Context Sensitive Health Informatics: Concepts, Methods and Tools

__Abstract__ Context is a key consideration when designing and evaluating health information technology (HIT) and cannot be overstated. Unintended consequences are common post HIT implementation and even well designed technology may not achieve desired outcomes because of contextual issues. While context should be considered in the design and evaluation of health information systems (HISs) there is a shortcoming of empirical research on contextual aspects of HIT. This conference integrates the sociotechnical and Human-Centered-Design (HCD) approaches and showcases current research on context sensitive health informatics. The papers and presentations outlines theories and models for studying contextual issues and insights on how we can better design HIT to accommodate different healthcare contexts

Patient centricity in IS healthcare – a framework proposing enablement, empowerment, and engagement of patients as individual IS users

The core of medicine and care is assisting patients with their health- related problems achieving the best results possible. Yet, recent Information Systems (IS) literature describes patient centered IS healthcare as “supporting assistants with IS”. In need of the patient in the center of the digital transformation process in healthcare, we focus our study on examining the IS scientific community’s contribution to digital healthcare regarding patients in the digital transformation process. We conducted an explorative, systematic but selective review of journal articles published in the best Senior Scholar Journals of the Association of Information Systems. Our results reveal a) a framework for digital health research in IS indicating underrepresented research directions, and b) three propositions on patient centricity in IS healthcare focusing on patient enablement, empowerment, and engagement as central streams

ADOPTION OF ELECTRONIC HEALTH RECORDS SYSTEM: DIFFERENTIATING MAIN ASSOCIATIONS

Health organizations are implementing health information technologies such as electronic health records (EHR), information systems (IS), and health information exchange (HIE) networks to improve decision-making. However, over the years, the healthcare environment has demonstrated numerous unsuccessful implementations of such technologies. One of the reasons is that physicians tend not to make use of these technologies in the healthcare environment. The various explanations put forward typically refer to patient, physician, and/or work environment-related factors. \ \ This study evaluated the factors associated with the EHR use among physicians in the complex environment of emergency departments. \ \ We used log-files retrieved from an integrative and interoperable EHR that serves Israeli hospitals. We found that EHR was primarily consulted for patients presenting with internal diagnoses, patients of older age, and it was used more by internists than by surgical specialists. Furthermore, EHR usage was larger for admitted patients than for those discharged. \ \ The findings show factors associated with EHR use and suggest that it is mostly related to case-specific features and to physician specialty. The findings strongly suggest that when planning assimilation projects for EHR systems and HIE networks, attention should be paid to those factors associated with system usage. Specifically, in order to increase the efficiency of the system, and enhance its use in the ED environment, physicians´ preferences and practice-related needs need to be taken into account. Furthermore, well-thought IT design and implementation are necessary to generate an increase in meaningful use of HIT, which can serve both physicians´ and patients´ needs

EXPLAINING THE INFLUENCE OF WORKAROUNDS ON EFFECTIVE USE – THE CASE OF A SUPPLY CHAIN MANAGEMENT SYSTEM

The stage of post-adoption of an enterprise system (ES) implementation has been in the focus of recent information systems research. However, a thorough understanding of how users effectively use an enterprise system to complete their tasks is still missing. Prior research has implied that adaptive use is of great importance to facilitate effective use of a system. We investigate adaptive use solutions, which are outside the original system. This behavior is known as workaround. We conduct an interpretive case study to investigate the impact of workarounds and explain why workarounds can lead to an advance in effective use of a standard ES. We expand the theory of effective use with an explanation why workarounds can improve transparent interaction, representation fidelity and informed action via alleviating users’ issues with the surface structure and the faithfulness in representations of an implemented standard ES

Conceptualizing Workarounds: Meanings and Manifestations in Information Systems Research

We reviewed papers in core IS outlets that defined the term workaround or presented an example of a workaround. In the analysis, we used Ogden and Richard’s triangle of reference as a theoretical framework to analyze the relationship between 1) the term workaround; 2) theories, definitions, and use of the term; and 3) their empirical basis and empirical workaround behavior that the papers describe. First, we summarize the existing theoretical insights regarding workarounds and investigate their validity. Second, we show that studies have defined and used the term workaround differently to the extent that they have not always applied it to the same empirical phenomena, which raises questions about some theoretical insights’ validity. Third, we suggest a definition for workarounds that we inductively derived from empirical accounts of workaround behavior and, therefore, that adequately describes how researchers commonly use the term and makes it possible to distinguish workarounds from other similar phenomena

