The electronic patient record as a meaningful audit tool: accountability and autonomy in general practitioner work
Abstract
Health authorities increasingly request that general practitioners (GPs) use information and communication technologies such as electronic patient records (EPR) 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.
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There was no simplistic zero-sum relationship between being rendered accountable and retaining clinical autonomy; rather, accountability and autonomy appeared to co-evolve such that new, positive forms of autonomy emerged alongside the accountability agenda.
“Winthereik concluded that there was no simplistic zero-sum relationship between being rendered accountable and retaining clinical autonomy.Rather, accountability and autonomy appeared to co-evolve such that new, positive forms of autonomy emerged alongside the accountability agenda.”
Cites
Science in Action: How to Follow Scientists and Engineers through Society
Bijker, W. E., & Latour, B. (1988) · Technology and Culture · doi:10.2307/3105094 · Cited by 10,768 · see citing works
(1987) · Cited by 8,955 · see citing works
Simians, Cyborgs and Women: The Reinvention of Nature
McNeil, M., & Haraway, D. (1992) · Feminist Review · doi:10.2307/1395245 · Cited by 6,794 · see citing works
Sorting Things Out: Classification and Its Consequences
Bowker, G. C., & Star, S. L. (1999) · doi:10.7551/mitpress/6352.001.0001 · Cited by 6,188 · see citing works
Simians, Cyborgs, and Women: The Reinvention of Nature.
Green, P. A., & Haraway, D. (1992) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2076334 · Cited by 5,437 · see citing works
Sorting Things Out: Classification and Its Consequences
(2000) · The Journal of Academic Librarianship · doi:10.1016/s0099-1333(00)00155-5 · Cited by 5,212 · see citing works
Pandora's Hope: Essays on the Reality of Science Studies
Casper, M. J., & Latour, B. (2000) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2655272 · Cited by 5,021 · see citing works
The Audit Society: Rituals of Verification
Quam, L. (1998) · BMJ · doi:10.1136/bmj.316.7133.787a · Cited by 3,608 · see citing works
The Audit Society: Rituals of VerificationPreprint
Power, M. (1999) · RePEc: Research Papers in Economics · Cited by 3,597 · see citing works
Strathern, M. (2003) · Routledge eBooks · doi:10.4324/9780203449721 · Cited by 2,665 · see citing works
Representation in Scientific Practice
Lynch, M. F., & Woolgar, S. (1990) · Oxford University Research Archive (ORA) (University of Oxford) · Cited by 1,744 · see citing works
Patient care information systems and health care work: a sociotechnical approach
Berg, M. (1999) · International Journal of Medical Informatics · doi:10.1016/s1386-5056(99)00011-8 · Cited by 786 · see citing works
Self-citationThe gold standard : the challenge of evidence-based medicine and standardization in health care
Timmermans, S., & Berg, M. (2003) · Cited by 758 · see citing works
Self-citation(1992) · HAL · Cited by 593 · see citing works
A Sociology of Attachment: Music Amateurs, Drug Users
Gomart, E., & Hennion, A. (1999) · The Sociological Review · doi:10.1111/j.1467-954x.1999.tb03490.x · Cited by 509 · see citing works
Clinical autonomy, individual and collective: the problem of changing doctors’ behaviour
Armstrong, D. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00309-4 · Cited by 295 · see citing works
The contextual nature of medical information
Berg, M., & Goorman, E. (1999) · International Journal of Medical Informatics · doi:10.1016/s1386-5056(99)00041-6 · Cited by 253 · see citing works
Self-citationInfrastructure and ethnographic practice: working on the fringes
Star, S. L. (2002) · Journal of the Association for Information Systems · Cited by 222 · see citing works
Gomart, E. (2002) · Social Studies of Science · doi:10.1177/0306312702032001005 · Cited by 194 · see citing works
THE GOLD STANDARD: THE CHALLENGE OF EVIDENCE-BASED MEDICINE AND STANDARDIZATION IN HEALTH CARE
Rosoff, A. J. (2004) · Journal of Legal Medicine · doi:10.1080/01947640490458568 · Cited by 187 · see citing works
(1997) · Health Information Management Journal · doi:10.1177/183335839702700321 · Cited by 144 · see citing works
Hogg, S. A. (1991) · Nurse Education Today · doi:10.1016/0260-6917(91)90022-3 · Cited by 137 · see citing works
