Document Dreams: Patient-Centered Records versus Practice-Centered Records (Research Seminar, February 20th, 2002) Carsten Osterlund MIT Abstract This presentation explores the challenges and difficulties of using medical information systems to share knowledge across dispersed healthcare settings. I ask why, and with what consequences, do patients have their medical histories taken and retaken repeatedly as they move across healthcare locales? And, why do doctors and nurses choose to record these histories in such a variety of information systems? In addressing these questions I draw on an 18-month, multi-sited ethnographic study in several pediatric health care settings, following patients from primary care clinics, to emergency rooms, to in-patient units. The analysis focuses on the practices that go into documenting patients’ care. I refer to these as ‘documenting practices,’ and include in this category the recordings on various note cards, on-line systems, preprinted forms, and whiteboards. By combining the previously distinct lenses of communicative genres (Orlikowski & Yates, 1994, 1998), temporal and spatial dimensions of social interaction (Schultze & Boland, 2001; Giddens, 1989), and trajectories (Bowker & Star, 1999) I identify the documenting practices that doctors, nurses, and secretaries use to manage, not only patients’ movements across geographic and temporal settings, but also their own distributed work. I argue that doctors and nurses use medical records/documents as itineraries to organize their distributed work practices. I introduce the concept of ‘re-localizing’ (i.e., the continuous documenting of a patient’s care across settings within multiple information systems) as a phenomenon that allows professionals to handle a complex flow of information across distributed work settings. The notion of ‘re-localizing’ has important consequences for both organizational design and information system policies. In particular, it allows one to shift focus, from the pursuit of universal patient information systems, towards establishing specific intersections among documenting practices (both organizational and technological) that facilitate patient care across distributed settings. More broadly, the research has implications for our general understanding of, first, how organizational members manage their distributed work, with consequences for information system design, and secondly, the organizational impacts of IT.