Inter-organisational use of the electronic health record in mental health
DOI:
https://doi.org/10.1558/cam.32398Keywords:
electronic health record (EHR), Finland, focus group interviews, mental health, recording, tracingAbstract
The creation and use of electronic records in welfare services is a subject that has received widespread attention. The electronic health record (EHR) is used by different stakeholders (NGOs, hospitals, health care clinics and commissioning agencies) and thus enables the distribution and sharing of recorded information between them, and in this article we focus on the tensions that arise from the inter-organisational use of the EHR in the context of mental health services. The data corpus consists of four focus group interviews from three NGOs in Finland, and we draw on ethnomethodology to analyse the ways in which mental health workers together talk and make sense of these tensions in their interview talk. Our findings suggest that the EHR addresses concerns about the dislocation of clients and continuity of care, which create a need for mental health workers to trace clients' service use and also the contributions by other professionals. However, the introduction of the EHR has increased the recording work of mental health workers as well as of the monitoring of their work performance. Our findings strengthen the case for more transparent practices and rules of recording and information sharing among the different users of the EHR.
References
Atkinson, P. (2004) The discursive construction of competence and responsibility in medical collegial talk. Communication & Medicine 1 (1): 13-23. https://doi.org/10.1515/come.2004.001
Baker, C. (1997) Membership categorization and interview accounts. In D. Silverman (ed.) Qualitative Research: Theory, Method and Practice, 130-143. London: Sage.
Baker, C. (2003) Ethnomethodological analyses of interviews. In J. A. Holstein and J. F. Gubrium (eds) Inside Interviewing: New Lenses, New Concerns, 395-412. London: Sage.
Banks, S. (2011) Ethics in an age of austerity: Social work and evolving new public management. Journal of Social Intervention: Theory and Practice 20 (2): 5-23. https://doi.org/10.18352/jsi.260
Berg, M. and Bowker, G. (1997) The multiple bodies of the medical record: Towards a sociology of an artifact. Sociological Quarterly 38 (3): 513-537. https://doi.org/10.1111/j.1533-8525.1997.tb00490.x
Bowker, G. C. and Star Leigh, S. (1999) Sorting Things Out: Classification and Its Consequences. Cambridge, MA: MIT Press.
Burton, J. and van den Broek, D. (2009) Accountable and countable: Information management systems and the bureaucratization of social work. British Journal of Social Work 39 (7): 1326-1342. https://doi.org/10.1093/bjsw/bcn027
CGI. (n.d.) Potilastietojärjestelmät: Oikeaa hoitoa oikeaan aikaan [Electronic health records: Appropriate care at the appropriate time]. Available online: http://www.cgi.fi/hyvinvointi/potilastietojarjestelmat
Cicourel, A. V. (1974) Police practices and official records. In R. Turner (ed.) Ethnomethodology, 85-95. Harmondsworth: Penguin.
Clarke, K., Hartswood, M., Procter, R., Rouncefield, M. and Slack, R. (2003) Trusting the record. Methods of Information in Medicine 42 (4): 345-352. https://doi.org/10.1055/s-0038-1634228
De Witte, J., Declercq, A. and Hermans, K. (2016) Street-level strategies of child welfare social workers in Flanders: The use of electronic client records in practice. British Journal of Social Work 46 (5): 1249-1265. https://doi.org/10.1093/bjsw/bcv076
Ferraris, M. (2013) Documentality: Why it is Necessary to Leave Traces. New York: Fordham University Press.
Fetter, M. S. (2009) The electronic health record. Issues in Mental Health Nursing 30 (5): 345-347. https://doi.org/10.1080/01612840902754677
Frers, L. (2009) Space, materiality and the contingency of action: A sequential analysis of the patient’s file in doctor-patient interactions. Discourse Studies 11 (3): 285-303.
https://doi.org/10.1177/1461445609102445
Garfinkel, H. (1967) Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice Hall.
Günther, K. (2014) Multi-voiced assessment in a mental health final statement. Text & Talk 34 (6): 665-684. https://doi.org/10.1515/text-2014-0026
Günther K. (2015) Asiakasdokumentaatio Arviointina Mielenterveystyön Arjessa: Tutkimus Ammatillisesta Kirjaamisesta. Tampere: Tampere University Press.
Günther, K., Raitakari, S. and Juhila, K. (2015) From plan meetings to care plans: Genre chains and the intertextual relations of text and talk. Discourse & Communication 9 (1): 65-79. https://doi.org/10.1177/1750481314555265
Hak, T. (1992) Psychiatric records as transformations of other texts. In G. Watson and R. M. Seiler (eds) Text in Context: Contributions to Ethonomethodology, 138-155. Newbury Park, CA: Sage.
