Sociotechnical Changes Brought about by Electronic Medical Record

This paper provides analysis of a 3-year longitudinal ethnographic study following the gradual adaptation of an Electronic Medical Record (EMR) in a community health centre in Canada. Adopting a sociotechnical perspective, I follow the EMR and the work practices as they undergo continuous modifications and I identify changes that are brought about by the EMR. Findings from this research show essential differences between types of sociotechnical changes and their implications. I distinguish between the initial changes that occurred and their implications which I characterize as having straightforward, direct, and immediate effects; and the emergent changes and their implications which I characterize as being broader and having a deeper level of impact in the long term. Furthermore, I illustrate how some of these changes reflected realizations of the visions behind the dream of implementing an EMR; while other changes enabled new practices and illuminated issues that were invisible before. Finally, drawing upon insights from actor-network theory, I show how the EMR is becoming more than just a tool; it is participating in creating new practices and gradually transforming the medical profession

Welfare-to-work Policies Meeting Complex Realities of Unemployed Citizens:Examining Assumptions in Welfare

This paper draws on a longitudinal ethnographic study conducted at one of the largest municipal jobcenters in Denmark. It investigates what happens when welfare-to-work policies meet the complex lived realities of unemployed citizens. I examine the nature of welfare policies, and show how these inscribe neoliberal economic discourse, which are not easily applicable to the lived reality of unemployed citizens. Findings from this study illustrate that there are incongruences between the nature of policies and the policies-in-use. I argue that these incongruences are a result of myriad of assumptions that are inscribed in the welfare apparatus, constituting tools, people, policies, and practices. I, therefore, unpack assumptions about caseworkers as well as benefit recipients, appointments they must attend, and activation programs assigned to them. This way, the paper aims at initiating a discussion about finding ways to develop policies that are better applicable to the citizen’s lived realitie

Tactics for Constructing Visions about Electronic Health Records (EHRs)

Background Many qualitative studies focus on the ways healthcare technologies affect situated practices. Although these studies are undeniably important, it is equally important to pay attention to visions about these technologies. This article investigates the media discourse surrounding electronic health record (EHR) initiatives in Northm America.Analysis Drawing upon Bruno Latour’s (1987) framework for analyzing the process of constructing scientific facts, this article examines the tactics through which media discourses construct visions of EHR technologies.Conclusions and implications The analysis shows how these are used to highlight the potential of EHR initiatives in spite of weak empirical evidence. Furthermore, the article demonstrates how visions can be constructed and to support specific agendas by encouragingm and discouraging particular interpretations, expectations, and practices.RÉSUMÉContexte De nombreuses études qualitatives portent sur les manières dont les technologies des soins de santé affectent les pratiques situées. Bien que ces étudesm soient incontestablement importantes, il est tout aussi important de se soucier des visions envers ces technologies véhiculées par des parties intéressées. Cet article examine le discours médiatique sur certaines initiatives nord-américaines envers les dossiers de santé informatisés (DSI).Analyse Cet article s’inspire du cadre développé par Bruno Latour (1987) pour analyser lamconstruction du savoir scientifique. L’article a recours à ce cadre afin d’examiner les tactiquesnemployées par les médias pour développer des visions particulières à l’égard des technologies DSI.Conclusions et implications L’analyse montre comment certains médias vantent lepotentiel d’initiatives DSI sans fournir de données empiriques à l’appui. L’article montre en outre comment ces médias construisent leur perspective en encourageant ou endécourageant certaines interprétations, attentes et pratiques, et ce sous l’influence de partiesnprenantes particulières

In touch with james orvil beady’s poetry...

