We need to know how clinicians' use their paper based medical records to secure a local participation in the implementation process of Electronic Patient Record (EPR). In what way their use of paper based medical records is related to, or dependent on, other people and artifacts. The research presented in this paper was done as part of a work flow analysis of the particular sequence of doing rounds at two distinct hospital departments, a thoracic surgical and a cardiology department. It was designed to develop a method that would let the hospital clinicians obtain knowledge on the daily use of the paper based medical records during rounds and thus make use of their local knowledge to start a discussion on changes in organization and knowledge before EPR can be successfully implemented.

We are grateful to the following clinicians, Cathrine H. Foss, MD. Pauline Schrødder, MD. Morten Smerup MD and Niels Henrik Stålsen, MD and the medical director Børge H. Jensen, MD, Skejby Sygehus, Aarhus University Hospital for sharing their knowledge with us.