Coordinating the Medical Division of Labour: The Travails of Electronic Patient Records in the United Kingdom and United States

This paper explores the interrelations between medical specialisation, the changing division of medical labour and the technologies that have emerged to coordinate and integrate patient care. Drawing on the examples of the United Kingdom and the United States, countries whose health systems provide important points of commonality and distinction, I explore the intersections between the rise of medical specialisation and the creation of new medical and paramedical roles. These roles have often emerged as a palliative to the increasing fragmentation and atomisation of medical labour, to 'assist' overburdened clinicians and provide better coordinated and integrated patient care. However, as they have proliferated, these new roles have challenged the very nature of work itself. Technology has long held promise as a means of integrating the workforce, service provision and care in ways that might enhance the patient experience and outcomes. Turning to the example of the electronic patient record as one such coordination technology, I explore the travails of its implementation with respect to the healthcare workforce trends and patient care. In so doing, I aim to further contribute to recent scholarship on healthcare workforce trends, role proliferation, 'taskification' and strategies to manage the negative externalities of these on patient care.