New approaches in the design of information technologies for work practices are drawing upon theories from sociology, anthropology, and social philosophy. Under the labels of Computer-Supported Cooperative Work and Participatory Design, work is done to "neturn" to design insights gained in the social study of the use of technological artifacts. Aftera brief introduction of these developments, the article zooms in on those authors for whom "better" technologies refer to hopes for more democratic and more worker-oriented workplaces. How do these approaches (...) conceptualize "humans, " "machines, " and their interrelation in work practices? The conceptual engine which generates the analytical and political power of this approach, I argue, thrives upon the assertion of an ontological difference between the realms of "technology" and "human work. " What are the consequences of such conceptualizations for design? How do different ways of depicting "technology" and "work practice" yield different politics of technology? (shrink)

Formal tools are attributed central roles in organizing work within many modern workplaces. How should one comprehend the power of these tools? Taking the medical record as an example, this article builds on recent calls to overcome the dichotomy between the formal and the informal and proposes an understanding of the generative power of such tools that does not attribute mythical capacities to either tool or human work. To do so, it is important to look both at the history offormal (...) tools and to their real-time use in concrete work practices. These steps toward a sociology of the formal are crucial for a more comprehensive understanding and evaluation offormal systems in practice. (shrink)

Health authorities increasingly request that general practitioners use information and communication technologies such as electronic patient records for accountability purposes. This article deals with the use of EPRs among general practitioners in Britain. It examines two ways in which GPs use the EPR for accountability purposes. One way is to generate audit reports on the basis of the information that has been entered into the record. The other is to let the computer intervene in the clinical process through prompts. The (...) article argues that GPs' ambivalence toward using the EPR makes them active in finding ways that turn the EPR into a meaningful tool for them, that is, a tool that helps them provide what they see as good care. The article's main contribution is to show how accountability and autonomy are coproduced; less professional autonomy does not follow from more requests to document one's work. Instead, new forms of autonomy are produced in the sociotechnical network that is made up by health policy and local engagements with patients and technology. (shrink)

The Royal Dutch Medical Association recently completed a researchproject aimed at investigating how guidelines for `appropriatemedical care' should be construed. The project took as a startingpoint that explicit attention should be given to ethical andpolitical considerations in addition to data about costs andeffectiveness. In the project, two research groups set out todesign guidelines and cost-effectiveness analyses (CEAs) for twocircumscribed medical areas (angina pectoris and majordepression). Our third group was responsible for the normativeanalysis. We undertook an explorative, qualitative pilot study ofthe (...) normative considerations that played a role in constructingthe guidelines and CEAs, and simultaneously interviewedspecialists about the normative considerations that guided theirdiagnostic and treatment decisions. Explicating normativeconsiderations, we argue, is important democratically: the issuesat stake should not be left to decision analysts and guidelinedevelopers to decide. Moreover, it is a necessary condition for asuccessful implementation of such tools: those who draw uponthese tools will only accept them when they can recognizethemselves in the considerations implied. Empirical normativeanalysis, we argue, is a crucial tool in developing guidelinesfor appropriate medical care. (shrink)

This article discusses the emergence of the modern body, as portrayed by Foucault, in early 20th-century medical practice. Specifically, this article argues how the coming of the patient-centered record in the United States was a pivotal event in this emergence. We argue how the shape and functions that the record acquired during this period was fundamentally intertwined with the new shape that both the patient’s body and medical institutions acquired. We zoom in on two specific examples: the re-historizing and subjectifying (...) of the body, both afforded by new record-keeping practices. The topic addressed here is the embodying of the patient: the production of a patient with a body whose characteristics are the effect of the interrelation of the patient with a growing number of professionals and investigative instruments, and with a medical record which becomes more and more significant in these interrelations. (shrink)

Modelling nursing activities: electronic patient records and their discontents A fully integrated and operating EPR in a clinical setting is hard to find: most applications can be found in outpatient or general practice settings or in isolated hospital wards. In clinical work practice problems with the electronic patient record (EPR) are frequent. These problems are at least partially due to the models of health care work embedded in EPRs. In this paper we will argue that these problems are at least (...) partially due to the models of health care work embedded in current EPRs. We suggest that these models often contain projections of nurses’ and doctors’ work as it should be performed on the ward, rather than depicting how work is actually performed. We draw upon sociological insights to elucidate the fluid and pragmatic nature of healthcare work and give recommendations for the development of an empirically based EPR, which can support the work of nurses and other health care providers. We argue that these issues are of great importance to the nursing profession, since the EPR will help define the worksettings of the future. Since it is a tool that will impact the development of the nursing profession, nurses have and should have a stake in its development. (shrink)