How digital documentation in electronic health records forms healthcare professionals’ identity
A qualitative case study
DOI:
https://doi.org/10.7146/qhc.156787Keywords:
digital documentation, electronic health records, healthcare professionals, identity regulation, municipal healthcare, professional identity, qualitative case studyAbstract
Background: Digital documentation systems are increasingly used in healthcare to streamline workflows and improve resource management. However, their influence extends beyond administration, potentially affecting healthcare professionals’ identity. Aim: The aim is to analyse how digital documentation in Danish municipal healthcare influences Health Care Professionals (HCP)’ identity through subtle identity regulation processes, focusing particularly on mechanisms of organisational control. Methods: A qualitative single-case study was conducted in a medium-sized Danish municipality. Data were collected through 124 hours of field observations and 15 semi-structured interviews with 23 HCPs. Alvesson and Willmott’s (2002) identity regulation framework guided the analysis. Results: Three modes of identity regulation were identified: 1) regulating context, 2) regulating actions, and 3) regulating organisational functions. These modes shaped how HCPs perceived and enacted their professional identity. Discussion: Digital documentation systems position HCPs as efficient service providers rather than autonomous professionals. However, HCPs engage in identity work to adapt, resist, or reinterpret these regulatory demands, highlighting tensions between care values and managerial logic. Conclusion: Digital documentation serves as both a technical tool and a powerful identity-regulating mechanism. To support professional autonomy and care quality, future digitalisation strategies must involve HCPs and recognise the complexity of their work.
References
Abbott, A. (1988). The system of professions: an essay on the division of expert labour. University of Chicago Press.
Abma, T. A., & Stake, R. E. (2014). Science of the Particular: An Advocacy of Naturalistic Case Study in Health Research. Qualitative health research, 24(8), 1150-1161. https://doi.org/10.1177/1049732314543196
Allen, D. (2015). The invisible work of nurses: hospitals, organisation and healthcare. Routledge. https://doi.org/10.4324/9781315857794
Alvesson, M., & Willmott, H. (2002). Identity Regulation as Organizational Control: Producing the Appropriate Individual. Journal of management studies, 39(5), 619-644. https://doi.org/10.1111/1467-6486.00305
Baxter, P., & Jack, S. (2008). Qualitative case study methodology: study design and implementation for novice researchers. Qualitative report, 13(4), 544-559.
Bresnen, M., Hodgson, D., Bailey, S., Hassard, J., & Hyde, P. (2019). Hybrid managers, career narratives and identity work: A contextual analysis of UK healthcare organizations. Human relations (New York), 72(8), 1341-1368. https://doi.org/10.1177/0018726718807280
Croft, C., Currie, G., & Lockett, A. (2015). The Impact of Emotionally Important Social Identities on the Construction of a Managerial Leader Identity: A Challenge for Nurses in the English National Health Service. Organization studies, 36(1), 113-131. https://doi.org/10.1177/0170840614556915
Department of Economic and Social affairs. (2024). United Nations E-Government Survey 2024- Accelerating digital transformation for sustainable development. https://desapublications.un.org/sites/default/files/publications/2024-09/%28Web%20version%29%20E-Government%20Survey%202024%201392024.pdf
Duval Jensen, J., Ledderer, L., & Beedholm, K. (2023a). How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis. Nursing inquiry, 30(1), e12499-n/a. https://doi.org/10.1111/nin.12499
Duval Jensen, J., Ledderer, L., Kolbæk, R., & Beedholm, K. (2023b). Fragmented care trajectories in municipal healthcare: Local sensemaking of digital documentation. Digital Health, 9, 20552076231180521. https://doi.org/10.1177/20552076231180521
European Commission. (2020). Digital Economy and Society Index 2020: European Analysis. E. Commission. https://digital-strategy.ec.europa.eu/en/policies/desi
Findikoglu, M., & Watson-Manheim, M. B. (2016). Linking macro-level goals to micro-level routines: EHR-enabled transformation of primary care services. Journal of Information Technology, 31(4), 382-400. https://doi.org/10.1057/s41265-016-0023-5
Galasiński, D., & Ziółkowska, J. (2022). Managing the communication channel. Discursive representations of clinical communication in forensic psychiatric reports. Qualitative Health Communication, 1(1), 134-150. https://doi.org/10.7146/qhc.v1i1.130374
Gao, H., Yous, M.-L., Connelly, D., Hung, L., Garnett, A., Hay, M., & Snobelen, N. (2023). Implementation and impacts of virtual team-based care planning for older persons in formal care settings: A scoping review. Digital Health, 9, 20552076231151567. https://doi.org/10.1177/20552076231151567
Gilster, S. D., Boltz, M., & Dalessandro, J. L. (2018). Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care. The Gerontologist, 58(suppl_1), S103-S113. https://doi.org/10.1093/geront/gnx174
Greenhalgh, T., Potts, H. W. W., Wong, G., Bark, P., & Swinglehurst, D. (2009). Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method. The Milbank quarterly, 87(4), 729-788. https://doi.org/10.1111/j.1468-0009.2009.00578.x
Hjort, K. (2012). Det affektive arbejde [The affective work] (1st ed.). Samfundslitteratur.
