Continuity of health care has in recent years received increased attention. To achieve ‘seamless’ care over time and across service providers, and to reducing redundancy related to duplicated information in parallel systems, electronic patient records have been recommended.
Low-income countries need systems to monitor diseases such as HIV/AIDS, as well as being able to follow a patient on individual level. The global vision is to introduce electronic systems to meet these needs. Human, physical and financial resources form however special challenges in these countries, where often the most essential resources are lacking, showing a gap between vision and reality.
This thesis questions the vision of integrated electronic system as a means to provide robust systems and complete patient records. An ethnographic case study within Primary Health Care in South Africa, gives a rich description of health work practices within HIV/AIDS care and treatment. In the process of creating a patient record, collection and coordination of patient data are performed using paper and electronic artefacts in combination, adapted to the resources available. Based on these findings, it is argued that a certain degree of redundancy contributes to more robust systems. A re-vision of the policies and goals for integrated electronic records is suggested, and principles for designing hybrid health information systems are presented.