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Paper long abstract:

The proposed paper draws on empirical data about clinicians' experiences of Electronic Patient Records (EPRs) from interviews with users in multiple healthcare settings across 8 National Health Service Trusts in England.

EPRs facilitate classification of patients, their conditions and treatments through the use of clinical coding including Read and ICD10 coding schemes. Using Actor-Network Theory I theorise clinical coding as a significant actor in the actor-network for EPRs, and as an inscription of non-clinical agendas associated with ambitions to quantify illness and the work practices which constitute healthcare.

Clinical coding comes into its own in the context of EPRs, serving to legitimise measures of clinical work and classifications of illness, and opening up possibilities for quantifying healthcare on a grand scale. The NHS information strategy aspires not only to improve clinical information flows, but also to use information captured at the point of care to serve a range of secondary purposes including commissioning, clinical audit and administration, particularly in the context of public accountability. There is also an aspiration to commercially exploit datasets extracted from EPRs.

In this respect clinical coding has implications for clinicians in terms of the measurement and increased visibility of work practices and the changing constitution of healthcare with the framing of health and illness in economic and 'audit' terms. Moreover risks to patient privacy from the aggregation of EPR data, its storage, manipulation and transfer raise questions about the ethical consequences for ownership and custodianship of patient records and implications for shifting conceptions of privacy.