Hoeyer, K., & Wadmann, S. (2020). 'Meaningless work': How the datafication of health reconfigures knowledge about work and erodes professional judgement. Economy and society, 49(3), 433-454. https://doi.org/10.1080/03085147.2020.1733842
Jensen, M. C. F., & Muhr, S. L. (2020). Performative identity regulation in rehabilitative home care work: an analysis of how experts’ embodied mediation of the managerial ideology “activates” new frontline identities. Culture and Organization, 26(3), 211–230. https://doi.org/10.1080/14759551.2019.1566234
Justesen, L., & Plesner, U. (2024). Invisible Digi-Work: Compensating, connecting, and cleaning in digitalized organizations. Organization Theory, 5(1). https://doi.org/10.1177/26317877241235938
KL - Local Government Denmark. (2019). Common Language Platform - the method handbook vs. 1.61. KL. https://fs3.nu/filer/Dokumenter/Metode/FSIII-Metodeh%C3%A5ndbog.pdf?t=1681887592
Kvale, S., & Brinkmann, S. (2015). Interview : det kvalitative forskningsinterview som håndværk [Interviews: Learning the Craft of Qualitative Research Interviewing] (3rd ed., 1st printing). Hans Reitzel.
Landis, T. T., Severtsen, B. M., Shaw, M. R., & Holliday, C. E. (2020). Professional identity and hospital‐based registered nurses: A phenomenological study. Nursing forum (Hillsdale), 55(3), 389-394. https://doi.org/10.1111/nuf.12440
Laukvik, L. B., Rotegård, A. K., Lyngstad, M., Slettebø, Å., & Fossum, M. (2023). Registered nurses’ reasoning process during care planning and documentation in the electronic health records: A concurrent think‐aloud study. Journal of clinical nursing, 32(1-2), 221-233. https://doi.org/10.1111/jocn.16210
Paring, G., Pezé, S., & Huault, I. (2017). ‘Welcome to the whiteboard, the new member of the team’: Identity regulation as a sociomaterial process. Organization (London, England), 24(6), 844-865. https://doi.org/10.1177/1350508416686407
Petrakaki, D., Klecun, E., & Cornford, T. (2016). Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital. Organization, 23(2), 206-226. https://doi.org/10.1177/1350508414545907
Salminen‐Karlsson, M., & Golay, D. (2022). Information systems in nurses' work: Technical rationality versus an ethic of care. New technology, work, and employment, 37(2), 270-287. https://doi.org/10.1111/ntwe.12231
Solbrekke, T. D., & Heggen, K. (2009). Responsibility of Nursing -- From Professional Moral Responsibility to Technical Accountability?. Tidsskrift for Arbejdsliv, 11(3), 49-61.
Stake, R. E. (1995). The art of case study research. Sage.
Thompson, W., & McNamara, M. (2022). Revealing how language builds the identity of the advanced nurse practitioner. Journal of clinical nursing, 31(15-16), 2344-2353. https://doi.org/10.1111/jocn.16054
Wadel, C. (2014). Feltarbeid i egen kultur [Fieldwork in own culture] (Rev. ed., 1st printing). Cappelen Damm Akademisk.
Wallenburg, I., & Bal, R. (2019). The gaming healthcare practitioner: How practices of datafication and gamification reconfigure care. Health Informatics Journal, 25(3), 549-557. https://doi.org/10.1177/1460458218796608
Watson, A. R. (2016). Impact of the digital age on transforming healthcare. In C. A. Waever, M. J. Ball, G. R. Kim, & J. M. Kiel (Eds.), Healthcare information management systems (4. ed., pp. 219-233). Springer International Publishing. https://doi.org/10.1007/978-3-319-20765-0_13
Yoo, S., Lim, K., Jung, S. Y., Lee, K., Lee, D., Kim, S., Lee, H.-Y., & Hwang, H. (2022). Examining the adoption and implementation of behavioral electronic health records by healthcare professionals based on the clinical adoption framework. BMC medical informatics and decision making, 22(1), 1-210. https://doi.org/10.1186/s12911-022-01959-7
Öresland, S., Määttä, S., Norberg, A., & Lützén, K. (2011). Home-based nursing: An endless journey. Nursing ethics, 18(3), 408-417. https://doi.org/10.1177/0969733011398098
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Julie Duval Jensen, Loni Ledderer, Kirsten Beedholm, Raymond Kolbæk
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles submitted to Qualitative Health Communication should not be submitted to or published in other journals.
Articles published in Qualitative Health Communication may be used (downloaded) and reused (distributed, copied, cited) for non-commercial purposes with reference to the authors and publication host.
For all publications published in the first four issues, i.e. 1(1), 1(2), 2(1) and 3(1), copyright is shared between the author and QHC. For all future publications, the author is the sole copyright holder.
