Critical Questions for Community Informatics in Practice

Randy Stoecker noted in 2005 that CI remains underdeveloped as a field of practice as long as it does not have its own set of ethical guidelines. While Averweg & O’Donnell published a researcher-focused set of guidelines in 2007, a full-scale work for CI practice has not yet been completed. Workshops employing a range of collaborative techniques have been held at the last three Community Informatics Research Network conferences, identifying perspectives and ideas from attendees regarding ethical CI practice and guiding critical questions. This paper is published as a means to widen the audience reviewing and commenting on these

Local ownership, exercise of ownership and moving from passive to active entitlement: a practice-led inquiry on a rural community network

In this paper, we aim to shed light on local ownership from a double practical and theoretical perspective, and examine its meaning as well as the factors that are bound to influence its development in community based interventions. The questions we intend to answer are: How can 'local ownership' be defined in a way that facilitates its investigation in CI practice, and enables at the same time its theoretical examination and relation with other CI key conceptual constructs? What key factors contribute to fostering local ownership in CI initiatives, taking the case of an externally initiated rural community network? To answer these questions, the paper reports on a study which assessed the development of local ownership in a rural community network in South Africa and singled out the factors found to delineate the development of a sense of ownership in local people, as well as driving the exercise of ownership towards autonomous local action. Based on a detailed analysis of the development of community ownership in this project, and in constant dialogue with the community informatics and social science literature, the paper makes three key contributions to CI theory and practice, as well as more specifically to future practice in community networks: An operational definition of local ownership and a conceptual model which highlights relations to other constructs such as responsibility, power and control and emphasises the role of local ownership in moving from passive to active entitlement towards community assets or CI interventions An empirical analysis of the development of local ownership in a community network in rural South Africa, highlighting the critical factors that led to fostering ownership An examination and critical discussion of factors that are positively related with the development of ownership, carried out in dialogue with CI scholarship and highlighting the bearing of and relations with other critical constructs in CI research, such as participation, empowerment, and capacity building These contributions come at a critical stage in community informatics development as a discipline, in which, we argue, a more solid and critical engagement with theory is required to firmly establish its place and the premises for dialogue with other sociotechnical disciplines.Web of Scienc

A manifesto for a socio-technical approach to NHS and social care IT-enabled business change - to deliver effective high quality health and social care for all

80% of IT projects are known to fail. Adopting a socio-technical approach will help them to succeed in the future. The socio-technical proposition is simply that any work system comprises both a social system (including the staff, their working practices, job roles, culture and goals) and a technical system (the tools and technologies that support and enable work processes). These elements together form a single system comprising interacting parts. The technical and the social elements need to be jointly designed (or redesigned) so that they are congruent and support one another in delivering a better service. Focusing on one aspect alone is likely to be sub-optimal and wastes money (Clegg, 2008). Thus projects that just focus on the IT will almost always fail to deliver the full benefits

Addressing the Quality and Safety Gap Part II: How Nurses Are Shaping, and Being Shaped by, Health Information Technologies

Explores the role of health information technologies (HIT) in improving patient safety and the role of nurses in designing, implementing, and educating clinicians to use HIT, including electronic health records and bar code medication administration

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

e-Democracy driven by civil society: Developing a theoretical basis to design for bottom-up participation

This short paper outlines initial ideas for a programme of research related to e-Democracy which commences in October 2008 and will be undertaken over the next three years. The research specifically intends to focus on factors in the architecture of online discursive spaces which may affect sustained and meaningful participation. It begins by describing the context as it relates to Community Informatics (CI). It then outlines the nature of one of the online communities that will be at the centre of the enquiry. Finally, it outlines four theoretical perspectives which seem to offer a route to analysis and sense-making, suggesting how a synthesis of these perspectives might contribute to original insights for CI

Decision makers\u27 experience of participatory dynamic simulation modelling: Methods for public health policy

Background: Systems science methods such as dynamic simulation modelling are well suited to address questions about public health policy as they consider the complexity, context and dynamic nature of system-wide behaviours. Advances in technology have led to increased accessibility and interest in systems methods to address complex health policy issues. However, the involvement of policy decision makers in health-related simulation model development has been lacking. Where end-users have been included, there has been limited examination of their experience of the participatory modelling process and their views about the utility of the findings. This paper reports the experience of end-user decision makers, including senior public health policy makers and health service providers, who participated in three participatory simulation modelling for health policy case studies (alcohol related harm, childhood obesity prevention, diabetes in pregnancy), and their perceptions of the value and efficacy of this method in an applied health sector context. Methods: Semi-structured interviews were conducted with end-user participants from three participatory simulation modelling case studies in Australian real-world policy settings. Interviewees were employees of government agencies with jurisdiction over policy and program decisions and were purposively selected to include perspectives at different stages of model development. Results: The ‘co-production’ aspect of the participatory approach was highly valued. It was reported as an essential component of building understanding of the modelling process, and thus trust in the model and its outputs as a decision-support tool. The unique benefits of simulation modelling included its capacity to explore interactions of risk factors and combined interventions, and the impact of scaling up interventions. Participants also valued simulating new interventions prior to implementation in the real world, and the comprehensive mapping of evidence and its gaps to prioritise future research. The participatory aspect of simulation modelling was time and resource intensive and therefore most suited to high priority complex topics with contested options for intervening. Conclusion: These findings highlight the value of a participatory approach to dynamic simulation modelling to support its utility in applied health policy settings

Implementing Guided Inquiry Learning and Measuring Engagement Using an Electronic Health Record System in an Online Setting

In many courses, practical hands-on experience is critical for knowledge construction. In the traditional lab setting, this construction is easy to observe through student engagement. But in an online virtual lab, there are some challenges to track student engagement. Given the continuing trend of increased enrollment in online courses, learning sciences need to address these challenges soon. To measure student engagement and actualize a social constructivist approach to team-based learning in the virtual lab setting, we developed a novel monitoring tool in an open-source electronic health records system (EHR). The Process Oriented Guided Inquiry Learning (POGIL) approach is used to engage students in learning. In this paper, we present the practice of POGIL and how the monitoring tool measures student engagement in two online courses in the interdisciplinary field of Health Information Management. To the best of our knowledge, this is the first attempt at integrating POGIL to improve learning sciences in the EHR clinical practice. While clinicians spend over 52% of a patient visit time on computers (called desktop medicine), there is very little focus on learning sciences and pedagogy to train clinicians. Our findings provide an approach to implement learning sciences theory to eHealth use training