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

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.