7.63 Simonsen, J. (2009): "Empowering Nurses by Making Electronic Health Records Collaboratively Available", the Third International Conference on Design Principles and Practices, University of the Arts, Berlin, 15-17 February, 2009.


The paper demonstrates a participatory, real-life experimentation-based design approach comprising design as well as organizational implementation of large IT systems. Evaluations within a series of sustained iterative cycles are supported by ethnographically inspired observations to identify and analyze changes to work practices that emerge from using the IT system. The approach might empower users by identifying and turning selected emergent changes into planned interventions and opportunity-based change in the following iteration.

A large-scale experiment was conducted where an advanced prototype of an Electronic Health Record (EHR) system was configured in collaboration with clinicians and subsequently exposed to real-life use at an acute neurological stroke unit. The system replaced all paper records. The clinicians used the system 24 hours a day throughout one week. The observations focused on the nurses’ use of a large shared EHR display during highly collaborative situations.

An ethnographic analysis of emergent changes to the nurses’ work reveals (a) a change from oral presentation to collective reading of patient records, (b) initiation of collective investigations of patient records, and (c) that nurses’ observations became a prominent part of the shared agenda during interdisciplinary team conferences (attended by all clinicians).

The presentation will present video excerpts and audio transcripts from the observations and demonstrate (1) the empowerment experienced by the nurses during the experiment, and (2) the implications with regard to design.