The mediating role of documents: Information sharing through medical records in healthcare

Abstract

The focus of this paper is on the mediating role of medical records in patient care. Their informative, communicative and constitutive facets are analysed on the basis of a case study in an African University teaching hospital. A practice-oriented approach and the concept of boundary objects were adopted to examine medical records as information artefacts. Data from nonparticipant observations and interviews with physicians were triangulated in a qualitative analysis. Three distinctive practices for information sharing – absorbing by reading, augmenting by documenting and recounting by presenting – were identified as central to the mediating role of medical records in the care of patients. Additionally, three information-sharing functions outside the immediate care of patients were identified: facilitating interactions, controlling hegemonic order and supporting learning. The records were both a useful information resource and a blueprint for sustaining shared practices over time. The medical records appeared as an essential part of patient care and amendments to them resulted in changes in several other work practices. The analysis contributes to research on documents as enacting and sustaining work practices in a workplace.