There is a growing interest in the issues of how to organise healthcare work along individual patient cases rather than along the demarcation lines of healthcare organisations. Health information systems, such as electronic patient records, are seen as important change agents, since they are asserted to help the coordination of care across organisations through fast and accurate exchange of clinical data. The paper explores how a semi-standardised discharge letter is employed to communicate about the patient between two organisational settings, the hospital and the general practitioner. It is shown that the discharge letter plays a double role as informational tool and accounting device. And it is argued that further standardisation of the discharge letter content -in order to facilitate electronic exchange -is likely to strengthen the letter's role as a tool for organisational accountability and weaken it as a clinical tool. The paper concludes that this finding adds to the theoretical understanding of how computers support cooperative work, and that understanding how healthcare professionals present themselves as accountable and trustworthy should be of major concern when designing healthcare ICTs.

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The notion of 'change' has become pervasive in contemporary organizational discourse. On the one hand, change is represented as an organizational imperative that increasingly appears to trump all other concerns. On the other hand, change is addressed as an abstract, generic entity that can be theorized, categorized, evaluated and acted upon without further specification. In this article, we argue that this combination of absolutism and abstraction has some unfortunate consequences for the precise assessment and practical management of particular organizational changes. Based on re-readings of two classic, but partially forgotten contributions within organization theory -the work of Wilfred R. Bion on group assumptions and the work of Elliott Jaques on 'requisite organisation' -we suggest that contemporary discussion of organizational change could benefit considerably from regaining a lost specificity; an empirical grounding in the detailed description of content, purpose and elements of change as a prerequisite for any normative appraisal or critique.

Performance standards and accountability pervade modern healthcare. According to Michael Power, this may signify a new rationality of governance characterized by control of controls, which affects practices not by direct intervention, but through the processes by which practices are made auditable. The paper addresses this thesis by exploring the construction of a Danish standard for electronic patient records. It is shown that making healthcare auditable activates deep tensions between programs of clinical practice, quality control, evidence based medicine, and casemix funding, resulting in an ambiguous and unstable standard. During this process, however, particular notions of patients, diseases, and diagnoses emerge as undisputed innovations, which may come to survive the subsequent career of the standard. The paper discusses the performative effects of these innovations and argues that information infrastructure has become an analytically important site for exploring the substantial effects of new rationalities of governance in healthcare.