Hallipelto, A. (2008) Paras tuottakoon! Hyvinvointipalvelujen tulevat markkinat. Kunnallisalan kehittämissäätiön Polemia-sarjan julkaisu nro 68. Helsinki: Kunnallisalan kehittämissäätiö.
Hardstone, G., Hartswood, M., Procter, R., Slack, R., Voss, A. and Rees, G. (2004) Supporting informality: Team working and integrated care records. Proceedings of the 2004 ACM Conference on Computer Supported Cooperative Work, 142-151. New York: Association for Computing Machinery. https://doi.org/10.1145/1031607.1031632
Harrison, G. and Melville, R. (2010) Rethinking Social Work in a Global World. New York: Palgrave Macmillan. https://doi.org/10.1007/978-1-137-07077-7
Hartswood, M., Procter, R., Rouncefield, M. and Slack, R. (2003) Making a case in medical work: Implications for the electronic medical record. Computer Supported Cooperative Work 12 (3): 241-266. https://doi.org/10.1023/A:1025055829026
Henman, P. and Adler, M. (2003) Information technology and the governance of social security. Critical Social Policy 23 (2): 139-164. https://doi.org/10.1177/0261018303023002002
Iedema, R. and Scheeres, H. (2003) From doing work to talking work: Renegotiating knowing, doing and identity. Applied Linguistics 24 (3): 316-337. https://doi.org/10.1093/applin/24.3.316
Johnson, S., Prosser, D., Bindman, J. and Szmukler, G. (1997) Continuity of care for the severely mentally ill: Concepts and measures. Social Psychiatry and Psychiatry Epidemiology 32 (3): 137-142.
Kagle, J. and Kopels, S. (2008 [1995]) Social Work Records. Long Grove, IL: Waveland Press.
Morgan, D. L. (2012) Focus groups and social interaction. In J. F. Gubrium, J. A. Holstein, A. B. Marvasti and K. D. McKinney (eds) The SAGE Handbook of Interview Research: The Complexity of the Craft (2nd edition), 161-176. London: Sage.
O’Rourke, L. (2010) Recording in Social Work: Not just an Administrative Task. Bristol: Policy Press. https://doi.org/10.2307/j.ctt1t897kw
Peckover, S., Hall, C. and White, S. (2009) From policy to practice: The implementation and negotiation of technologies in everyday child welfare. Children and Society 23 (2): 136-148. https://doi.org/10.1111/j.1099-0860.2008.00143.x
Postle, K. (2002) Working ‘between the idea and the reality’: Ambiguities and tensions in care managers’ work. British Journal of Social Work 32 (3): 335-351. https://doi.org/10.1093/bjsw/32.3.335
Räsänen, J.-M. (2010) Tietojärjestelmien yhteiskäytön jännitteet seudullisessa sosiaalipäivystyksessä. In A. Pohjola, A. Kääriäinen and S. Kuusisto-Niemi (eds) Sosiaalityö, Tieto ja Teknologia, 291-318. Jyväskylä, Finland: PS-Kustannus.
Räsänen, J.-M. (2015) Emergency social workers navigating between computer and client. British Journal of Social Work 45 (7): 2106-2123. https://doi.org/10.1093/bjsw/bcu031
Räsänen, J.-M. and Saario, S. (2017) Welfare workers reflecting their everyday responsibilities in focus groups. In K. Juhila, S. Raitakari and C. Hall (eds) Responsibilisation at the Margins of Welfare Services, 153-173. London: Routledge.
Reynolds, J. F., Mair, D. C. and Fisher, P. C. (1995) Writing and Reading Mental Health Records: Issue and Analysis in Professional Writing and Scientific Rhetoric. Mahwah, NJ: Lawrence Erlbaum Associates.
Ryback, R. S., Longabaugh, R. and Fowler, R. D. (1981) The Problem Oriented Record in Psychiatry and Mental Health Care. New York: Grune & Stratton.
Saario, S., Juhila, K. and Raitakari, S. (2015) Boundary work in inter-agency and inter-professional client transitions. Interprofessional Journal of Care 29 (6): 610-615.
https://doi.org/10.3109/13561820.2015.1040490
Saario, S., Räsänen, J-M. and Hall, C. (2017) Negotiating boundaries of responsibilities in team meetings. In K. Juhila, S. Raitakari and C. Hall (eds) Responsibilisation at the Margins of Welfare Services, 174-195. London: Routledge.
