IN BETWEEN CURING AND COUNTING: PERFORMATIVE EFFECTS OF EXPERIMENTS WITH HEALTHCARE INFORMATION INFRASTRUCTURE

Abstract

Performance standards and accountability pervade modern healthcare. According to Michael Power, this may signify a new rationality of governance characterized by control of controls, which affects practices not by direct intervention, but through the processes by which practices are made auditable. The paper addresses this thesis by exploring the construction of a Danish standard for electronic patient records. It is shown that making healthcare auditable activates deep tensions between programs of clinical practice, quality control, evidence based medicine, and casemix funding, resulting in an ambiguous and unstable standard. During this process, however, particular notions of patients, diseases, and diagnoses emerge as undisputed innovations, which may come to survive the subsequent career of the standard. The paper discusses the performative effects of these innovations and argues that information infrastructure has become an analytically important site for exploring the substantial effects of new rationalities of governance in healthcare.