Strong, P. M., & Robinson, J. J. A. (1990) · Open University Press eBooks · Cited by 112 · see citing works
Using information systems to measure and improve quality
Bates, D. W., Pappius, E. M., Kuperman, G. J., Sittig, D. F., Burstin, H. R., Fairchild, D. G., Brennan, T. A., & Teich, J. M. (1999) · International Journal of Medical Informatics · doi:10.1016/s1386-5056(98)00152-x · Cited by 111 · see citing works
Challenges to theoretical psychology
Strien, V. P. (1999) · Cited by 108 · see citing works
ICT and Integrated Care: Some Dilemmas of Standardising Inter-Organisational Communication
Winthereik, B. R., & Vikkelsø, S. (2005) · Computer Supported Cooperative Work (CSCW) · doi:10.1007/s10606-004-6442-9 · Cited by 105 · see citing works
Self-citationGoverning Medicine: Theory and Practice
Brophy, C. (2004) · BMJ · doi:10.1136/bmj.329.7478.1351 · Cited by 104 · see citing works
Cutting Surgeons, Walking Patients
Mol, A. (2002) · Complexities · doi:10.1215/9780822383550-009 · Cited by 98 · see citing works
Proceedings of the 2001 International ACM SIGGROUP Conference on Supporting Group Work
Rodden, T. A., Ellis, C. A., & Zigurs, I. (2001) · Cited by 71 · see citing works
The Elusive Quest: Accountability in Hospitals
Wiener, C. L. (2000) · DigitalGeorgetown (Georgetown University Library) · Cited by 69 · see citing works
Making nursing visible? Gender, technology and the care plan as script
Wilson, M. (2002) · Information Technology and People · doi:10.1108/09593840210430570 · Cited by 68 · see citing works
Good care : enacting a complex ideal in long-term psychiatry
Pols, J. J. (2004) · University of Twente Research Information · Cited by 52 · see citing works
Bridging the quality chasm: integrating professional and organizational approaches to quality
van den Berg, M. P. (2005) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzi008 · Cited by 49 · see citing works
Self-citationWinthereik, B. R. (2003) · Methods of Information in Medicine · doi:10.1055/s-0038-1634244 · Cited by 40 · see citing works
Self-citationTHE ARCHITECTURE OF DIFFERENCE:
Timmermans, S., Bowker, G. C., & Star, S. L. (1998) · Duke University Press eBooks · doi:10.2307/j.ctv1220pvr.13 · Cited by 34 · see citing works
Winthereik, B. R., de Bont, A., & Berg, M. (2002) · Scandinavian Journal of Information Systems · Cited by 33 · see citing works
Self-citationMaking voices: new media technologies, disabilities, and articulation
Moser, I. B., & Law, J. (2003) · Open Research Online (The Open University) · Cited by 31 · see citing works
The Architecture of Difference
Timmermans, S., Bowker, G. C., & Star, S. L. (1998) · Duke University Press eBooks · doi:10.1215/9780822399179-010 · Cited by 24 · see citing works
Implementing clinical governance in Trusts
Hackett, M. C. (1999) · International Journal of Health Care Quality Assurance · doi:10.1108/09526869910280384 · Cited by 7 · see citing works
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GREENHALGH, T., POTTS, H. W. W., WONG, G., BARK, P., & SWINGLEHURST, D. (2009) · The Milbank Quarterly · doi:10.1111/j.1468-0009.2009.00578.x · Cited by 541 · see citing works
Greenhalgh, T., Swinglehurst, D., & Stones, R. (2014) · Health Services and Delivery Research · doi:10.3310/hsdr02390 · Cited by 71 · see citing works
- Authors
- Winthereik, B. R., van der Ploeg, I., & Berg, M.
- Affiliations
- Technical University of Denmark (DK)
- Zuyd University
- Erasmus University Rotterdam (NL)
- Venue
- Science, Technology, & Human Values
- Publisher
- SAGE Publications
- Published
- 2007-01
- Volume
- 32
- Issue
- 1
- Pages
- 6-25
- ISSN
- 0162-2439 (ISSN-L)
- 1552-8251
- OpenAlex
- W2078488880
- Cited by
- 64
- References
- 39
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 5 · 2014: 6 · 2013: 4 · 2012: 5
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Science Technology & Human Values (publishedVersion)
- Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- electronic health records, general practitioners, professional accountability, professional autonomy, clinical audit, clinical decision support, ambivalence toward technology, health information and communication technologies, sociotechnical networks, health policy, good care
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