Sarangi, S. and Brookes-Howell, L. (2006) Recontextualising the familial lifeworld in genetic counselling case notes. In M. Gotti and F. Salager-Meyer (eds) Advances in Medical Discourse Analysis: Oral and Written Contexts, 197-225. Bern: Peter Lang.
Ser, G., Robertson, A.and Sheikh, A. (2014) A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals. PLoS ONE 9 (1): e77669. doi:10.1371/journal.pone.0077669. https://doi.org/10.1371/journal.pone.0077669
Smith, D. (1990) Texts, Facts and Femininity: Exploring the Relations of Ruling. London: Routledge.
Stockdale, S. E., Sherin, J. E., Chan, J. A. and Hermann, R. C. (2011) Barriers and strategies for improving communication between inpatient and outpatient mental health clinicians. BMJ Quality & Safety 20 (11): 941-946. https://doi.org/10.1136/bmjqs.2010.050450
Taylor, C. and White, S. (2000) Practicing Reflexivity in Health and Welfare. Buckingham, UK: Open University Press.
Tsai, J. and Bond, G. (2008) A Comparison of electronic records to paper records in mental health centers. International Journal for Quality in Health Care 20 (2): 136-143. https://doi.org/10.1093/intqhc/mzm064
Vuorela, S. (2003) Perusterveydenhuollon tietojärjestelmä: Esimerkkinä Pegasos. In P. Nykänen (ed.) Terveydenhuollon Tietojärjestelmät, 87-100. Tampere, Finland: Tampereen yliopisto, Tietojenkäsittelytieteiden laitos.
Wheeler, S. (1969) On Record: Files and Dossiers in American Life. New York: Russell Sage Foundation.
Winman, T., Säljö, R. and Rystedt, H. (2012) Local knowing and the use of electronic patient records: Categories and continuity of health care. Health Technology 2 (3): 185-196. https://doi.org/10.1007/s12553-012-0029-0
Winthereik, B. R., van der Ploeg, M. and Berg, M. (2007) The electronic patient record as a meaningful audit tool: Accountability and autonomy in general practitioner work. Science, Technology and Human Values 32 (6): 6-25. https://doi.org/10.1177/0162243906293884
Winthereik, B. R. and Vikkelsø, S. (2005) ICT and integrated care: Some dilemmas of standardising inter-organisational communication. Computer Supported Cooperative Work 14 (1): 43-67. https://doi.org/10.1007/s10606-004-6442-9
Zimmerman, D. H. (1969) Record-keeping and the intake process in a public welfare agency. In S. Wheeler (ed.) On Record: Files and Dossiers in American Life, 319-354. New York: Russell Sage Foundation.
Baker, C. (1997) Membership categorization and interview accounts. In D. Silverman (ed.) Qualitative Research: Theory, Method and Practice, 130-143. London: Sage.
Baker, C. (2003) Ethnomethodological analyses of interviews. In J. A. Holstein and J. F. Gubrium (eds) Inside Interviewing: New Lenses, New Concerns, 395-412. London: Sage.
Banks, S. (2011) Ethics in an age of austerity: Social work and evolving new public management. Journal of Social Intervention: Theory and Practice 20 (2): 5-23. https://doi.org/10.18352/jsi.260
Berg, M. and Bowker, G. (1997) The multiple bodies of the medical record: Towards a sociology of an artifact. Sociological Quarterly 38 (3): 513-537. https://doi.org/10.1111/j.1533-8525.1997.tb00490.x
Bowker, G. C. and Star Leigh, S. (1999) Sorting Things Out: Classification and Its Consequences. Cambridge, MA: MIT Press.
Burton, J. and van den Broek, D. (2009) Accountable and countable: Information management systems and the bureaucratization of social work. British Journal of Social Work 39 (7): 1326-1342. https://doi.org/10.1093/bjsw/bcn027
CGI. (n.d.) Potilastietojärjestelmät: Oikeaa hoitoa oikeaan aikaan [Electronic health records: Appropriate care at the appropriate time]. Available online: http://www.cgi.fi/hyvinvointi/potilastietojarjestelmat
Cicourel, A. V. (1974) Police practices and official records. In R. Turner (ed.) Ethnomethodology, 85-95. Harmondsworth: Penguin.
