Shared care and boundaries: lessons from an online maternity record

Abstract

The paper seeks to examine how an online maternity record involving pregnant women worked as a means to create shared maternity care. Ethnographic techniques have been used. The paper adopts a theoretical/methodological framework based on science and technology studies. The paper shows how a version of "the responsible patient" emerges from the project which is different from the version envisioned by the project organisation. The emerging one is concerned with the boundary between primary and secondary sector care, and not with the boundary between home and clinic, which the project identifies as problematic and seeks to transgress. The pilot project, which is used as a case, is terminated prematurely. However, this does not affect the fact that more attention should be paid to the specific redistribution of responsibilities entailed in shared care projects. Rather than seeking to connect all actors in an unbounded space, shared care might instead suggest a space for patients and professionals to experiment with new roles and responsibilities. When designing coordination tools for health care, IT designers and project managers should attend to the specific ways in which boundaries are inevitably enacted and to the ways in which care is already shared. This will provide them with opportunities to use the potentials of new identities and concerns that emerge from changing the organisation of healthcare in relation to IT design. The paper shows that "unshared" care does not exist; care is always shared among human and nonhuman actors. It also points to the value of studying how boundaries are enacted in projects that seek to create continuity across boundaries.