The electronic health record as an interactional and epistemic resource: Insights from pediatric well-child visits

Abstract

Objective

Electronic health records (EHRs) have increasingly become integral to contemporary medical consultations, including pediatric care. This study aims at exploring the interactional use of the EHR during naturally occurring pediatric well-child visits, focusing specifically on how pediatricians and parents manage knowledge concerning infants’ growth inscribed in the EHR.

Methods

Conversation analysis is used to analyze 23 video-recorded Italian well-child visits involving two pediatricians and twenty-two families with children aged 0–18 months.

Results

The analysis focuses on the delicate activity of assessing infants’ growth, a widespread parental concern. It illustrates how a no-problem assessment is collaboratively achieved through the interactional mobilization of the EHR. While parents draw upon their experiential knowledge to assess their child’s “normality” (or not), pediatricians resort to expert knowledge inscribed in the EHR (e.g., growth percentiles and growth charts), thereby making the EHR a locally and institutionally relevant agent in the interaction.

Conclusion

A hierarchy of types and sources of knowledge is presupposed and ratified by both parents and pediatricians in these visits. Expert information inscribed in the EHR is collaboratively built as the most authoritative voice to the detriment of parent-reported experiential knowledge.

Practice implications

While acknowledging potential risks, leveraging the EHR can be a valuable interactional and epistemic resource for healthcare professionals working in pediatric care to a) soothe parental concerns regarding infants’ development, and b) offer evidential support for their evaluations, thereby displaying professional accountability.