How Physicians ‘Achieve Overview’: A Case-based Study in a Hospital Ward.
Clinicians' work in hospitals is safety- and time-critical, and often stressful due to the number and complexity of patient cases they must attend to. Therefore, how clinicians gather information, identify problems and make decisions concerning patients is a crucial concern, a process that can be labelled 'achieving overview'. In the process, clinicians use various artefacts amongst which medical records are central. Decades of experience is embedded in the structure and use of paper-based records. However, the development of electronic patient records (EPR) will change both structure and use of medical records, including 'achieving overview'. We conducted an ethnographic study in a hospital ward using paper-based medical records in order to understand how clinicians achieve overview. Inspired by the approach of exnovation, we elicit the use of paper-based records in order to inform the design of EPRs. We propose five axes which span out the process of achieving overview and describe implications for design of EPRs.