The Role of Information in the Street‐Level Bureaucrat–Client Relationship: Open‐Book Services and the Case of the Swedish Patient Accessible Electronic Health Record

ABSTRACT This paper focuses on how street‐level bureaucrats understand and manage information in their interactions with clients in the context of so‐called open‐book services, where digital tools make it possible for clients to easily access documentation conventionally viewed as internal work material for professionals' eyes only. Through a qualitative interview study of Swedish doctors regarding the national Patient Accessible Electronic Health Record, we examine how open‐book services and associated automation of information provision to clients can affect street‐level bureaucrats' information practices. We demonstrate how doctors express concern about patients misinterpreting medical information and suggest creating separate records for patient use. Despite the availability of digital tools, traditional information pathways remain preferred by doctors. Moreover, the contextual character of potential efficiency gains is examined, insofar as open‐book services are associated with these policy discourses. Building on our results, we propose and develop the concept of contextual layering to capture the challenge of creating documentation that simultaneously serves both professional and client information needs without compromising either. We conclude by highlighting the need for policymakers to consider the implications of automation and digitalization for information handling and the roles of street‐level bureaucrats in order to ensure their support.