Clarke, K., Hartswood, M., Procter, R., Rouncefield, M. and Slack, R. (2003) Trusting the record. Methods of Information in Medicine 42 (4): 345-352. https://doi.org/10.1055/s-0038-1634228
De Witte, J., Declercq, A. and Hermans, K. (2016) Street-level strategies of child welfare social workers in Flanders: The use of electronic client records in practice. British Journal of Social Work 46 (5): 1249-1265. https://doi.org/10.1093/bjsw/bcv076
Ferraris, M. (2013) Documentality: Why it is Necessary to Leave Traces. New York: Fordham University Press.
Fetter, M. S. (2009) The electronic health record. Issues in Mental Health Nursing 30 (5): 345-347. https://doi.org/10.1080/01612840902754677
Frers, L. (2009) Space, materiality and the contingency of action: A sequential analysis of the patient’s file in doctor-patient interactions. Discourse Studies 11 (3): 285-303.
https://doi.org/10.1177/1461445609102445
Garfinkel, H. (1967) Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice Hall.
Günther, K. (2014) Multi-voiced assessment in a mental health final statement. Text & Talk 34 (6): 665-684. https://doi.org/10.1515/text-2014-0026
Günther K. (2015) Asiakasdokumentaatio Arviointina Mielenterveystyön Arjessa: Tutkimus Ammatillisesta Kirjaamisesta. Tampere: Tampere University Press.
Günther, K., Raitakari, S. and Juhila, K. (2015) From plan meetings to care plans: Genre chains and the intertextual relations of text and talk. Discourse & Communication 9 (1): 65-79. https://doi.org/10.1177/1750481314555265
Hak, T. (1992) Psychiatric records as transformations of other texts. In G. Watson and R. M. Seiler (eds) Text in Context: Contributions to Ethonomethodology, 138-155. Newbury Park, CA: Sage.
Hallipelto, A. (2008) Paras tuottakoon! Hyvinvointipalvelujen tulevat markkinat. Kunnallisalan kehittämissäätiön Polemia-sarjan julkaisu nro 68. Helsinki: Kunnallisalan kehittämissäätiö.
Hardstone, G., Hartswood, M., Procter, R., Slack, R., Voss, A. and Rees, G. (2004) Supporting informality: Team working and integrated care records. Proceedings of the 2004 ACM Conference on Computer Supported Cooperative Work, 142-151. New York: Association for Computing Machinery. https://doi.org/10.1145/1031607.1031632
Harrison, G. and Melville, R. (2010) Rethinking Social Work in a Global World. New York: Palgrave Macmillan. https://doi.org/10.1007/978-1-137-07077-7
Hartswood, M., Procter, R., Rouncefield, M. and Slack, R. (2003) Making a case in medical work: Implications for the electronic medical record. Computer Supported Cooperative Work 12 (3): 241-266. https://doi.org/10.1023/A:1025055829026
Henman, P. and Adler, M. (2003) Information technology and the governance of social security. Critical Social Policy 23 (2): 139-164. https://doi.org/10.1177/0261018303023002002
Iedema, R. and Scheeres, H. (2003) From doing work to talking work: Renegotiating knowing, doing and identity. Applied Linguistics 24 (3): 316-337. https://doi.org/10.1093/applin/24.3.316
Johnson, S., Prosser, D., Bindman, J. and Szmukler, G. (1997) Continuity of care for the severely mentally ill: Concepts and measures. Social Psychiatry and Psychiatry Epidemiology 32 (3): 137-142.
Kagle, J. and Kopels, S. (2008 [1995]) Social Work Records. Long Grove, IL: Waveland Press.
Morgan, D. L. (2012) Focus groups and social interaction. In J. F. Gubrium, J. A. Holstein, A. B. Marvasti and K. D. McKinney (eds) The SAGE Handbook of Interview Research: The Complexity of the Craft (2nd edition), 161-176. London: Sage.
O’Rourke, L. (2010) Recording in Social Work: Not just an Administrative Task. Bristol: Policy Press. https://doi.org/10.2307/j.ctt1t897kw
Peckover, S., Hall, C. and White, S. (2009) From policy to practice: The implementation and negotiation of technologies in everyday child welfare. Children and Society 23 (2): 136-148. https://doi.org/10.1111/j.1099-0860.2008.00143.x
Postle, K. (2002) Working ‘between the idea and the reality’: Ambiguities and tensions in care managers’ work. British Journal of Social Work 32 (3): 335-351. https://doi.org/10.1093/bjsw/32.3.335
Räsänen, J.-M. (2010) Tietojärjestelmien yhteiskäytön jännitteet seudullisessa sosiaalipäivystyksessä. In A. Pohjola, A. Kääriäinen and S. Kuusisto-Niemi (eds) Sosiaalityö, Tieto ja Teknologia, 291-318. Jyväskylä, Finland: PS-Kustannus.
