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Paper long abstract

Digital data is expected to bring solutions for the crisis-ridden healthcare system. Consequently, data collected in electronic health record systems (EHRs) has intensified. Apotti is an EHRs based on intensifying data resourcing, necessitating a shift from traditional narrative documentation to structured records in healthcare practices.

This transition is critical, as narratives have dominated healthcare practices for decades. Previous studies also suggest that structured data may require heavier cognitive processing compared to writing and interpreting free text (narratives).

This research is based on workshop data with physicians using Apotti (n = 25), gathered in Spring 2023. The analysis reveals that structured documentation was perceived as challenging in terms of producing and interpreting clinical reality but also being cognitively constraining.

The analysis is framed with the notion of epistemic injustice, which refers to the discrimination when someone is wronged in their capacity as a knower. In healthcare, epistemic injustice has been investigated especially in the doctor-patient relationship from the patients’ perspective. In this study, physicians using Apotti found themselves paradoxically in the position where their capacity to know was questioned: physicians experienced that problems related to Apotti were reduced to mere lack of training, implying that it is the physicians, not Apotti, that needed more fixing.

While structured data may enhance secondary data use, this can compromise the primary users' needs, creating tension that undermines their credibility. Furthermore, poorly produced structured data undermines the very foundation on which the promises of datafication and structured data rest.