In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

在关于算法在临床实践中的使用的流行和学术讨论中，叙述往往利用算法的决定性潜力，并相信算法将极大地改变医疗保健。我们建议这种方法与中断逻辑相关联。然而，我们认为在临床实践中除了这种逻辑之外，还存在另一种不太为人所知的逻辑，即延续逻辑：这里算法的使用构成了既定做法的一部分。将这些逻辑用作我们的分析框架，我们着手探索政治利益相关者、医疗保健专业人员和患者如何制定临床决策算法，并在此过程中研究如何协商和获得委托给算法的合法性. 根据经验，我们借鉴了与丹麦在临床实践中开发和实施患者报告结果 (PRO) 工具（涉及算法排序）的尝试相关的民族志实地调查。我们关注两个疾病领域的工作：心脏康复和乳腺癌后续护理。我们展示了在政治层面，算法如何构成破坏的工具低效的工作和不系统的患者参与，虽然更接近临床实践，但算法构成了标准化和基于证据的诊断程序的延续以及医生专业知识和权威的延续。我们认为，这两种逻辑的共存具有重要意义，因为它们都推动了算法的使用，以及延续逻辑如何将注意力从自动数字决策支持系统引入的新问题上转移开。