Documentation is an important part of the daily work practice in the healthcare sector. Due to the fact that the medical work practice is highly complex and evolving, and various unexpected contingencies may arise, documentation is a challenging task. Different mechanisms have to be established in order to cope with the ambiguities related to the medical practice. This includes various kinds of workarounds and undocumented strategies developed in order to compensate the gap between the information system and the local situated work practices.

This paper will shed a light on challenges that were off the record and issues that were taken for granted or even silenced. In other words, we will listen to the noise created by the information system. For this purpose we draw upon results from extensive ethnographic research conducted in two settings. The first case takes place in two oncology clinics in Austria, that are about to introduce an Electronic Patient Record (EPR); while the second case takes place in a clinic in Canada that has already implemented an EPR. These cases are different in many perspectives, however our focus is on the documentation systems and the way in which they are worked around, both in a paper-based and electronic realm. Analyses from both studies emphasize the importance of having sensibility to such hidden issues, as well as providing configurability and adaptability of the system.