Not what it seems: Distributed agencies and clinical narratives in electronic health records

Medical records mediate clinical work at multiple levels. Focusing on the transition from paper-based medical records to Electronic Health Records (EHRs), we analyze how the incorporation of digital infrastructures reconfigures healthcare networks and reshapes practices of writing, reading, and narration. Our analysis draws on ethnographic research conducted between 2024 and 2025 in two psychiatric settings in southwestern Colombia. We trace how the implementation of EHRs redistributed agency within clinical documentation and altered relations among clinicians, administrative staff, software systems, and regulatory arrangements. Four interrelated transformations are identified: (i) shifting distribution of agency across sociotechnical networks; (ii) coexistence of writing and capturing clinical information; (iii) alteration in reading practices shaped by user profiles and distinct interfaces; and (iv) changeover from case histories anchored in biography and temporality toward label-oriented case conceptualization. We show that the integration of clinical, administrative, and financial records within EHR infrastructures privileges charting practices oriented toward diagnostic coding and billable services, while weakening the temporal and biographical anchors that previously sustained continuity and meaning-making in psychiatric documentation aimed at understanding the patient as a whole. These changes may reshape which forms of information become consequential as clinical knowledge.