More than meets the eye: Working around technology in cross-boundary work contexts

© Emerald Group Publishing Limited. enact technology in cross-boundary work contexts during e-government implementation in a public organization in East Malaysia. Design/methodology/approach – Case study methodology involving semi-structured interviews, unobtrusive observations, and archival records was utilized in the study. Interview subjects include management staff, general employees, and information technology (IT) specialists to provide rich descriptions of their work practice. Findings – Three distinct contexts contribute to cross-boundary work practice in relation to IT use and non-use, namely, standardization (complete IT use), hybridization (partial IT use), and conventionalization (zero IT use). Technology enactment strategies such as acceptance, avoidance, adaptation, and configuration are employed depending on actors’ interpretation of technology complexity and task interdependency. Practical implications – Early interventions could involve examining how and why employees accept or avoid technology as part of their work practice and how they switch between enactment strategies. Organizations could ensure better team support to capitalize on the robust social interaction in cross-boundary work contexts to develop greater synergy in technology improvisations. Originality/value – The study extends the technology enactment perspective as it offers new meanings to structures of action by understanding the temporal agentic orientations and how these are constructed by cross-boundary work contexts. It also offers insight into how enactment strategies are developed according to the productive tensions that arise from the interplay of cognitive orientations

Connective Routines: How Medical Professionals Work with Safety Checklists

New standards like checklists are introduced to establish so-called “connective professionalism,” but it is difficult to work with checklists in daily circumstances. Professionals might comply with standards, but they might also neglect or resist them. By linking the sociology of professions to routine theory, we develop a relational perspective on working with standards, which is sensitive to the actual usage of standards, not so much “by” but “in-between” professionals. We analysed whether and how checklists are part of daily professional routines. Our ethnographic data show that medical professionals pragmatically cope with checklists. They “tick boxes,” but also use standards to improve case treatment, depending on the nature of cases, time pressure, and team composition. Connections between professionals not so much result from standards, but are a prerequisite for using standards. Professionals themselves rather than checklists establish collaboration, but checklists might be important devices for using “connective potential.”Various exogenous developments force professions to organize collaboration. New standards, like checklists, are introduced to reconfigure work and organize so-called ‘connective professionalism’. Despite serious efforts, it has proven difficult to incorporate these standards in daily practice. Different perspectives on the reconfiguration of professional work explain noncompliance. While implementation science employs a solely instrumental perspective, Sociology of Professions literature employs a broader social perspective mostly focusing on maintaining professional power. By combining Sociology of Professions and Routine Theory, this paper provides an analytical perspective that embraces possibilities for change of routines. A critical case in surgical care is used to empirically show how a checklist (re)creates professional routines. Our ethnographic data show that rather than the result of active professional resistance, differences between checklists and routines emerge from pragmatic coping with checklists amidst high-paced circumstances. Though deviating from the formal rule, these might be meaningful action patterns

Informatisation incrémentale ou de rupture? : le cas du dossier patient hospitalier

Au niveau international, l’informatisation de la production des soins hospitaliers ne se développe que lentement. Un terme souvent utilisé dans la littérature pour expliquer ce phénomène est celui des "facteurs organisationnels", mais sans, la plupart du temps, que ce terme soit précisé. L’article, à partir d’une recherche observationnelle multi-sites, analyse sur le cas français les évolutions organisationnelles des unités cliniques consécutives à l’implantation d’un Dossier Patient Informatisé (DPI). Il montre que le système en place n’a subi que peu de transformations, au prix d’accommodements avec l’outil informatique. Une telle situation peut paraitre satisfaisante aux yeux des tutelles qui promeuvent l’innovation technologique, mais pose la question de la création de valeur organisationnelle, c’est-à-dire la possibilité pour les professionnels de soins de se saisir de l’outil dans une optique de transformation et d’amélioration à terme des différentes composantes de la performance.At the international level, the computerization of hospital care production develops only slowly. Past research has often used the term "organizational factors" to explain this phenomenon, but without specification so far. This article builds on results from an empirical research led in multiple French hospitals to investigate the organizational evolutions of clinical units due to the implementation of an Electronic Patient Record. It shows that the extant organizational system underwent only few transformations, thanks to local adjustments with the IT tool. Such a situation may be satisfactory for the eyes of the supervising structures which promote the technological innovation, but raises the issue of true organizational value creation