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A critical investigation of electronic patient records in the NHS in England : Tracing an elusive object through its actor- network

Goff, M 2014, A critical investigation of electronic patient records in the NHS in England : Tracing an elusive object through its actor- network , PhD thesis, University of Salford.

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This study is a critical investigation of electronic patient records in the National Health Service in England. It explores whether EPRs benefit clinicians in the context of a technology that has been explicitly designed to fulfil multiple purposes, both clinical and non-clinical, and is critical in its motivation to challenge their apparent sense of inevitability. Against the backdrop of a government vision of a nationally networked EPR the research takes a meso level perspective using primary data from interviews with users across multiple NHS Trusts and healthcare settings. The study uses Actor-Network Theory from the outset as both a methodological and theoretical approach with the aim to be revelatory about the interests at work in sustaining this technology and to question whether clinicians bear the costs of network-building for the EPR. This has shaped the trajectory of the research, which is as a consequence highly reflexive and in which theoretical and methodological concerns are given equal weight to investigation of EPRs. Whilst EPRs undoubtedly benefit clinicians fundamentally through improved access to patient information, benefits are constrained by material and social interests that reproduce existing relations. In particular, non-clinical agendas are strongly inscribed within EPRs, reshaping clinical work practices by defining what may and must be recorded, and shifting attention within clinical care. A performative conception of EPRs acknowledges the messy and multiple realities and enables theorisation of the technology as complicit in a reshaping of reality towards informatized healthcare. EPRs mediate a quantification of clinical practice that implies additional work for clinicians, and new regimes of control based around recording in the EPR. The study paints a complex and subtle picture of the use of EPRs by mapping its actor-network through the experiences of users and conceptualising the EPR as emerging from a messy, heterogeneous network of socio-material relations.

Item Type: Thesis (PhD)
Contributors: Fletcher, G (Supervisor)
Schools: Schools > Salford Business School
Funders: Non funded research
Depositing User: Mhorag Goff
Date Deposited: 27 Jul 2015 15:09
Last Modified: 05 Apr 2016 18:21

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