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A Review of 25 Years of CSCW Research in Healthcare: Contributions, Challenges and Future Agendas
Abstract
CSCW as a field has been concerned since its early days with healthcare, studying how healthcare work is collaboratively and practically achieved and designing systems to support that work. Reviewing literature from the CSCW Journal and related conferences where CSCW work is published, we reflect on the contributions that have emerged from this work. The analysis illustrates a rich range of concepts and findings towards understanding the work of healthcare but the work on the larger policy level is lacking. We argue that this presents a number of challenges for CSCW research moving forward: in having a greater impact on larger-scale health IT projects; broadening the scope of settings and perspectives that are studied; and reflecting on the relevance of the traditional methods in this field - namely workplace studies - to meet these challenges.
... 1 ○ participatory workshops, 2 ○ consent interface design, 3 ○ experimental evaluation, 4 ○ expert workshops, and 5 ○ user evaluations with patients. Each phase informed the subsequent as outlined below: For our initial qualitative investigation, we conducted 1 ○ participatory workshops to explore patients' values on health data-sharing within the research context [11,35]. These findings, along with insights from literature (see Section 2), informed our proposed 2 ○ consent interface design, the Value-Centered Consent Interface. ...
... These findings, along with insights from literature (see Section 2), informed our proposed 2 ○ consent interface design, the Value-Centered Consent Interface. The following quantitative evaluation served to examine the effects of our proposed interface design on decision-making in a 3 ○ online experiment, evaluating the effect of our devised design in supporting people's decisions and providing insights informing the consent interface design beyond our research context [35]. Finally, we returned to the research context to apply and evaluate our devised consent interface for supporting data donation decisions at German university hospitals through a co-creation workshop with subject experts 4 ○ and user evaluations with patients 5 ○. ...
... In summary, research in the field of CSCW has focused on healthcare as a workplace, where "patients were invisible apart from being the object of the information and coordination efforts" [35]. However, the advent of new data collection methods has necessitated the development of ethical consent frameworks in digital healthcare, empowering data subjects to act in accordance with their values. ...
In the digital health domain, ethical data collection practices are crucial for ensuring the availability of quality datasets that drive medical advancement. Data donation, allowing patients to share their clinical data for secondary research use, presents a promising resource for such datasets. Yet, current consent interfaces mediating data-sharing decisions are found to favor data-collectors' values by leveraging cognitive biases in data-subjects towards higher data-sharing rates. This raises ethical concerns about the use of data collected, as well as concerning the quality of the resulting datasets. Seeking to establish patient-centered data collection practices in digital health, we investigate the design of consent interfaces that support end-users in making value-congruent health data-sharing decisions. Focusing our research efforts on the situated context of health data donation at the psychosomatic unit of a German university hospital, we demonstrate how a human-centered design can ground technology within the perspective of a vulnerable group. We employed an exploratory sequential mixed-method approach consisting of five phases: Participatory workshops explore patient values, informing the design of a proposed Value-Centered Consent Interface. An online experiment demonstrates our interface element's effect, increasing value-congruence in data-sharing decisions. Our proposed consent interface design is then adapted to the research context through a co-creation workshop with subject experts and a user evaluation with patients. Our work contributes to recent discourse in CSCW concerning ethical implications of new data practices within their socio-technological context by exploring patient values on medical data sharing, introducing a novel consent interface to support value-congruent decision-making, and providing a situated evaluation of the proposed interface with patients.
... In these contexts, teamwork is inherently complex, involving cognitive, affective, verbal, and behavioural interactions among team members, often supported by various technologies and tools [51]. As a result, developing effective teamwork skills has been a central focus of CSCW and HCI research for many years [15,32]. ...
... This study contributes to CSCW and HCI research, which has long focused on how digital technologies support effective teamwork [15,32]. Specifically, it adds to recent HCI work on using AI to enhance teamwork practices [49]. ...
