Subtle Redistribution of Work, Attention and Risks: Electronic Patient Records and Organisational Consequences

Based on an actor-network study of the way in which medical work in a hospital has changed after the introduction of an electronic patient record system, the paper addresses the question of organisational consequences of ICT. It describes how the introduction of electronic patient records (EPR) has occasioned redistribution of work, of organisational attention, and of risks. By comparing these findings to the public expectations of EPR and to the literature on organisational effects of EPR, it is argued that we need to shift from a theory of improvement to a theory of distribution in order to understand the way in which ICT affects work practices. The paper further argues that this shift also has implications for the theoretical understanding and practical management of design, implementation, and evaluation of ICT

Social Factoring the Numbers with Assisted Reproduction

In late winter 2009, the airwaves came alive with stories about Nadya Suleman, the California mother who gave birth to octuplets conceived via assisted reproductive technology. Nadya Suleman and her octuplets are the vehicles through which Americans express their anxiety about race, class and gender. Expressions of concern for the health of children, the mother’s well-being, the future of reproductive medicine or the financial drain on taxpayers barely conceal deep impulses towards racism, sexism and classism. It is true that the public has had a longstanding fascination with multiple births and with large families. This is evidenced by a long history of media attention and film depictions of such families, both fictitious and real. However, there is a point at which fascination turns to disdain, and that occurs all too often when the time that parents of the children are revealed to be Other — outside of racial and class norms. This essay describes eight socio-legal anxieties that coalesce in response to Suleman\u27s story: (1) race and racial hierarchies; (2) the contingency of white privilege; (3) the nature of white motherhood; (4) the role of doctors as agents of the state; (5) reproductive technology and class; (6) bodily perfection and class markers; (7) the bounds of the traditional family; and (8) geographical differences. The bounds of tolerance strain and break when individual autonomy collides with majoritarian notions of civic and moral virtue. Derision of Suleman reveals the limitations of tolerance for women who deviate from prescribed norms, including norms of “choice.” Suleman’s story is not just about multiple births, then, but about society’s multiple anxieties when a woman breaches the bounds of racial, class and gender expectations

Digest of the Philadelphia College of Osteopathic Medicine (Spring 2011)

The Spring 2011 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles: Opening Remarks PCOM Updates Development News Moonlighting in the Big Leagues Closing the Gap in Primary Care In Love & War Driven by Adventure: Nilam Vaughan, DO ’11, recipient of the 2011 Mason W. Pressly Memorial Medal, GA–PCOM Stand by the Struggling: Jenna Stokes, DO ’11, recipient of the 2011 Simmy Ginsburg Humanitarian Award Class Notes In Memoriam My Turn Essayhttps://digitalcommons.pcom.edu/digest/1208/thumbnail.jp

APPROPRIATING VALUE FROM INFORMATION TECHNOLOGY IN HEALTHCARE

The value potential of information technology (IT) in healthcare settings has generated considerable optimism yet, significant questions remain unanswered. This dissertation employs the lens of social structure to investigate the value of information technology in healthcare situated in two distinct contexts: hospitals, that exemplify the traditional institutional form for the delivery of healthcare services, and online patient communities that represent new organizational forms enabled by IT. It seeks to address the following fundamental research questions "What is the impact of information technology in healthcare settings? How does social structure influence the appropriation of the value of information technology in healthcare?" Each of the two contexts is investigated in a separate essay, drawing upon distinct bodies of literature and using both qualitative and quantitative analytical methods. Essay 1: Evolving Work Routines: A Theory of Successful Adaptation to Information Technology in Healthcare The first essay investigates the impact of healthcare technologies such as electronic medical record systems in the traditional hospital environment. It traces the development of changes in social structure before and after an IT implementation. Using a longitudinal field study, the process of how information technology and routines interact is deconstructed. A theory of the co-evolution of routines and technology is proposed and described. Essay 2: The Social Value of Online Health Communities The second essay examines the impact of health information technology in the form of online patient communities by uncovering the social structure of the community. Using data collected from a popular online patient community, I identify the generative processes using support patterns between patients within the community. I find that online patient communities yield social value through information and emotional support to patients by enabling the transfer of support between patients with differential needs. Results also provide descriptive insights into the attributes of patients that contribute to variation in the provision of support within such online patient communities. The two studies in this dissertation make theoretical and empirical contributions. They shed light on the impact of information technology in healthcare, and further inform us about the appropriation of HIT value from a social structure perspective

