Ellen Balka (Senior Scholar, Michael Smith Foundation for Health Research Professor, School of Communication, & Director, Assessment of Technology in Context Design Lab, Simon Fraser University; Senior Research Scientist, Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health)

Mapping the body across diverse information systems: The anatomy of cross jurisdictional patient handovers

Patients, healthcare organizations, care providers and patient safety organizations frequently call for a unified electronic patient health record. Patients, particularly in the middle of medical emergencies often are ill equipped to repeat pertinent data over and over again, with each new encounter with a health care provider. Healthcare organizations need to curb costs, and see electronic records as not only a means to achieve administrative efficiencies, but also as a means through which to measure performance according to varied metrics, such as efficiency of delivery of care and health outcomes achieved in relation to care delivered. Care providers and patient safety organizations often worry that each time data are handed over about a patient the possibility for error is introduced, and, when treating patients in emergency situations, care providers may also be aware that each time a patient repeats personal information, the amount of time which elapses prior to treatment increases, potentially compromising care.

Electronic patient records are being developed and introduced into complex environments amidst ample and varied expectations about the problems they will help solve. In this paper, I explore varied senses of the body and its systems, health and illness, in relation to the problem of computerizing patient handovers during the pre-hospital care trajectory. Using ski area injuries as a starting point, I explore notions of health and illness as they are negotiated across multiple jurisdictions (such as the ski patrol, ambulance service, local clinic), information needs (e.g., those of a provincial safety officer, who receives information if an injury involves a ski lift) and information systems between a point of rural injury and definitive care in an acute care facility in an urban area. A focus on pre-hospital handovers in care renders jurisdictional boundaries and differing views of the body – “shadow bodies” (Star and Balka, 2009) visible, along with organizational and bodily messiness and variation when viewed through the multiple lenses of computerizing pre-hospital care handovers, conducting epidemiological research about ski area injuries, and the personal lens of caring for an injured child or oneself.

 Ellen Balka Ph.D. is a Professor in Simon Fraser University's School of Communication, in Vancouver, Canada, where she also holds a position as a senior research scientist at Vancouver Coastal Health's Centre for Clinical Epidemiology and Evaluation. She holds a Michael Smith Foundation for Health Research Senior Scholar's Award, and adjunct faculty positions in the University of British Columbia Faculty of Medicine and in the University of Victoria's Department of Heath Information Sciences. Her current work is concerned with how new health sector technology changes work practices, the governance of health sector technology and patient safety, and the relationship between system design and health indicator quality and availability. Recent projects have included studies of duplicate medical charts, issues related to computerization of electronic patient records to support continuity of care, and computerization of handovers in care. Her work is informed by several interdisciplinary areas of inquiry including science, technology and society studies, computer supported cooperative work, women’s studies, and, increasingly, finds expression through artistic practice.

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