Healthcare simulations help learners develop teamwork and clinical skills in a risk-free setting, promoting reflection on real-world practices through structured debriefs. However, despite video's potential, it is hard to use, leaving a gap in providing concise, data-driven summaries for supporting effective debriefing. Addressing this, we present TeamVision, an AI-powered multimodal learning analytics (MMLA) system that captures voice presence, automated transcriptions, body rotation, and positioning data, offering educators a dashboard to guide debriefs immediately after simulations. We conducted an in-the-wild study with 56 teams (221 students) and recorded debriefs led by six teachers using TeamVision. Follow-up interviews with 15 students and five teachers explored perceptions of its usefulness, accuracy, and trustworthiness. This paper examines: i) how TeamVision was used in debriefing, ii) what educators found valuable and challenging, and iii) perceptions of its effectiveness. Results suggest TeamVision enables flexible debriefing and highlights the challenges and implications of using AI-powered systems in healthcare simulation.
... We have noted that both HCI and CSCW underscore the complex situated nature of technology adoption (e.g., [45,66]) and the importance of understanding its impacts not just on functionality but also on the broader social and emotional facets of people's lives (e.g., [70]). Yet it is well known that actual user interactions with technology can diverge from what designers anticipate [109,130]. ...
... Values. HCI and CSCW research has long emphasized the importance of understanding the situated context of technology use [45] to ensure that its adoption aligns with the social and cultural milieu (e.g., [65,117,118]), particularly in high-stakes and sensitive areas [21]. Kaye's [70] exploration of low bandwidth devices for couples in long-distance relationships to communicate intimacy, for example, illustrates how simple devices can foster users' rich interpretations of simple interaction behavior on a single-bit medium of communication, since it is situated in emotionally and socially rich pre-existing relationships. ...
AI's integration into education promises to equip teachers with data-driven insights and intervene in student learning. Despite the intended advancements, there is a lack of understanding of interactions and emerging dynamics in classrooms where various stakeholders including teachers, students, and AI, collaborate. This paper aims to understand how students perceive the implications of AI in Education in terms of classroom collaborative dynamics, especially AI used to observe students and notify teachers to provide targeted help. Using the story completion method, we analyzed narratives from 65 participants, highlighting three challenges: AI decontextualizing of the educational context; AI-teacher cooperation with bias concerns and power disparities; and AI's impact on student behavior that further challenges AI's effectiveness. We argue that for effective and ethical AI-facilitated cooperative education, future AIEd design must factor in the situated nature of implementation. Designers must consider the broader nuances of the education context, impacts on multiple stakeholders, dynamics involving these stakeholders, and the interplay among potential consequences for AI systems and stakeholders. It is crucial to understand the values in the situated context, the capacity and limitations of both AI and humans for effective cooperation, and any implications to the relevant ecosystem.
... Usability testing methods are not equipped to consider social interaction. There are many empirical examples from CSCW research where cooperative technologies have been implemented into an organizational practice only to reveal fundamental design problems that only became pertinent after the groupware system had been implemented in real-life situations [75][76][77]. In some cases, expensive IT systems were taken out of use due to these problems [78], while in other cases organizations were forced to live with problematic systems and identify workarounds to survive [79,80]. ...
... We were very surprised to experience two cases, where the challenge of exception handling did not appear. Any literature review or summaries of empirical cases published in CSCW will demonstrate a wide range of exception-handling problems [77,81]. Reflecting analytically upon this surprise, we discovered that the list of groupware systems that we have explored in the empirical cases were all fundamentally open-ended in nature as well as re-configurable -and thus the success of these concrete systems within the two organizations is very much due to that the technologies used, have in the very design of the groupware, including users' ability to revise, re-structure, and re-organize content, folders, and structures. ...
In 1994, Jonathan Grudin wrote his famous paper Eight Challenges for Groupware Developers; The question is whether these challenges still persist, or have we moved on here 30 years later? We revisit the challenges empirically through ethnographic observations in two companies examining their work practices, organizational structure, and cooperative setups concerning their use of groupware technologies. Today, groupware is seamlessly integrated into organizations, considered essential infrastructure that becomes part of the daily work routine. Contextualizing the original challenges proposed by Grudin, we categorize them into cooperative challenges, social challenges, and organizational challenges, and refine their phrasings to reflect present and future considerations faced by developers of groupware technologies. While the main arguments of the social and organizational challenges remain consistent, we rephrase the cooperative challenges as emergent exception handling and exaggerated accessibility to reflect the emerging characteristics associated with the ubiquity and seamless integration of groupware.
