Shared care and boundaries: lessons from an online maternity record.

Area of Science:

• Science and Technology Studies (STS)
• Sociology of Health and Illness
• Health Informatics

Background:

• Shared maternity care models aim to improve coordination between healthcare providers and pregnant women.
• Online maternity records are increasingly used as tools to facilitate communication and information sharing.
• Understanding the practical implementation and emergent properties of such tools is crucial for effective healthcare design.

Purpose of the Study:

• To examine the functionality of an online maternity record in establishing shared maternity care.
• To analyze how pregnant women and healthcare professionals interact with the digital record.
• To investigate the socio-technical aspects of implementing shared care through IT.

Main Methods:

• Ethnographic research techniques were employed to observe and analyze the implementation of the online maternity record.
• A theoretical framework from science and technology studies guided the analysis of social and technical interactions.
• Case study approach focusing on a pilot project involving pregnant women.

Main Results:

• The online record fostered a version of the "responsible patient" focused on navigating primary and secondary care boundaries, rather than the intended home-clinic boundary.
• The project highlighted that care is inherently shared among diverse human and nonhuman actors.
• The redistribution of responsibilities within shared care projects requires careful attention.

Conclusions:

• IT designers and project managers must acknowledge and design for the inevitable enactment of boundaries in healthcare coordination tools.
• Shared care projects offer opportunities for patients and professionals to experiment with new roles and responsibilities.
• Studying boundary enactment is valuable for creating continuity in healthcare and leveraging IT for organizational change.