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ABSTRACT: Users gave us 104 different reasons for the failure of implementing an EPR in a surgical clinic. We classify the reasons with the issue order model, where the first issue level is for simple and technical issues, the second one for more complex and combined issues, and the third one for political or ideological issues. However, what appears as a first order issue to a manager might be seen as an insurmountable third order issue for a worker and vice versa. The issues are interrelated, and solving one issue might have a substantial influence on other issues. Also, the issues seemed to accumulate and concentrate on points. The analysis helps focus on key problems, with consideration to related issues.
Studies in health technology and informatics 01/2010; 157:118-26.
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International Journal of Medical Informatics 12/2009; 78(12):786-7. · 2.41 Impact Factor
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ABSTRACT: Nursing work is intertwined with a number of technologies. This paper explores the work practices in a pediatric intensive
care unit, and discusses some possible directions for introducing new technologies. Work in intensive care is approached as
a set of complex and networked practices that are characterized by dynamism and reflexivity of situated action. We observed
how, in the intensive care unit, the emerging issues and complexity of organizational action are anticipated with situational
adaptability and self-ordering of action. Although the nurses are capable of adapting to rapidly changing situations, at the
same time, the nursing practices are bounded by the situational rationalities, such as the information available on the patient.
With new technologies, we see several opportunities for change in time-place arrangements, in coordination and communication
practices, and in information sharing practices. The roles and tasks of the various actants may reformulate, and thereby possibly
their skills and professional identities as well. All of this will take place when work practices, new technologies, and care
processes are negotiated and made irreversible through the actions of the participants.
06/2008: pages 143-157;
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ABSTRACT: Nursing narratives are an important part of patient documentation, but the possibilities to utilize them in the direct care process are limited due to the lack of proper tools. One solution to facilitate the utilization of narrative data could be to classify them according to their content.
Our objective is to address two issues related to designing an automated classifier: domain experts' agreement on the content of classes Breathing, Blood Circulation and Pain, as well as the ability of a machine-learning-based classifier to learn the classification patterns of the nurses.
The data we used were a set of Finnish intensive care nursing narratives, and we used the regularized least-squares (RLS) algorithm for the automatic classification. The agreement of the nurses was assessed by using Cohen's kappa, and the performance of the algorithm was measured using area under ROC curve (AUC).
On average, the values of kappa were around 0.8. The agreement was highest in the class Blood Circulation, and lowest in the class Breathing. The RLS algorithm was able to learn the classification patterns of the three nurses on an acceptable level; the values of AUC were generally around 0.85.
Our results indicate that the free text in nursing documentation can be automatically classified and this can offer a way to develop electronic patient records.
International Journal of Medical Informatics 01/2008; 76 Suppl 3:S362-8. · 2.41 Impact Factor
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ABSTRACT: The present study discusses ethics in building and using applications based on natural language processing in electronic nursing documentation. Specifically, we first focus on the question of how patient confidentiality can be ensured in developing language technology for the nursing documentation domain. Then, we identify and theoretically analyze the ethical outcomes which arise when using natural language processing to support clinical judgement and decision-making. In total, we put forward and justify 10 claims related to ethics in applying language technology to nursing documents.
A review of recent scientific articles related to ethics in electronic patient records or in the utilization of large databases was conducted. Then, the results were compared with ethical guidelines for nurses and the Finnish legislation covering health care and processing of personal data. Finally, the practical experiences of the authors in applying the methods of natural language processing to nursing documents were appended.
Patient records supplemented with natural language processing capabilities may help nurses give better, more efficient and more individualized care for their patients. In addition, language technology may facilitate patients' possibility to receive truthful information about their health and improve the nature of narratives. Because of these benefits, research about the use of language technology in narratives should be encouraged. In contrast, privacy-sensitive health care documentation brings specific ethical concerns and difficulties to the natural language processing of nursing documents. Therefore, when developing natural language processing tools, patient confidentiality must be ensured. While using the tools, health care personnel should always be responsible for the clinical judgement and decision-making. One should also consider that the use of language technology in nursing narratives may threaten patients' rights by using documentation collected for other purposes.
Applying language technology to nursing documents may, on the one hand, contribute to the quality of care, but, on the other hand, threaten patient confidentiality. As an overall conclusion, natural language processing of nursing documents holds the promise of great benefits if the potential risks are taken into consideration.
