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front-line clinicians who still largely care for patients one case at a time. HIP ethics, like business ethics, also place a high premium on efficiency, order, security, and control, and most HIP ethical codes explicitly acknowledge that the information rights of individuals must sometimes be balanced against the information needs of groups—arguably including the administrative needs of health care organizations and the public health needs of the state. Further, because they bear day-to-day responsibility for making information systems work, HIPs have both a principled ethical investment and an immediate practical stake in the integrity of record-keeping practices, the security of computing networks, and the sanctity of data; and this protective impulse often overrides more pro-social principles of patient self-determination, participatory design, and user-friendliness. In many situations, these orientations are more likely to align HIPs with hospital administrators and public-health authorities than with clinicians, putting HIP professionalism and medical professionalism at least somewhat at odds. Our research on HIPAA compliance and clinical IT implementation has revealed a number of contexts in which these inter-professional tensions surface.120 One mundane source of friction centers on security measures like passwords and timeouts: Busy clinicians have trouble understanding why passwords must be arcane, frequently changed, and repeatedly reentered, and so their sense of professionalism as caregivers leads them to share log-ins with co-workers, scribble passwords on Post-it notes, and retrospectively update records during off-peak hours when there is less chance of being called away and timed out. HIPs, in contrast, have trouble understanding how anyone could be so cavalier about system integrity, and so their sense of professionalism as information managers leads them to push for sanctioning authority and to develop “technical safeguards” that are ever harder to circumvent and that are therefore all the more clinically intrusive. Another, more dramatic, sore point involves “shadow charts”—duplicate patient records that clinicians maintain (usually in hard copy) in a ready location such as a desk-side filing drawer. For the clinician, the shadow chart is a harmless convenience in most cases, a safeguard against retrieval delays in some cases, and a device for keeping particularly sensitive patient information out of the inter-organizational data stream in at least a few cases. For the HIP, in contrast, the shadow chart is a fundamental threat to the integrity of the entire clinical record system: shadow charts spawn delays and omissions in updating the official file, thereby putting patients at risk; and shadow charts frustrate “professional ” information management practices (and violate HIPAA requirements) for secure data storage and rigorous access accounting, thereby putting the A Profession of IT’s Own 171 organization at risk. In some hospitals, this struggle over shadow charts has escalated to the point where health information managers and privacy officers routinely conduct “night raids” of physicians’ offices, in search of contraband files. Beyond these discreet dust-ups, HIPs and clinicians in many settings find themselves embroiled in much larger philosophical debates over the design, implementation, and use of multi-million-dollar clinical IT systems. To reap the maximum benefit from these systems, the HIP world view prescribes that use should be universal and non-optional, and that users should be encouraged— through technical constraints, through persuasion, and through sanctions if necessary—to employ standardized data fields whenever possible, and to minimize reliance on verbal explanations and free-form notes. Clinicians, in contrast , generally prize the nuances and flexibilities of open-ended charting, and resist efforts to reduce clinical details to a series of rigid check-boxes. Structured data-entry may be the only practical way to harness the power of clinical IT for systemic improvement, but systemic improvement is often a value closer to the hearts of administrators, policymakers, and the HIPs who serve them than to the hearts of front-line clinical caregivers. Although each of these confrontations has its own idiosyncratic contours and its own colorful vocabulary of moves and countermoves, heroes and villains , these encounters are not merely petty jurisdictional squabbles. Rather, they reflect genuine tensions between the competing values embedded in any clinical IT system—tensions that would exist (in latency at least) even if there were no cadre of HIPs to bring them to the fore. Nonetheless, the emergence of HIPs as champions of some of these values over others means that the course of medical professionalism in the new information age will depend not only on the medical...