... A recurring theme across all five contributions is the role of sense-making in the appropriation and evaluation of digital technologies. 18 How do healthcare practitioners perceive and reflect on these technologies? How do patients and caregivers interact with them? ...
... The evolution of the integration of AI with PHT offers significant potential. Future PHT is expected to engage individuals in interactive dialogues that personalise the recommendations to their specific health concerns and preferences [26]. As PHT evolves from simple tracking tools to more autonomous and collaborative systems, understanding how individuals perceive and interact with AI-assisted HDM becomes crucial [50]. ...
As artificial intelligence (AI) becomes more embedded in personal health technology, its potential to transform health decision-making through personalised recommendations is becoming significant. However, there is limited understanding of how individuals perceive AI-assisted decision-making in the context of personal health. This study investigates the impact of AI-assisted decision-making on trust in physical activity-related health decisions. By employing MoveAI, a GPT-4.0-based physical activity decision-making tool, we conducted a mixed-methods study and conducted an online survey (N=184) and semi-structured interviews (N=24) to explore this dynamic. Our findings emphasise the role of nuanced personal health recommendations and individual decision-making styles in shaping trust in AI-assisted personal health decision-making. This paper contributes to the HCI literature by elucidating the relationship between decision-making styles and trust in the AI-assisted personal health decision-making process and showing the challenges of aligning AI recommendations with individual decision-making preferences.
... The computer-supported cooperative work (CSCW) is concerned with systems on which users generally have great in uence. It recommends a step-by-step evolutionary approach Fitzpatrick and Ellingsen 2013) with a clear focus on the stakeholders involved, especially the users but also developers and other stakeholders. In this study, we investigate how reminders and alerts, visualization tools, checklists, and streamlined interfaces support better clinical documentation when part of the work ow of healthcare professionals using a newly developed mobile application. ...
Good clinical documentation is important for patient safety, communication between healthcare professionals, legal protection, quality assurance, reimbursement, and research. In this study, we conduct a two-phased field study on a mobile application designed to support healthcare professionals in improving clinical documentation directly into Electronic Health Records (EHRs). First, we introduced the application to four hospital wards and conducted interviews, user testing, usability, and user experience testing. Second, we measured the application’s usage over three months and compared it to the three months before implementation. The results show that this mobile application significantly saves time for healthcare professionals and supports their clinical documentation practices. We also evaluate if embedding digital nudging into the design of the mobile application impacts healthcare professionals and their established workflows and routines.
... have been observed in the United States, Canada, Australia, and several European countries including the UK, Austria, and Norway (2). Thorough examinations of healthcare IT demonstrate the increasing impact of community health work structures on patient outcomes (3). ...
... Khanal et al. (2023) explained how technical and nontechnical factors must be leveraged in the design and implementation of the NHI including policy formulation. Some of these factors can be noticed in the processes, cultural and sociological areas (Fitzpatrick & Ellingsen, 2013). Moreover, George et al. (2012) state that some of the challenges of IT are security and confidentiality because patients' information is saved online to keep track of their health status. ...
The South African government embarked on the implementation of the National Health Insurance (NHI) system without readiness assessment. Consequently, potential challenges and the influencing factors from information technology (IT) were not empirically known. This study aimed to examine the factors that influence the implementation of the South African NHI, from an IT perspective. Qualitative data were gathered from several sources and the duality of structure from structuration theory was used as a lens for the analysis. The analysis reveals the factors that can influence the implementation of the NHI, from assessment of readiness assessment. The study reveals crucial gaps in the deployment of IT solutions in enabling and supporting the implementation of the NHI. The gaps are essential in assessing the success or failure of the NHI. The factors provide a fresh perspective for developing policies, principles, and standards, to guide the implementation of the NHI in the country which are both technical and non-technical.
... Computer-supported cooperative work (CSCW) has long been recognized for its crucial role in improving patient-provider interactions [36,86]. Key studies have demonstrated how CSCW principles can be applied to develop systems that facilitate effective communication between patients and providers [89,109]. ...