Resumo:Neste ensaio descreve-se a função estética de mitos e metáforas em poema de James Orvil Beady. Um segundo objetivo foi estimular os estudantes a efetuarem consultas eletrônicas. Os fundamentos teóricos, assim, foram localizados em sites e midiatecas e de lá transcritos na íntegra, com rigor lógico, em compilação peculiar ao estudo preliminar, ou complementar, nesse tipo de ensaio. Num primeiro momento, são reproduzidos ensaios sobre a crítica literária fundada nos mitos e, ainda, algumas interpretações míticas da Maternidade e Mãe Terra através dos tempos. Em seguida, estudo sobre o papel estetizante da metáfora no poema. E, a final, é efetuada a análise de mitos e metáforas no poema Mãe Terra. Abstract:I have chosen the myth criticism to emphasize the poetical function of myths and metaphors in James Orvil Beady's poetry. A secondary proposal is to motivate students to increase e- theorical researches during introductory or complementary studies. In this aim, foundations for critical approaches were reached in e-sites all over Internet. First there is a study about Myth criticism and some different approaches to the subject Motherhood and Mother Earth's myths throughtout time. In sequence a study about the role of metaphors in poetry. And the analysis of myths and metaphors in James Orvil Beady's poem Mother Earth

Função estética da ideologia em contos de Rubem Fonseca

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Comunicação e Expressão. Programa de Pós-Graduação em Letra

Managing the Gradual Transition from Paper to Electronic Patient Record (EPR)

This thesis is drawn from an ongoing, large-scale project of implementing Electronic Patient Record (EPR) at Rikshospitalet, which is the national hospital in Norway. The fact that the notion of the electronic record dates back to the 60’s and 70’s, illustrate how highly challenging task the transformation to digital record has been. The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the electronic patient record. In addition, to study how to manage a gradual transition to digital patient record. The analytical framework that was used in this thesis constitute of Actor Network Theory (ANT) which I will use as a methodological theory to view Information Infrastructures (IIs). This will provide a framework for the socio-technical aspects and cover processes that are accumulated in the implementation, use and change of a new technology. In addition, I use theoretical concepts from studies undertaken within the Computer-Supported Cooperative Work (CSCW). This research is framed by qualitative research methods following an ethnographic approach. By applying a combination of several techniques, I collected and generated the empirical data. The fieldwork in this study, was conducted over three phases, and lasted over a period of one year. Most of the fieldwork was conducted in two departments, including the neurology and neurosurgery department. The thesis includes four cases, where the first one describes the development and implementation process of the EPR in two departments. Thereafter, a case study of a Parkinsons patient is presented. The transformation to internal electronic referral letters is described as the third case, and finally, an introduction of the implementation of the scanning project is provided. Subsequently, all these cases are analyzed by holding infrastructural focus together with a work practice orientation. Drawing upon the analysis, I discuss the implications of the empirical cases and the analyses for theory. I view the transition process as a mutual, dynamic, and reflexive transformation of both information infrastructures and situated practices of use. The study shows us how implementing an electronic record changes not only one element in this interplay between the paper-based and the electronic record, but also the work practices that were developed around it. In addition, I will illustrate how the medical record and the work practice are not singular elements, but rather part of a large heterogeneous socio-technical network that includes artefacts, tools, people etc. By applying an infrastructural orientation, I focus on the heritage of the installed base, as well as the need for strategies to manage gradual transitions, such as cultivating the installed base and developing gateways which can link various components. By merging this perspective together with a work practice orientation, I illustrate how the transition process to an EPR is not merely a transformation of information infrastructure, but also of situated work practices. I explore how the heterogeneous actors, the complex medical practice, and the various artefacts, are interlinked and aligned to each other, and illustrate how a transformation of one of these components will affect the socio-technical infrastructure. This again, sheds a light on the importance of finding a way to conduct changes while avoiding breakdown in the whole chain of work. In addition to cultivation and the use of gateways, a gradual transition can be conducted by identifying borderline issues. Beside the theoretical implications, the case of the EPR provides an opportunity to study the issues of scaling large information infrastructure, and thereby provide an empirical contribution to studies within the Information System (IS) field. Finally, I reflect upon several practical implications for organization of change in such a large and complex healthcare organization. I hope that the finding form this research can be useful for Rikshospitalet, which is on the threshold of great challenges