Table 1 Data fragments illustrating ostensive, performative and proxy routine for scanning and coding incoming letters

Ostensive routine

From researcher's summary based on narratives of practice staff

The 'old' system involves the doctors highlighting in pen on the letter the things they want READ coded (ring round) or added as free text (scored through with highlighter pen). With DOCMAN [a recent add-on to the EMIS electronic record software], a letter is received by the practice, stamped with a date stamp which also has other things on the stamp (Problem Title; Date; Active; Past; Minor; GP init; sum; s/c (meaning scanned)). X [receptionist] said that the person scanning the letter initials it. The other fields on this stamp are essentially not used. The letter is then scanned and added to DOCMAN. It is then sent electronically through DOCMAN for viewing/highlighting by the GP.

Performative routine

From field notes of direct observation of the routine

"I asked Z [secretary] if it was OK if I watched her sorting post next door and she was fine about that. Everything was date stamped. She explained that the stamp indicated that the letters had been scanned (but they hadn't - they had just come out of the envelopes). She explained that if a GP sees a letter without a date stamp on it they know that it is not scanned so it needs to be put back in the sec's tray. She said that X [fellow secretary] didn't stamp until after scanning - but that they both do things slightly differently. She had made a separate pile of letters which were printed on both sides and took those to the photocopier to photocopy the 'back' side of these letters which made it much easier to put them through the scanner. (again she pointed out X doesn't do this)."

Proxy routine

As depicted in formal protocol

Coding - a how to guide:

All written correspondence and test results that the Practice receives is scanned into the records of the relevant patient. Certain types of correspondence are also read coded to enable the information to be found by running searches. Items that need to be coded are detailed below.

Read codes

These are unique codes made up of a combination of up to 4 letters and numbers. There are read codes relating to almost everything - being sucked into the jet of a space craft, being bitten by a crocodile whilst at home and drowning accidentally (as though people often drown on purpose) whilst pearl diving. Logging information under its specific read code means that it can be easily retrieved - eg a search for code 621 would bring up all women who are currently pregnant. In this way we can keep on top of all our patients with particular conditions.