Distributed Plot-Making Creating overview via paper-based and electronic patient records
This paper investigates how physicians create an overview of patient cases through an analysis of physicians’ work practices. Based on observation of and interviews with physicians, we analyse what overview means to physicians and how they establish it by using different socio-technical systems (paper-based and electronic patient records). Drawing on the theory of distributed cognition and narrative theory, primarily inspired by the work done within health care by Cheryl Mattingly, we propose that the creation of overview may be conceptualised as ‘distributed plot-making’. Distributed cognition focuses on the role of artefacts, humans and their interaction in information processing, while narrative theory focuses on how humans create narratives through plot construction. Hence, the concept of distributed plot-making highlights the distribution of information processing between different social actors and artefacts, as well as the filtering, sorting and ordering of such information into a narrative that is made coherent by a plot. The analysis shows that the characteristics of paper-based and electronic patient records support or hinder the creation of overview in both similar and different ways. In the light of the current move towards electronic patient records, we explore ways in which the benefits of paper records may be carried over into the electronic patient record as well as the ways in which the possibilities afforded by digital artefacts may be exploited more fully than is currently the case.