Opening Up the “Black Box” of the Electronic Patient Record: A Linguistic Ethnographic Study in General Practice

Authors

  • Deborah Swinglehurst Barts and The London School of Medicine and Dentistry
  • Celia Roberts King's College London
  • Tricia Greenhalgh Barts and The London School of Medicine and Dentistry

DOI:

https://doi.org/10.1558/cam.v8i1.3

Keywords:

electronic patient record, primary health care, discourse analysis, clinician-patient communication, video ethnography,

Abstract

One of the most pervasive changes in general practice is the introduction of the electronic patient record (EPR). The EPR supports both immediate clinical and anticipatory care (e.g. management of risk factors). Incorporating the EPR into social interaction is a complex task which is achieved discursively, clinician and patient responding to interactional contingencies as the consultation unfolds. Clinicians are presented with a “dilemma of attention” as they seek to deal with the immediacy (“here and now”) of the interpersonal interaction and the institutional demands (“there and then”) of the EPR. We present data analysis which illuminates the EPR as an important presence in the clinic consultation context, one which places material and textual demands. Developing previous work on the triadic (three party) consultation, our novel multi-modal analysis of the EPR-in-use suggests there is value in considering the EPR as a collection of silent but consequential voices. Micro-analytic attention to the way in which these different voices are managed, combined with understandings drawn from ethnographic observation of the primary care context, reveals the EPR as exhibiting a previously under-explored kind of “agency” within the consultation.

Author Biographies

Deborah Swinglehurst, Barts and The London School of Medicine and Dentistry

Deborah Swinglehurst is a general practitioner in Ipswich and a clinical lecturer at Barts and The London School of Medicine and Dentistry, London, UK. She holds a NIHR (National Institute of Health Research) Researcher Development Award and is currently doing a PhD on the role of the electronic patient record in the primary care consultation using ethnography and discourse analysis approaches.

Celia Roberts, King's College London

Celia Roberts is Professor of Applied Linguistics in the Centre for Language, Discourse and Communication, King’s College London, UK. Her research interests include: institutional discourse, language and ethnicity and the methods of linguistic ethnography.

Tricia Greenhalgh, Barts and The London School of Medicine and Dentistry

Trisha Greenhalgh is a general practitioner in north London and Professor of Primary Health Care at Barts and the London School of Medicine and Dentistry, London, UK. Her diverse research interests include the recursive relationship between ‘eHealth’ technologies and social practice.

Published

2011-11-29

How to Cite

Swinglehurst, D., Roberts, C., & Greenhalgh, T. (2011). Opening Up the “Black Box” of the Electronic Patient Record: A Linguistic Ethnographic Study in General Practice. Communication and Medicine, 8(1), 3–15. https://doi.org/10.1558/cam.v8i1.3

Issue

Section

Articles