The product and process of referral: Optimizing general practitioner-medical specialist interaction through information technology

With the growing complexities of health care delivery in western industrialized countries, the need for inter-organizational communication is increasingly emphasized. In this paper, we focus on a system – ZorgDomein – that was developed to optimize GP-medical specialist communication. Contrary to the notion of ‘shared’ or ‘integrated care’ that often assumes a ‘seamless’ health care, we will focus on the negotiated order of GP-specialist cooperation, showing the precarious localized arrangements that allow both a bridging and a separation of professional activities concerning patient care. Furthermore, we analyze how ZorgDomein changes the arrangements to maintain a working order. The main focus of the article is on the way GP-specialist referrals are on the one hand conceptualized as discrete events of information sharing, while on the other hand are part of a process of care. We will argue that in standardization attempts by national and local actors, embodied within the technology, information exchange between first and secondary care is made into a product. This conceptualization and materialization neglects the process in which this information comes about or is being created. We discuss the consequences of this for the design and use of the technology.