Räsänen, J.-M. (2015) Emergency social workers navigating between computer and client. British Journal of Social Work 45 (7): 2106-2123. https://doi.org/10.1093/bjsw/bcu031
Räsänen, J.-M. and Saario, S. (2017) Welfare workers reflecting their everyday responsibilities in focus groups. In K. Juhila, S. Raitakari and C. Hall (eds) Responsibilisation at the Margins of Welfare Services, 153-173. London: Routledge.
Reynolds, J. F., Mair, D. C. and Fisher, P. C. (1995) Writing and Reading Mental Health Records: Issue and Analysis in Professional Writing and Scientific Rhetoric. Mahwah, NJ: Lawrence Erlbaum Associates.
Ryback, R. S., Longabaugh, R. and Fowler, R. D. (1981) The Problem Oriented Record in Psychiatry and Mental Health Care. New York: Grune & Stratton.
Saario, S., Juhila, K. and Raitakari, S. (2015) Boundary work in inter-agency and inter-professional client transitions. Interprofessional Journal of Care 29 (6): 610-615.
https://doi.org/10.3109/13561820.2015.1040490
Saario, S., Räsänen, J-M. and Hall, C. (2017) Negotiating boundaries of responsibilities in team meetings. In K. Juhila, S. Raitakari and C. Hall (eds) Responsibilisation at the Margins of Welfare Services, 174-195. London: Routledge.
Sarangi, S. and Brookes-Howell, L. (2006) Recontextualising the familial lifeworld in genetic counselling case notes. In M. Gotti and F. Salager-Meyer (eds) Advances in Medical Discourse Analysis: Oral and Written Contexts, 197-225. Bern: Peter Lang.
Ser, G., Robertson, A.and Sheikh, A. (2014) A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals. PLoS ONE 9 (1): e77669. doi:10.1371/journal.pone.0077669. https://doi.org/10.1371/journal.pone.0077669
Smith, D. (1990) Texts, Facts and Femininity: Exploring the Relations of Ruling. London: Routledge.
Stockdale, S. E., Sherin, J. E., Chan, J. A. and Hermann, R. C. (2011) Barriers and strategies for improving communication between inpatient and outpatient mental health clinicians. BMJ Quality & Safety 20 (11): 941-946. https://doi.org/10.1136/bmjqs.2010.050450
Taylor, C. and White, S. (2000) Practicing Reflexivity in Health and Welfare. Buckingham, UK: Open University Press.
Tsai, J. and Bond, G. (2008) A Comparison of electronic records to paper records in mental health centers. International Journal for Quality in Health Care 20 (2): 136-143. https://doi.org/10.1093/intqhc/mzm064
Vuorela, S. (2003) Perusterveydenhuollon tietojärjestelmä: Esimerkkinä Pegasos. In P. Nykänen (ed.) Terveydenhuollon Tietojärjestelmät, 87-100. Tampere, Finland: Tampereen yliopisto, Tietojenkäsittelytieteiden laitos.
Wheeler, S. (1969) On Record: Files and Dossiers in American Life. New York: Russell Sage Foundation.
Winman, T., Säljö, R. and Rystedt, H. (2012) Local knowing and the use of electronic patient records: Categories and continuity of health care. Health Technology 2 (3): 185-196. https://doi.org/10.1007/s12553-012-0029-0
Winthereik, B. R., van der Ploeg, M. and Berg, M. (2007) The electronic patient record as a meaningful audit tool: Accountability and autonomy in general practitioner work. Science, Technology and Human Values 32 (6): 6-25. https://doi.org/10.1177/0162243906293884
Winthereik, B. R. and Vikkelsø, S. (2005) ICT and integrated care: Some dilemmas of standardising inter-organisational communication. Computer Supported Cooperative Work 14 (1): 43-67. https://doi.org/10.1007/s10606-004-6442-9
Zimmerman, D. H. (1969) Record-keeping and the intake process in a public welfare agency. In S. Wheeler (ed.) On Record: Files and Dossiers in American Life, 319-354. New York: Russell Sage Foundation.
Published
2018-07-03
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How to Cite
Räsänen, J.-M., & Günther, K. (2018). Inter-organisational use of the electronic health record in mental health. Communication and Medicine, 15(1), 65-76. https://doi.org/10.1558/cam.32398
