Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context

This paper argues that we should understand the process of IT design as the development of sociotechnical configurations. Drawing upon our experiences with an electronic patient record (EPR) on an Intensive Care Unit (ICU), we depict medical work practices as natural systems. Several considerations for design are developed. First, the EPR should not be overly structured with rationalistic and prefixed notions of the organization and content of medical work. Implementing structure is crucial, however, this should be derived from detailed, empirical knowledge of the practice involved. Second, it is crucial to ensure that the usage of the system will yield immediate benefits for primary users: the systems should support work, not generate it. Third, designing IT should include being aware of the socio political nature of seemingly 'neutral' tools as EPRs.

[1]  Marc Berg,et al.  The contextual nature of medical information , 1999, Int. J. Medical Informatics.

[2]  Costas Pappas,et al.  Medical informatics Europe '97 , 1996 .

[3]  L Boydell,et al.  European prototype for integrated care (EPIC). , 1994, Computer methods and programs in biomedicine.

[4]  G De Moor,et al.  From natural language to formal language: when MultiTALE meets GALEN. , 1997, Studies in health technology and informatics.

[5]  J R Scherrer,et al.  Natural Language Processing and Semantical Representation of Medical Texts , 1992, Methods of Information in Medicine.

[6]  Nancy M. Lorenzi,et al.  Transforming Health Care Through Information , 1995, Computers in Health Care.

[7]  Marc Berg,et al.  Rationalizing Medical Work: Decision-support Techniques and Medical Practices , 2022 .

[8]  M A Musen,et al.  The Strained Quality of Medical Data , 1989, Methods of Information in Medicine.

[9]  Diana E. Forsythe,et al.  Using ethnography in the design of an explanation system , 1995 .

[10]  M Berg,et al.  Medical Work and the ComputerBased Patient Record: A Sociological Perspective , 1998, Methods of Information in Medicine.

[11]  S. Tanenbaum,et al.  What physicians know. , 1993, The New England journal of medicine.

[12]  Clement J. McDonald.  Physicians' needs for computer-based patient records , 1992 .

[13]  Victor Kaptelinin,et al.  Computer-mediated activity: functional organs in social and developmental contexts , 1995 .

[14]  John P. McDermott,et al.  Computer support for clinical practice: embedding and evolving protocols of care , 1996, CSCW '96.

[15]  S. Kay,et al.  Medical Records and Other Stories: a Narratological Framework , 1996, Methods of Information in Medicine.

[16]  P W Moorman,et al.  Towards unambiguous representation of patient data. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[17]  Bonnie Kaplan,et al.  Fitting System Design to Work Practice:Using Observation in Evaluating A Clinical Imaging System , 1995 .

[18]  T. Peters.  Computerization and Controversy: Value Conflicts and Social Choices (2nd Ed.), edited by Rob Kling , 1996, J. Am. Soc. Inf. Sci..

[19]  J. Mattison,et al.  Naming Notes: Transitions from Free Text to Structured Entry , 1995, Methods of Information in Medicine.

[20]  Kjeld Schmidt,et al.  Taking CSCW Seriously: Supporting Articulation Work * , 1992 .

[21]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[22]  E Nygren,et al.  Reading the medical record. I. Analysis of physicians' ways of reading the medical record. , 1992, Computer methods and programs in biomedicine.

[23]  Marc Berg,et al.  Practices of reading and writing: the constitutive role of the patient record in medical work , 1996 .

[24]  Aaron V. Cicourel,et al.  The integration of distributed knowledge in collaborative medical diagnosis , 1990 .

[25]  R. T. Riley,et al.  Transforming Health Care through Information: Case Studies , 1995 .

[26]  A. Young,et al.  The creation of medical knowledge: some problems in interpretation. , 1981, Social science & medicine. Part B, Medical anthropology.

[27]  Levitt Ji.  Why physicians continue to reject the computerized medical record. , 1994 .

[28]  S. L. Star,et al.  Social science, technical systems, and cooperative work: beyond the great divide , 1999 .

[29]  Philip E. Agre,et al.  Surveillance and Capture: Two Models of Privacy , 1994, Inf. Soc..

[30]  Bonnie Kaplan,et al.  Organizational Evaluation of Medical Information Resources , 1997 .

[31]  W T Goossen,et al.  Nursing information management and processing: a framework and definition for systems analysis, design and evaluation. , 1996, International journal of bio-medical computing.

[32]  W J Clancey,et al.  The Learning Process in the Epistemology of Medical Information , 1995, Methods of Information in Medicine.

[33]  B. Kaplan,et al.  Objectification and negotiation in interpreting clinical images: implications for computer-based patient records , 1995, Artif. Intell. Medicine.

[34]  Marion J. Ball,et al.  Aspects of the Computer-based Patient Record , 1992, Computers in Health Care.

[35]  W. Orlikowski,et al.  Information Technology and Changes in Organizational Work , 1996, IFIP Advances in Information and Communication Technology.

[36]  J. van der Lei,et al.  Use and abuse of computer-stored medical records. , 1991 .