A framework for designing constructionist approaches to community-centered messaging

Thesis (Ph.D.)--Massachusetts Institute of Technology, School of Architecture and Planning, Program in Media Arts and Sciences, 2000.Includes bibliographical references (leaves 137-143).Social constructionism is a term used to describe systems where individuals take an active role in development that can enhance their community's social setting. This thesis asks, "What is the role of communication technologies in a social constructionalist approach to community-centered messaging?" Towards answering this question, a framework is described for developing and assessing such a system. This framework accounts for the varying skills of the community members, the amount of support the network provider is willing to invest, and the effort needed to use tools. A well designed system can meet the ambitions of the community that employs them, while a poor design leads to frustration and apathy. An experimental platform, Canard, has been built in order to explore this framework. It provides a unified communication representation and tools that allow rapid development of community-centered communication applications that do not require significant expertise to use them. The Canard system has been used by diverse communities over the past two years with varying degrees of success. The degree of success is a function of the group's ambition and willingness to participate in the process of crafting communication solutions for personal and community benefit.by Pascal Roger Chesnais.Ph.D

Should we primarily publish electronic guidelines as reminders?

I believe that creating guidelines as word processed documents primarily for paper publication leads to a number of problems: • There is a risk of the document expanding into a lengthy evidence based textbook which takes years to write and is expensive to revise [Eccles 02] • The bulk makes it hard for users to find the specific page, paragraph and sentence that applies to this patient this visit. It also makes it hard for human authors to ensure that the guideline is complete and that words are used consistently • Any versions for different audiences (eg. patients, nurses, audit clerks) need to be written separately and kept by hand synchronised with the master version • The evidence shows that it is rare for such guideline documents themselves to change clinical practice or patient behavior [Grimshaw 04] • The material is designed to be read linearly, limiting our ability to extract text fragments to populate computer screens. To use the knowledge contained in the guideline for reminders or decision support, someone must spend weeks trying to locate and model small parts of the guideline as a knowledge base, only to find that it lacks detail or even disagrees with itself in places. I will argue that we should instead focus our evidence search and authoring process around proven clinical problems (ie. health decisions or actions with demonstrated and unexplained variation or deviation from evidence or patient preferences), rather than on a large number of questions spread out along the patient pathway. In addition, I believe we should publish guidelines primarily as a set of well structured computer reminders and alerts, with a secondary hypertext version reserved for browsing on screen