Abstract
Use of electronic health records (EHR) within clinical encounters is increasingly pervasive. The digital record allows for data storage and sharing to facilitate patient care, billing, research, patient communication and quality-of-care improvement—all at once. However, this multifunctionality is also one of the main reasons care providers struggle with the EHR. These problems have often been described but are rarely approached from a philosophical point of view. We argue that a postphenomenological case study of the EHR could lead to more in-depth insights. We will focus on two concepts—transparency and multistability—and translate them to the specific situation of the EHR. Transparency is closely related to an embodiment relation in which the user becomes less aware of the technology: it fades into the background, becoming a means of experience. A second key concept is that of multistability, referring to how a technology can serve multiple purposes or can have different meanings in different contexts. The EHR in this sense is multistable by design. Future EHR design could incorporate multistable information differently, allowing the provider to focus on patient care when interacting with the EHR. Moreover we argue that the use of the EHR in the daily workflow should become more transparent, while awareness of the computer in the specific context of the patient-provider relationship should increase.
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Notes
Other authors have conducted postphenomenological studies of concepts and topics in health care though—we will mention just three studies here, but there are many more publications. Anette Forss provided a very interesting analysis of the interaction between practitioners, microscopes and cells or the patient in cytology labs (Forss 2012). Marjolein de Boer and Jenny Slatman applied the concept of technological mediation to better understand the impact of technologies on the agency of women with breast cancer (de Boer and Slatman 2018). And lastly, Adam Rosenfeld analyzed the multistability of brain-dead bodies in the book Postphenomenological Investigations (Rosenfeld 2015).
Strictly, this could also be seen as a form of ‘use’, but use in the context of the patient–provider relationship. ‘Context’ as introduced by Yoni Van Den Eede, would rather refer to a meta-level of health care organization. However, we will focus on use within the context of the patient–provider relationship and refer to this as our focus on context.
Abbreviations
- COW:
-
Computer-on-wheels
- EHR:
-
Electronic health record
- ICD:
-
International classification of diseases
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Acknowledgements
We would like to thank Yoni Van Den Eede, Mark Paterson, Lisa Parker and Branden Nemecek for their useful contributions to the writing of this paper. We would also like to thank two anonymous reviewers for their constructive comments.
Funding
The first author was supported by a FWO Clinical Fellowship Grant (number 1700618N).
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Moerenhout, T., Fischer, G.S. & Devisch, I. The elephant in the room: a postphenomenological view on the electronic health record and its impact on the clinical encounter. Med Health Care and Philos 23, 227–236 (2020). https://doi.org/10.1007/s11019-019-09923-5
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DOI: https://doi.org/10.1007/s11019-019-09923-5