Quality patient-provider communication is critical to improve clinical care and patient outcomes. While progress has been made with communication skills training for clinicians, significant gaps exist in how to best monitor, measure, and evaluate the implementation of communication skills in the actual clinical setting. Advancements in ubiquitous technology and natural language processing make it possible to realize more objective, real-time assessment of clinical interactions and in turn provide more timely feedback to clinicians about their communication effectiveness. In this paper, we propose CommSense, a computational sensing framework that combines smartwatch audio and transcripts with natural language processing methods to measure selected ``best-practice'' communication metrics captured by wearable devices in the context of palliative care interactions, including understanding, empathy, presence, emotion, and clarity. We conducted a pilot study involving N=40 clinician participants, to test the technical feasibility and acceptability of CommSense in a simulated clinical setting. Our findings demonstrate that CommSense effectively captures most communication metrics and is well-received by both practicing clinicians and student trainees. Our study also highlights the potential for digital technology to enhance communication skills training for healthcare providers and students, ultimately resulting in more equitable delivery of healthcare and accessible, lower cost tools for training with the potential to improve patient outcomes.
... Conceptually, we drew on the CSCW field, which has a long tradition of attending to stakeholders' perspectives on local practices (Fitzpatrick and Ellingsen 2013). We also drew on the information infrastructure concept, particularly in relation to evolution (Aanestad and Jensen 2011;Bossen and Markussen 2010;Hanseth and Lyytinen 2010;Star and Ruhleder 1996). ...
In information infrastructures at hospitals, various stakeholders are responsible for specific information and communications technology (ICT) portfolios. Each portfolio represents a unique digital trajectory with a past, present, and future. This study investigated how stakeholders (in this study, software developers, ICT operations organizations, and users) collaborate to facilitate the convergence of different digital trajectories, thus contributing to the successful evolution of information infrastructures. Empirically, we focused on the preparatory work involved in implementing an app that would enable nurses to register and calculate National Early Warning Scores at Nordland Hospital in northern Norway. Specifically, we examined the collaboration between three stakeholders to align their respective ICT portfolios and prepare for the new solution. These stakeholders were the Finnish software developer Medanets, the Norwegian Electronic Health Record developer DIPS ASA, and the Northern Norway Regional Health Authority, which governed the regional health ICT infrastructure. These stakeholders governed three distinct portfolios that had been developed over many years and, in this sense, represented digital trajectories with a past, a present, and a possible future. This study is positioned within the computer-supported cooperative work field, and the analysis draws upon the theoretical concepts of information infrastructure and trajectories.
... /10.1101/10. /2024 in care patterns, an artificial intelligence (AI) clinical decision support system (CDSS) could ameliorate uncertainty in these complex decisions (Chen et al., 2022;Gandhi et al., 2023) support personalized treatment recommendations, (Shah et al., 2021;Yildirim et al., 2024a), and overcome known barriers to optimal IMV care (Dexter and Schleyer, 2022;Fitzpatrick and Ellingsen, 2013;Yildirim et al., 2024b). ...
Treatment decisions for patients receiving invasive mechanical ventilation (IMV) are complex and depend simultaneously on the current ventilator settings, the function of multiple interrelated organ systems, and other treatments. An artificial intelligence (AI)-based clinical decision support system (CDSS) offers a promising approach to alleviate uncertainty in this complex management and provide personalized treatment recommendations. However, little is known about clinician preferences for which treatment decisions clinicians think would most benefit from a CDSS. Therefore, we conducted a cross- sectional electronic survey of practicing physicians, nurses, advanced practice providers, and respiratory therapists to identify key treatment decisions in IMV care. We sent the survey instrument to 132 clinicians across six geographically diverse health systems. Among 51 respondents (39% response rate), there were 24 (47%) physicians, 7 (14%) registered nurses, 8 (16%) advanced practice providers, and 12 (24%) respiratory therapists. Participants were from five US states including Pennsylvania, California, Michigan, Minnesota, and Nebraska. At least 50% of participants identified 18 distinct treatment decisions for IMV care as very important or absolutely essential, including many that were outside of the ventilator settings themselves. The highest agreement about importance was for the decision to extubate (N=51, 100%), and the decisions to conduct a spontaneous awakening trial (N=48, 94%) and spontaneous breathing trial (N=48, 94%). The highest agreement about a decision being not important or only slightly important was for the shape of the inspiratory flow pattern (N=15, 29%). These findings underscore the scope and complexity of clinical decision making across multidisciplinary teams in caring for people receiving IMV. Furthermore, they underscore the gap between important clinician-identified decisions and existing IMV CDSSs that provide suggestions for at most 5 ventilator settings without support for other related decisions. Future work is needed to identify which of these decisions might be most appropriate for inclusion in a CDSS to support IMV management.
