Coordinating Medication Information Across Primary and Specialized Care: An Ethnographic Study of Health...

Coordination among health professionals across levels of care is essential for safe treatment, yet fragmented digital systems complicate the obtaining and sharing of patients' medication information. This ethnographic study explores how medication information is coordinated in everyday work and how tools are involved. We observed 145 hours of work and conducted 24 interviews with physicians, pharmacists, and nurses in Norwegian primary and specialized care. Data were analyzed thematically, informed by sociocultural and boundary work perspectives. We found that coordination is continuous, situated work that can be supported, but not replaced, by digital tools. The observed health professionals engaged in both competitive and collaborative boundary work. Competitive strategies (disengagement, opposing established responsibilities, and delegating work tasks) rendered coordination of medication information "dirty work." Collaborative strategies (requesting information, cleaning up, and preventing discrepancies) restored alignment and enabled the sharing of accurate information. Digital medication lists operated as boundary objects: they facilitated the sharing of patients' medication use but sometimes failed to align perspectives, contributing to fragmentation and the construction of "dirty work." Conceptually, we extend boundary work understandings by documenting the defense against jurisdiction as a competitive strategy and by demonstrating how this boundary work may produce "dirty work." This study thus contributes to understanding the interplay between structural fragmentation, professional practices, and digital tools in healthcare coordination. Policy and system design should recognize and support the boundary work that enables the coordination of medication information.