Sonic Skills

It is common for us today to associate the practice of science primarily with the act of seeing—with staring at computer screens, analyzing graphs, and presenting images. We may notice that physicians use stethoscopes to listen for disease, that biologists tune into sound recordings to understand birds, or that engineers have created Geiger tellers warning us for radiation through sound. But in the sciences overall, we think, seeing is believing. This open access book explains why, indeed, listening for knowledge plays an ambiguous, if fascinating, role in the sciences. For what purposes have scientists, engineers and physicians listened to the objects of their interest? How did they listen exactly? And why has listening often been contested as a legitimate form of access to scientific knowledge? This concise monograph combines historical and ethnographic evidence about the practices of listening on shop floors, in laboratories, field stations, hospitals, and conference halls, between the 1920s and today. It shows how scientists have used sonic skills—skills required for making, recording, storing, retrieving, and listening to sound—in ensembles: sets of instruments and techniques for particular situations of knowledge making. Yet rather than pleading for the emancipation of hearing at the expense of seeing, this essay investigates when, how, and under which conditions the ear has contributed to science dynamics, either in tandem with or without the eye

Concentration in Health Care Markets: Chronic Problems and Better Solutions

Health care providers with market power enjoy substantially more pricing freedom than monopolists in other markets, for a reason not generally recognized: US-style health insurance. Consequently, monopolies in health care cause undesirable redistribution of wealth and inefficient allocation of resources, both of which burden consumers at levels beyond those of other monopolists. The unusual costliness of monopoly power in health care markets demands far more policy attention than it has received. For starters, the health sector needs a more aggressive antitrust policy that effectively prevents the creation of new provider market power through mergers, alliances, or government immunity. An immediate need is ensuring that the formation of accountable care organizations under the Patient Protection and Affordable Care Act (PPACA), which in theory might achieve efficiencies through vertical integrations, do not primarily lead to horizontal integrations that give providers additional market power. Because antitrust policy has been so inadequate for so long in the health sector, and because it remains unlikely that courts or enforcement agencies will undo past mergers that created these powerful provider monopolies, policymakers should pursue additional strategies for contesting existing monopolies. One approach is to apply antitrust rules against “tying” arrangements so that purchasers can combat providers’ profit-enhancing practice of overcharging for large bundles of services instead of trying to exploit separately any monopolies they possess in various submarkets. Another strategy is to use antitrust or regulatory rules to prohibit anticompetitive provisions, such as “antisteering” or “most-favored-nation” clauses, in provider-insurer contracts. Policymakers could also help restore price competition in monopolized markets by enabling private payers to negotiate prices for specific provider services and encouraging insurers to expand the scope of competition — via medical tourism, for example, or configuring innovative health care delivery that bypasses many of the embedded costs in the current system. Some commentators have suggested that the provider monopoly problem is severe enough to warrant consideration of a more radical alternative: regulating provider prices. By restricting how insurers can purchase health services, the PPACA might effectuate a regulatory regime that significantly limits price and nonprice competition. However, even under the PPACA room remains for creative regulatory policies that enhance competition in health care markets and encourage better uses of our increasingly scarce health care dollars

Documenting Practices: The indexical centering of medical records

This paper explores how organizational members use documents to share their knowledge within and across work settings. I suggest that organizational studies of distributed knowledge sharing and information systems would greatly benefit from the linguistic analysis of communicative practices. Specifically, the paper highlights the notion of indexical centering as formulated by the linguistic anthropologist William Hanks and demonstrates its analytical power in studying documenting as a communicative practice. Drawing on a 15-month, multi-sited ethnographic study in several pediatric healthcare settings, the paper focuses on how two doctors compose and use two medical histories found in two distinct medical information systems. The analysis suggests that the doctors use documents to index the temporal, spatial, and participatory dimensions of their knowledge sharing. They do so by indexing, on the one hand, the participants, times and places for their communicative practices and, on the other hand, the participants, times and places of their general care practices. The indexical analysis allows us to perceive documents, as more than mere vessels for knowledge transfer among organizational members, but as an integrated part of how people structure their work practices and situate their knowledge sharing in complex distributed organizational settings

Rich man, poor man in Jerusalem according to the letter of James

This article is an investigation into what the Letter of James communicates to the reader regarding socioeconomic stratifications in one of the early Christian communities. Rather than discussing economics in any single section or chapter, the author of the Letter of James makes a number of direct and indirect references to this issue. Dialectical reflections on wealth (“rich”) and poverty (“poor”) occur cyclically throughout the epistle. This is part of the author’s rhetoric, and his aim is to focus the reader’s attention on the tension between rich and poor which was prevalent in the early church and society in Jerusalem. Each time the author returns to this topic he develops the theme further by adding new thoughts on the subject. The main issue that James wishes to address in this regard appears to be the antithesis between the rich and the absolutely poor.Christian Spirituality, Church History and Missiolog