... A decade ago, a review of 25 years of Computer-Supported Cooperative Work in healthcare suggested that the adaptation of AAL systems would involve intricacies far beyond their intended purpose to routinely recognize or infer activities of daily living [33]. Specifically, privacy and security concerns seem to be substantial aspects that impede the successful adoption of AAL technology in everyday settings [63,73,83,98]. ...
... HCI research has a rich history of empowering individuals with chronic conditions [46], particularly those who face cognitive and communication challenges, such as individuals with autism [60,63] and dementia [41,69]. Such efforts allow researchers to employ innovative methods that honor the autonomy and agency of these individuals [34]. ...
... Given physical distancing measures, many trusted messengers in CBPR engagements have embraced digital channels for communication, such as social media posts [17], group chats on messaging platforms [132], webinars and virtual town halls [2,39], and email listservs [17]. While there is a deep literature of CSCW research in healthcare [38], its engagement with public health and health communication at the community level has been emerging more recently. Researchers have looked at frontline community health workers in India, who are a key part of the Indian public health workforce, and characterized their role as one of an infomediary bridging disconnected situated knowledges between patients and clinic-based healthcare providers [61]. ...
While social computing technologies are increasingly being used to counter misinformation, more work is needed to understand how they can support the crucial work of community-based trusted messengers, especially in marginalized communities where distrust in health authorities is rooted in historical inequities. We describe an early exploration of these opportunities in our collaboration with Black and Latinx young adult "Peer Champions" addressing COVID-19 vaccine hesitancy the U.S. state of Georgia. We conducted interviews engaging them with a social media monitoring and outreach dashboard we designed, to probe their understanding of their roles and current and potential use of digital platforms. With the concept of cultural code-switching as a framing, we found that the Peer Champions leveraged their particular combination of cultural, health, and digital literacy skills to understand their communities' concerns surrounding misinformation and to communicate health information in a culturally appropriate manner. While being positioned between their communities and public health research and practice motivated and enabled their work, it also introduced challenges in finding (mis)information online and navigating tensions around authenticity and respect when engaging those close to them. Our research contributes towards characterizing the valuable and difficult work trusted messengers do, and (re)imagining collaboratively designed interpretive digital tools to support them.
... Building on a rich history of designing collaborative technology in HCI and Computer-Supported Cooperative Work (CSCW) (Fitzpatrick and Ellingsen 2013;Grudin 1988), recent work shows an increasing interest towards enabling effective Human-AI collaboration. Collaboration is a process of activities typically done between two or more individuals which involve co-management, shared goal setting, understanding, and progress tracking (Wang et al. 2020). ...
Medical training is a key element in maintaining and improving today’s healthcare standards. Given the nature of medical work, students must master not only theory but also develop their hands-on abilities and skills in clinical practice. Medical simulators play an increasing role in supporting the active learning of these students due to their ability to present a large variety of tasks allowing students to train and experiment indefinitely without causing any patient harm. While the criticality of explainable AI systems has been extensively discussed in the literature, the medical training context presents unique user needs for explanations. In this paper, we explore the potential gap of current limitations within simulation-based training, and the role Artificial Intelligence (AI) holds in supporting the needs of medical students in training. Through contextual inquiries and interviews with clinicians in training (N = 9) and subsequent validation with medical experts (N = 4), we obtain an understanding of the shortcomings in current simulation-based training and offer recommendations for future AI-driven training. Our results stress the need for continuous and actionable feedback that resembles the interaction between clinical supervisor and resident in real-world training scenarios while adjusting training material to the residents’ skills and prior performance.
