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

Framing Outcomes and Program Assessment for Digital Scholarship Services: A Logic Model Approach

This is an Accepted Manuscript of an article published by the Association of College and Research Libraries in College and Research Libraries in March 2021, available online: https://doi.org/10.5860/crl.82.2.142Assessing digital scholarship services offered either through academic libraries or elsewhere on campuses is important for both program development and service refinement. Digital scholarship support is influenced by fluid campus priorities and limited resources, including staffing, service models, infrastructure, and partnership opportunities available at a university. Digital scholarship support is built upon deep, ongoing relationships and there is an intrinsic need to balance these time-intensive collaborations with scalable service offerings. Therefore, typical library assessment methods do not adequately capture the sustained engagement and impacts to research support and collaboration that come from digital scholarship services. This article discusses the creation of a logic model as one approach to frame assessment of digital scholarship services in the university environment.Publisher allows immediate open acces

Building Capacity Through a Regranting Strategy: Promising Approaches and Emerging Outcomes

This is an evaluation report on the Community Leadership Project (CLP) in which 27 well-established intermediary organizations--community foundations, grantmaking public charities, and funder affinity groups--regrant to smaller organizations to provide financial support and tailored organizational assistance and coaching to small to mid-size organizations; technical assistance; and leadership development.The evaluation is interested in understanding not only the impact of CLP on leaders, organizations, intermediaries, and foundation partners, but also the key lessons on: (1) reaching and providing capacity-building supports to organizations and leaders serving low-income communities and communities of color; (2) characteristics of effective, culturally relevant, and community-responsive capacity building; and (3) which kinds of capacity-building supports are most effective for small and mid-sized organizations serving low-income communities and communitiesof color

An emerging user-led participatory methodology: Mapping impact pathways of urban food system sustainability innovations

This chapter presents an emerging effort to develop a participatory mapping methodology that will illuminate the pathways through which sustainable urban food systems achieve lasting impact. Carried out in collaboration with Està (Economia e Sostenibilità), the UNESCO Chair in World Food System (at Montpellier SupAgro), CIRAD (French Agricultural Research Centre for International Development) and the LCSFS (Laurier Center for Sustainable Food Systems), this initiative aims to provide an alternative to quantitative tools that lack precision at the local level, and to qualitative approaches holding a narrow focus that may obscure broader systemic dynamics. This URBAL project focuses on innovations in consumer practices, value-chains, and governance by examining 12 case studies in eight cities in the Global South and North

Cyber-physical systems design for runtime trustworthiness maintenance supported by tools

The trustworthiness of cyber-physical systems is a critical factor for establishing wide-spread adoption of these systems. Hence, especially the behavior of safety-critical software components needs to be monitored and managed during system operation. Runtime trustworthiness maintenance should be planned and prepared in early requirements and design phases. This involves the identification of threats that may occur and affect user’s trust at runtime, as well as related controls that can be executed to mitigate the threats. Furthermore, observable and measureable system quality properties have to be identified as indicators of threats, and interfaces for reporting these properties as well as for executing controls have to be designed and implemented. This paper presents a process model for preparing and designing systems for runtime trustworthiness maintenance, which is supported by several tools that facilitate the tasks to be performed by requirements engineers and system designer

Culturally Responsive Educational Leadership: A Qualitative Study of Indigenous Innovations

This qualitative study of culturally responsive educational leadership (CREL) explores noteworthy cases of system-wide innovation spanning decades through interviews with seven education professionals active within Indigenous movements and organizations driving Native Hawaiian education and the revitalization of Hawaiian language and culture. The research focus includes the Na Honua Mauli Ola Guidelines (and Pathways) for Culturally Healthy and Responsive Learning Environments, along with the preceding Kumu Honua Mauli Ola Philosophy Statement. Interviewees, all with direct connections to these innovations, illuminate their local and global significance through personal accounts of their development and implementation. The study’s uniquely situated methodology yields rich data for systems-level analysis of these innovative cases of CREL and related work addressing persistent inequities for historically underserved students in the singularly unique environment, education system and socio-cultural context of Hawai‘i. A transformative leadership centered theoretical framework guides data analyses striving for a more complete process-oriented understanding, organizationally and operationally, of effective system-wide CREL practice (across all levels of the P-20 continuum and among various organizational types) in an uncommonly diverse community, as demonstrated in these cases of Indigenous innovation exemplifying CREL in Hawai‘i

Sustainability Design and Software: The Karlskrona Manifesto

Sustainability has emerged as a broad concern for society. Many engineering disciplines have been grappling with challenges in how we sustain technical, social and ecological systems. In the software engineering community, for example, maintainability has been a concern for a long time. But too often, these issues are treated in isolation from one another. Misperceptions among practitioners and research communities persist, rooted in a lack of coherent understanding of sustainability, and how it relates to software systems research and practice. This article presents a cross-disciplinary initiative to create a common ground and a point of reference for the global community of research and practice in software and sustainability, to be used for effectively communicating key issues, goals, values and principles of sustainability design for software-intensive systems. The centrepiece of this effort is the Karlskrona Manifesto for Sustainability Design, a vehicle for a much needed conversation about sustainability within and beyond the software community, and an articulation of the fundamental principles underpinning design choices that affect sustainability. We describe the motivation for developing this manifesto, including some considerations of the genre of the manifesto as well as the dynamics of its creation. We illustrate the collaborative reflective writing process and present the current edition of the manifesto itself. We assess immediate implications and applications of the articulated principles, compare these to current practice, and suggest future steps