Information Rx: Prescribing Good Consumerism and Responsible Citizenship

Recent medical informatics and sociological literature has painted the image of a new type of patient—one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been re-named “reflexive consumers.” At the same time, literature about the questionable reliability of web-based information has suggested the need to create both user tools that have pre-selected information and special guidelines for individuals to use to check the individual characteristics of the information they encounter. In this article, we examine suggestions that individuals must be assisted in developing skills for “reflexive consumerism” and what these particular skills should be. Using two types of data (discursive data from websites and promotional items, and supplementary data from interviews and ethnographic observations carried out with those working to sustain these initiatives), we examine how users are directly addressed and discussed. We argue that these initiatives prescribe skills and practices that extend beyond finding and assessing information on the internet and demonstrate that they include ideals of consumerism and citizenship

Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles

Trisha Greenhalgh and Jill Russell discuss the relative merits of “scientific” and “social practice” approaches to evaluation and argue that eHealth evaluation is in need of a paradigm shift

Assessing the impact of area-based initiatives in deprived neighborhoods: The example of S. João de Deus in Porto, Portugal

Though there have been many area-based initiatives to regenerate rundown areas in numerous cities around the world, many of them involving the demolition of stigmatized housing estates, far fewer attempts have been made to assess the effects of these initiatives upon the fortunes of displaced households and those who remain in these areas. By presenting the results of an empirical in-depth case study on the effects of an area-based initiative targeted at one of the most deprived neighborhoods in Porto, this article raises several epistemological concerns related to the goals, ideological assumptions, and social and spatial effects of these initiatives. Among other interrelated issues, the article discusses the impact of conflicting ideologies upon processes of radical strategy shift and of social and territorial marginalization and appeals to the need for more pluralistic approaches to evaluation.I gratefully acknowledge the financial support of the Portuguese Fundação para a Ciência e Tecnologia for research grant SFRH/BPD/75863/2011, POPH/FSE

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

BACKGROUND: Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. METHODS: A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. RESULTS: According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering telehealth within the broader organisation of health care services in remote and rural regions. CONCLUSION: This study identified core elements that should be considered when implementing telehealth applications with the purpose of supporting medical practice in rural and remote regions. Decision-makers need to be aware of the specific conditions that could influence telehealth integration into clinical practices and health care organisations. Thus, strategies addressing the identified conditions for telehealth success would facilitate the optimal implementation of this technology

Customisation as a distributed process of cycles of translation: producing an electronic patient record in England

No description supplie

How a paper chart affords collaborative and distributed small data experiments for decision making under uncertainty

This paper presents a micro-level study of affordances of a hospital paper drug chart in the clinical context of a care of the elderly. It discusses how the chart mediates the activity of prescribing pain medication under conditions of uncertainty, in a context of distributed work among different clinical roles, each with its own rules, rights and responsibilities. The chart is a multidisciplinary tool used over the course of time of a patient hospitalization. Its paper format is known to afford flexibility, more so than rigid computer systems and digital forms. Under uncertainty it would be reasonable to expect paper flexibility to support sensemaking. Yet, in this context it is its structure rather than its flexibility that affords reducing clinical uncertainty. The chart structures and solidifies messiness of pain management, by transforming patients' experiences into 'data points' (gathering small data) and building a record of a therapeutic trial. Thus, it simultaneously reduces and obfuscates uncertainty. This paper contributes to the literature on working with uncertainty in everyday practice, artifact's affordances and the role of small data (as opposed to big data) in decision making under uncertainty

Sociotechnical changing in healthcare organisations: the introduction of Electronic Patient Record (EPR) in an English hospital

No description supplie

‘IT’S PEOPLE HEAVY’: A SOCIOTECHNICAL VIEW OF HOSPITAL DISCHARGE

This paper is about the enduring challenge of establishing a hospital discharge process that will supply the right medicines to patients as they leave hospital to use when they return home. The paper is written in a ‘documentary genre’, chosen to show rather than tell. We want to show how sociotechnical this quotidian task is. More broadly, this gives insight on how 21st century healthcare continues to present fundamental sociotechnical challenges, how we slowly chip away at these, and reconfigure in the context of systems use and as digital technologies become more deeply embedded in contexts of care. We hope to show what sociotechnical means in everyday practice, how healthcare work is ‘peo-ple heavy’ and how it spills out of its digital confines into different artefacts, physical places and timelines. Layers of digital innovation enter into and sediment in organizations, and reshape infrastructures, posing questions about the limits of sociotechnical ideas in the face of real life. The paper is based on three ethnographic studies conducted in England (UK) over six years