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Infrastructuring and Ordering Devices in Health Care: Medication Plans and Practices on a Hospital Ward

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Abstract

In this paper, we analyse physicians’ and nurses’ practices of prescribing and administering medication through the use of paper-based, and digitalized medication plans. Our point of departure is an ethnographic study of the implications of upgrading an electronic medication module (EMM) that is part of an electronic health record (EHR), carried out at an endocrinology department. The upgrade led to a temporary breakdown of the EMM, and a return to paper-based medication plans. The breakdown made visible and noticeable the taken-for-granted capabilities of medication plans in their paper-based and digital versions, and the distribution of functionalities between medication plans and clinicians. We see the case as an opportunity to analyse infrastructuring in health care, the process by which medical practices and artefacts become parts of social and technological networks with longer reaches and more channels through which coordination among distributed actors is enabled and formed. In this case, infrastructuring means an extended scope and intensity of the coordinative capabilities of medication plans, and an increased vulnerability to, and dependency on events outside the immediate loci of interaction. We particularly note the capacity of the EMM to facilitate different kinds of ordering of information and practices, and propose the conceptualizing of such digitalized artefacts as ‘ordering devices’. Ordering devices order information, stipulate action, and coordinate interaction across and within social worlds, and achieve this through the flexible support of different kinds of ordering.

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Notes

  1. An often-used term in health informatics is ‘Computerized Physician Order Entry’ (CPOE). However, since the module discussed here is used not only by physicians when prescribing, but also by nurses when dispensing and administering drugs, the term seems misleading. Another, rarer term is ‘electronic medication administration records’ (eMAR), which, for a similar reason, is also inadequate, since the artefact is also used for prescribing. We therefore use the term ‘EMM’, instead.

  2. This is in keeping with Muniesa et al. (2007), and the concept of ‘market device’, informed by Deleuze’s exploration of what a device might be:

    ... a tangle, a multi-linear ensemble. It is composed of different sorts of lines. And these lines do not frame systems that would be homogenous as such (e.g. the object, the subject, the language). Instead, they follow directions, they trace processes that are always at disequilibrium, sometimes coming close to each other and sometimes getting distant from each other. Each line is broken, is subjected to variations in direction, bifurcating and splitting, subjected to derivations. (Deleuze (1989, p. 185), in Muniesa et al. (2007, p. 2); their translation, emphasis in original)

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Acknowledgements

Our sincere thanks to the clinical staff, which was kind enough to work with us.

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Authors and Affiliations

  1. Information and Media Studies, Aarhus University, Helsingforsgade 14, 8200, Aarhus N, Denmark

    Claus Bossen

  2. IT University of Copenhagen, Rued Langgaardsvej 7, 2300, Copenhagen S, Denmark

    Randi Markussen

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  1. Claus Bossen
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  2. Randi Markussen
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Correspondence to Claus Bossen.

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Bossen, C., Markussen, R. Infrastructuring and Ordering Devices in Health Care: Medication Plans and Practices on a Hospital Ward. Comput Supported Coop Work 19, 615–637 (2010). https://doi.org/10.1007/s10606-010-9131-x

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