Health-Related Stigma: The Affordances of Electronic Health Management Systems in the Production of Structural Stigma.

Encounters with stigma in healthcare settings are well-documented. In recent years, significant attention has begun to be paid to how we can reduce these stigmas, including through the identification and reformation of structural forces that shape and sustain them. This article analyses 30 interviews conducted with clinical and nonclinical healthcare workers, as part of a larger project that aims to reduce health-related stigma for all. A major theme running through the interviews was the constitutive role of medical records in the production of stigma. Interview participants expressed several concerns about the ways such records can produce and reproduce stigma associated with numerous health conditions, identities, and practices. We examine how the very process of producing medical records can be implicated in stigma. We ask, how do systems shape data production, reproduction, access and dissemination? To what extent might processes and systems help to generate, maintain or exacerbate stigma through the demands of medical record keeping, and are reforms needed at these levels too? In addressing these questions, we work with Latour's notion of affordances to examine medical records as a technology that can reflect and reproduce social and political arrangements, including stigma. We argue that institutions and structures responsible for the governance of these systems need to contend with the important entanglements between medical record systems and stigma. We conclude with recommendations for how policymakers, health service leaders and researchers might intervene in the production of stigma afforded by these forms of communication.