At the Center of The Galaxy: The Integrative Role of Medical Progress Notes

Studies of the medical record have generally taken the progress notes as just
one entity among many. In contrast, we argue that progress notes are a coordinative artifact of a rather special kind that constitute the core of the medical record, in which physicians organize and summarize the immense amount of data that is available in the modern hospital environment. The study we report indicates that narrative plays a fundamental role in the way physicians document their findings and thoughts in the progress notes, because it allows them to not only record “facts” but also – by filtering, interpreting, organizing and qualifying information – to impose some order on events. Furthermore, we show how physicians use the progress notes to question available information, speculate about possible or plausible reasons for why something has happened, and suggest appropriate lines of action. This insight has important implications for the design of EMR systems.