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

New Materiality in Intimate Care

Textiles have a long history of supporting personal health and wellbeing, and textile innovations concerned with the body abound. This paper delves into the biology of the body and brings to the fore its materiality as embodiment to reimagine modes of knowing in intimate care through textiles. It introduces two designerly studies of intimate care in women to advance that material engagement enables knowing and that the fabric of the body is a material of care in itself. In this paper, I embrace an epistemic practice that entwines a feminine sociocultural imaginary that challenges traditional approaches to health and care and, nonetheless, the design of textiles

PRIMA — Privacy research through the perspective of a multidisciplinary mash up

Based on a summary description of privacy protection research within three fields of inquiry, viz. social sciences, legal science, and computer and systems sciences, we discuss multidisciplinary approaches with regard to the difficulties and the risks that they entail as well as their possible advantages. The latter include the identification of relevant perspectives of privacy, increased expressiveness in the formulation of research goals, opportunities for improved research methods, and a boost in the utility of invested research efforts

Autonomous Exchanges: Human-Machine Autonomy in the Automated Media Economy

Contemporary discourses and representations of automation stress the impending “autonomy” of automated technologies. From pop culture depictions to corporate white papers, the notion of autonomous technologies tends to enliven dystopic fears about the threat to human autonomy or utopian potentials to help humans experience unrealized forms of autonomy. This project offers a more nuanced perspective, rejecting contemporary notions of automation as inevitably vanquishing or enhancing human autonomy. Through a discursive analysis of industrial “deep texts” that offer considerable insights into the material development of automated media technologies, I argue for contemporary automation to be understood as a field for the exchange of autonomy, a human-machine autonomy in which autonomy is exchanged as cultural and economic value. Human-machine autonomy is a shared condition among humans and intelligent machines shaped by economic, legal, and political paradigms with a stake in the cultural uses of automated media technologies. By understanding human-machine autonomy, this project illuminates complications of autonomy emerging from interactions with automated media technologies across a range of cultural contexts

Designing technologies for intimate care in women

PhD ThesisDesigning for intimate care remains an underexplored area of Human-Computer Interaction (HCI): while technologies for health and wellbeing might be plentiful, technologies for intimate care are limited. Intimate care is associated with personal hygiene, bodily functions and bodily products, and is a lifetime practice that requires well-defined interventions – by the self, or supported by others. With a move to experience, HCI has explored and responded to some of the concepts of intimate care in recent research, by addressing taboo and life disruptions. However, a wider understanding and conceptualization of intimate care work is missing from the broader HCI discourse on health and wellbeing, as well as a distinct framework for negotiating the design of technologies of intimate care. Addressing this space is noteworthy, within a field that designs technologies to support, enhance, and improve human life (Kannabiran et al. 2011). It is possible that this is related to uncertainty regarding the challenges that technology might bring to intimate interactions, particularly the challenges faced in practices that encompass bodywork and proximity to hidden parts of the body, and the impact of troublesome topics upon wellbeing education. The aim of this research is to enquire into the integration of digital technologies and intimate care towards the development of technologies for engagement with intimate care practices in women. I seek to investigate a methodological approach with a focus on the woman to understand the challenges of designing for and with intimate care; explore the qualities of such woman-centered approach in practice. In this thesis I present three case studies that incorporate empirical methods and new designs that I developed throughout this programme of research. These include 1) ethnographic observations of women’s health physiotherapy within a clinic to understand the components of intimate care within a professional setting; 2) a design toolkit that explores e-textiles for teaching female pelvic fitness, delivered through a series of workshops in which discussions that blended humour and laughter made it entertaining and less embarrassing to ask questions and to express curiosity about intimate bodies; 3) Labella, a probe/intimate wearable for self-learning about hidden parts of the female body and a technology which encompasses embodied interaction, that aims to contribute to breaking down the taboo of looking at oneself to help reduce the barrier of selfcare. Furthermore, Labella aims to support knowledge of the other, while exploring perceptions of esteem and reliance towards practices of care within the body. These three case studies begin to explore and offer insights on how designing for intimate care is entwined in woman-centered approaches to design. ! iv! This thesis contributes to interaction design research and outlines a framework for designing technologies for and with intimate care in women. The research highlights how intimate care pervades personal and professional settings, and its significance throughout the lifecourse. Specifically, I contribute to an underexplored area of HCI, women’s health (outside maternal health) by focusing on a woman-centered methodological approach. In doing this, I explore this approach in practice through challenging existing practices of care within women’s health and by offering novel design concepts and devices, in which I explore humour in design as a method to support learning of sensitive topics and as a tool to diminish the taboo nature of the interactions. Lastly, I propose woman-centered design as a novel form of inquiry in design practice research

A Feminist Ethics of Power Perspective on Gender Inequalities in Information Systems Development

With the rise of socio-political movements seeking to improve women\u27s circumstances in society, research on gender has been continuously growing in Information Systems (IS) research. Despite this growth, critical-ethical perspectives on gender power dynamics are lacking. Therefore, we critically investigate the perceptions of male and female IS developers on gender inequalities using feminist ethics of power. We find that interviewees coincide in the belief that inequalities are improving and that gender is not a limiting factor of competencies. However, men and women deviate regarding perceptions of respect and validation, equality, and the drivers that (re-)produce disparities. Additionally, women exhibit fragmented conceptualizations of inclusion. Through a critical analysis of these findings, we expose ethical dilemmas that arise from these contradictory perceptions of gender inequalities and propose pathways for transforming the prevailing order. Our study contributes by advancing a broader perspective on inequalities through the lens of feminist ethics of power

Articulating Nomadic Identities of Radio Signals

This article presents a new materialist approach to artificial neural networks, based on experimental research in categorization of data on radio signals. Picking up on Rossi Braidotti’s nomadic theory and a number of new materialist perspectives on informatics, the article presents identification of radio signals as a process of articulating identities with data: nomadic identities that are informed by all the others, always established anew. As a resistance to the dominant understanding of data as discreet, the experiments discussed here demonstrate a way to work with a digital archive in a materialist and non-essentialist way. The output of experiments, data observatories, shows the capacity of machine learning techniques to challenge fixed dichotomies, such as human/nature, and their role in the way we think of identities. A data observatory is a navigation apparatus which can be used to orient oneself in the vast landscape of data on radio transmissions based on computable similarity. Nomadic identities render materiality of radio signals as digital information

The Vital Network: An Algorithmic Milieu of Communication and Control

The biological turn in computing has influenced the development of algorithmic control and what I call the vital network: a dynamic, relational, and generative assemblage that is self-organizing in response to the heterogeneity of contemporary network processes, connections, and communication. I discuss this biological turn in computation and control for communication alongside historically significant developments in cybernetics that set out the foundation for the development of self-regulating computer systems. Control is shifting away from models that historically relied on the human-animal model of cognition to govern communication and control, as in early cybernetics and computer science, to a decentred, nonhuman model of control by algorithm for communication and networks. To illustrate the rise of contemporary algorithmic control, I outline a particular example, that of the biologically-inspired routing algorithm known as a ‘quorum sensing’ algorithm. The increasing expansion of algorithms as a sense-making apparatus is important in the context of social media, but also in the subsystems that coordinate networked flows of information. In that domain, algorithms are not inferring categories of identity, sociality, and practice associated with Internet consumers, rather, these algorithms are designed to act on information flows as they are transmitted along the network. The development of autonomous control realized through the power of the algorithm to monitor, sort, organize, determine, and transmit communication is the form of control emerging as a postscript to Gilles Deleuze’s ‘postscript on societies of control.