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Many approaches critical of traditional ISD make an important claim: they argue that an interpretative approach to human work and organizations is a sine qua non for proper ISD and that ISD is, therefore, as much—or even more — a social science as a technical one. The argument presented in this paper is that actor-network theory might help this science to better understand and design the important phenomena taking place in and through the interrelation of human and non-human elements in a work practice. Through a brief analysis of the paper-based and electronic patient record, this paper demonstrates how such tools can completely transform work practices through mediating the activities of doctors and nurses: by accumulating inscriptions and coordinating events. These interrelations cannot be captured in terms of the tool serving health care workers or automating part of their tasks. Neither concept sufficiently highlights the transformations of work practice and tasks that ensue from a synergistic interrelation. Synergy, rather, lies in mutually affording bringing out new capacities in each other. The record can only transform the activities of doctors and nurses, however, if they concurrently afford the tool to do so by partially submitting to the prerequisites of its operation. This submission is neither being deskilled nor being served—it is a form of coexisting with artifacts for which a theoretical vocabulary is as yet in its infancy.

DOI: 10.1007/978-0-387-35505-4_28

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