and number. Shows that some of these are locally and organisationally contingent. Research limitations/implications ? The ethnographic findings illustrate the character of information rather than offering data about the character of decisions in different clinical locations. Practical implications ? Caution is needed in the face of claims about ICT programmes in health care. It is possible to anticipate neither all the uses of information nor what will count as information in advance. Originality/value ? The paper develops a performative definition of information. This is whatever secures a decision in practice. Information thus reflects a situated process of simplification and bounding of relevancies. This suggests that information not only flows (which is assumed in ICT programme statements) but also is fluid, unpredictably changing its form and character. This claim is relevant both to the design and use of ICT in health care and to the theory of information