Healthcare organizations and workers are under pressure to produce increasingly complete and accurate data for multiple data-intensive endeavors. However, little research has examined the emerging occupations arising to carry out the data work necessary to produce “improved” data sets, or the specific work activities of these emerging data occupations. We describe the work of Clinical Documentation Integrity Specialists (CDIS), an emerging occupation that focuses on improving clinical documentation to produce more detailed and accurate administrative datasets crucial for evolving data-intensive forms of healthcare accountability, management, and research. Using ethnographic methods, we describe the core of CDIS’ work as a translation practice in which the language, interests, and concerns of clinicians and clinical documentation are translated via real-time “nudging” and ongoing education of clinicians into the language, interests, and concerns of medical coders, structured administrative datasets, and the various stakeholders of these datasets. Further, we show how the institutional context of CDIS’ work shapes the occupational virtues that guide CDIS’ translation practice, including financial reimbursement, quality measures, clinical accuracy, and protecting clinician’s time. Despite the existence of these multiple virtues, financial reimbursement is the most prominent virtue guiding CDIS’ limited attention. Thus, overall clinical documentation is “improved” in specific, partial ways. This research provides one of the first studies of the emergent data work occupations arising in the wake of digitization and big data opportunities, and shows how local data settings shape large scale data in specific ways and thus may influence outcomes of analyses based on such data.

中文翻译：

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更好的医疗记录的良好组织原因：临床文件完整性专家的数据工作

医疗保健组织和工作人员面临着为多个数据密集型工作生成越来越完整和准确的数据的压力。然而，很少有研究检查为执行生成“改进”数据集所需的数据工作而产生的新兴职业，或这些新兴数据职业的具体工作活动。我们描述了临床文档完整性专家 (CDIS) 的工作，这是一种新兴职业，专注于改进临床文档以生成更详细和准确的管理数据集，这对于不断发展的数据密集型医疗保健问责制、管理和研究形式至关重要。使用民族志方法，我们将 CDIS 工作的核心描述为一种翻译实践，其中的语言、兴趣、临床医生和临床文档的关注点和关注点通过对临床医生的实时“推动”和持续教育转化为医学编码人员、结构化管理数据集以及这些数据集的各个利益相关者的语言、兴趣和关注点。此外，我们展示了 CDIS 工作的制度背景如何塑造指导 CDIS 翻译实践的职业美德，包括财务报销、质量措施、临床准确性和保护临床医生的时间。尽管存在这些多重美德，但财务报销是引导 CDIS 有限关注的最突出美德。因此，整体临床文件以特定的、部分的方式“改进”。