Challenges for innovation in healthcare : eDiaMoND, a digital mammography database for the UK

This paper presents findings from an investigation into requirements for eScience in the context eDiaMoND, a Grid-enabled prototype system intended to support breast cancer screening. Detailed studies based on ethnographic fieldwork reveal the importance of accountability and visibility of work for trust and for the various forms of ‘practical ethical action’ in which clinicians are seen to routinely engage in this setting. We discuss the implications of our findings for realising the Grid’s potential for sharing data within and across institutions and hence for the prospects of using distributed screening to make more effective use of scarce clinical skills. Understanding how to afford trust and to provide adequate support for ethical concerns is a particular challenge for eHealth systems and for eScience in general. Future eHealth and eScience systems will need to be compatible with the ways in which practical ethical actions are distinguished and embedded within work practices. We conclude that to ensure this and the achievement of the wider eScience vision, requirements investigations must focus on gaining a detailed understanding of work practices.