International Journal of Medical Informatics 11/2007; 76 Suppl 2:S293-301. · 2.41 Impact Factor
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ABSTRACT: Integrated information systems for managing patient data transform the nature of hospital work to the extent that the work practices, the responsibilities, even the professional identities are likely to undergo major changes. Therefore, during the organizational implementation of the IS, attention should be paid to the future users and how they understand and see what is going on. Here the focus is on these interpretation processes, analyzed as technological frames. That is, people develop different assumptions, expectations and knowledge concerning new technology. During this sense-making process they build their idea of that technology, its technological frame. We analyzed the pre-implementation frames that could be discerned in 24 interviews of hospital personnel. Main influences on the frames in this case were the work role in the organization, knowledge about the new system, and attitudes toward the old systems. The social context appeared to have a significant influence in the users' interpretation processes and the frames seemed to be congruent within one group. So far, the incongruence between groups appeared to have caused no major problems for the implementation.
International Journal of Medical Informatics 07/2007; 76 Suppl 1:S136-40. · 2.41 Impact Factor
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GAMEON'2007, (Covers Game Methodology, Game AI, Art Design and Graphics, Mobile Gaming, Online Gaming and Security, Education, Serious Gaming), November 20-22, 2007, University of Bologna, Bologna, Italy; 01/2007
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ABSTRACT: This paper discusses theoretical considerations of ethics in building and using a text mining application in nursing documentation. Nursing documentation is based on the process of gathering information from the patient, setting goals for care, documenting nursing interventions and evaluating delivered nursing care. Privacy-sensitive health care documentation brings specific ethical concerns and difficulties that one needs to be aware of and conform to when developing and using text mining tools in electronic patient records. We discuss how patient confidentiality can be ensured in this domain and how text mining might support nurses to give better and more efficient care for their patients. Our conclusion is that text mining of nursing documents holds the promise of great benefits when the potential risks are taken into consideration.
Studies in health technology and informatics 02/2006; 122:359-64.
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ABSTRACT: Nursing work is intertwined with a number of technologies. This paper explores the work practices in a pediatric intensive care unit, and discusses some possible directions for introducing new technologies. Work in intensive care is approached as a set of complex and networked practices that are characterized by dynamism and reflexivity of situated action. We observed how, in the intensive care unit, the emerging issues and complexity of organizational action are anticipated with situational adaptability and self ordering of action. Although the nurses are capable of adapting to rapidly changing situations, at the same time, the nursing practices are bounded by the situational rationalities, such as the information available on the patient. With new technologies, we see several opportunities for change in time place arrangements, in coordination and communication practices, and in information sharing practices. The roles and tasks of the various actants may reformulate, and thereby possibly their skills and professional identities as well. All of this will take place when work practices, new technologies, and care processes are negotiated and made irreversible through the actions of the participants. Full Text at Springer, may require registration or fee
International Federation for Information Processing Digital Library; Information Technology in the Service Economy: Challenges and Possibilities for the 21st Century;.
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ABSTRACT: Contemporary issues such as increases in operational scope, connectivity, and dynamism in organizations have meant also a corresponding increase of complexity in producing everyday interaction. A simple task on the individual level can be approached as a part of complicated whole or even as adding to complexity on the organizational level. In this paper, we compare two strong metaphors for studying complex nonlinear interaction in heterogeneous networks: complexity theory and actor-network theory. Both examine sociotechnical phenomena as evolving in on going negotiations of participants within complex networks. Understanding complex networks can add to our understanding of relationships between social actors and technical artefacts, that is, of information systems in use. As an example, we introduce a study of work practices in intensive care. We argue that this work is carried out as multiple and interdependent interactions further generating complexity in a network of humans, technical artefacts, and other materials. In such socio-technical networks, work practices, new technology, and work processes are negotiated or made irreversible through the actions ofparticipants. Full Text at Springer, may require registration or fee
International Federation for Information Processing Digital Library; Organizational Dynamics of Technology-Based Innovation: Diversifying the Research Agenda;.
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ABSTRACT: Nursing work is intertwined with a number of technologies. This paper explores the work practices in a pediatric intensive care unit, and discusses some possible directions for introducing new technologies. Work in intensive care is approached as a set of complex and networked practices that are characterized by dynamism and reflexivity of situated action. We observed how, in the intensive care unit, the emerging issues and complexity of organizational action are anticipated with situational adaptability and self ordering of action. Although the nurses are capable of adapting to rapidly changing situations, at the same time, the nursing practices are bounded by the situational rationalities, such as the information available on the patient. With new technologies, we see several opportunities for change in time place arrangements, in coordination and communication practices, and in information sharing practices. The roles and tasks of the various actants may reformulate, and thereby possibly their skills and professional identities as well. All of this will take place when work practices, new technologies, and care processes are negotiated and made irreversible through the actions of the participants. Full Text at Springer, may require registration or fee
International Federation for Information Processing Digital Library; Information Technology in the Service Economy: Challenges and Possibilities for the 21st Century;.
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