... Design in healthcare increasingly concerns the design of systems for collaborative work, information sharing and flow among individuals and groups across locations, levels of care and care services (Fitzpatrick and Ellingsen 2013). Infrastructure design has been proposed as a way to understand design activities that go beyond designing for a local predefined context of use and take into account openness in C. Sadorge et al. the types and number of users, the multiplicity of agendas and purposes and the numerous and diverse existing systems and practices in multiple contexts of use (Monteiro et al. 2013). ...
This study explores the generative role of objects in design work. While the CSCW literature includes a range of contributions on infrastructure design and ways of accounting for diverse existing systems, practices and perspectives in design, the focus has typically been on the point of use, rather than the earlier stages of design processes. However, as more worker groups become involved in design there is a need to understand the microdynamics of collaborative design in this phase and the interplay between problem framing and exploration. We examined how the design of an information system in the health sector evolved through the instantiation and exploration of intermediary objects that become generative in the design process. The data comprised observations over 2 years from design meetings with a team of health professionals and software developers mandated to develop a system for the registration and sharing of patient information across primary care units. The analysis showed how intermediary objects formed focal points from which infrastructure design problems were framed and collectively explored. These processes required considerable negotiation and exploration within and between the interdependencies that become relevant in the design process. We identified how intermediary objects take different representational forms and become generative in two ways: By producing new or transformed objects, and by revealing layers of complexity inherent in the design problem. We discussed implications of the analysis as regards aspects of the infrastructure design that can be handled in the design team versus aspects that should be delegated to local adaptation.
... For instance, storing medical records outside of a health data warehouse will be forbidden in the near future due to the evolution of the regulations related to national healthcare policies. Some research in CSCW and healthcare points to policies as an important issue (Fitzpatrick & Ellingsen, 2013;Jackson et al., 2014). We are currently considering an approach for reflecting this aspect in MADRAE. ...
The results of CSCW studies should be more effectively incorporated into software engineering practices. This paper focuses on two concepts supporting software component choice and development in IS architecture: artifact ecologies and data work. Using a case study in telemedicine, we propose MADRAE, an extension of the UML component diagram, for modeling practice-based artifact ecologies that emphasize the necessary data work. In the hospital where we tried MADRAE, it was considered helpful by the head of the IS department to analyze existing artifact ecologies and generate design and architecture proposals.
... Indeed, numerous studies have described the important roles (e.g., medical secretaries) and/or mechanisms (e.g., note taking) put in place by healthcare actors that are totally ignored by large standardized systems (Abraham and Reddy 2008;Bansler et al. 2016;Bossen et al. 2012). The reflexive review by Fitzpatrick and Ellingsen (2013) on 25 years of CSCW studies in healthcare settings (published in the Jubilee issue of the CSCW Journal) consolidates the considerable body of knowledge within the discipline up to 2013. ...
... Primarily, though, care work has been studied in the context of healthcare, with the broad defnition as being the labor involved in improving the physical and mental health and wellbeing of the care recipient (e.g., [100]). Prior research has examined care work performed by formal healthcare workers like nurses [52] and medical teams [33], as well as informal workers such as family members (e.g., [80,89]) and community health workers [47,102]. Furthermore, prior research on the interaction dynamics of formal care work in the Indian healthcare context has noted a shifting balance of power between patients and doctors [9,13]. ...
... In most cases, quantitative methods such as statistics (TAs=14) were used to analyze additional quantitative data. Such approaches align with recent calls for 'mixed methods' or methods combining quantitative and qualitative data in HCI for healthcare [51,86]. Other methods were used to complement thematic analysis fndings, including data classifcation or charting [30,101,106], interpretive analysis and description of interactions [75], content analysis [65,123], and afnity diagrams [124]. ...
... Based on data, technology can provide many opportunities to support 1) professionals in improving health care processes and providing care and 2) people and their carers in their own self-care management as part of their everyday lives [14,31]. For the latter, mobile and pervasive technologies for mobile (mHealth) and ubiquitous health (uHealth) systems already provide a wide range of wellness and fitness applications and clinical systems that collect objective measures. ...
This workshop will explore future work in the area of intelligent, conversational, data-driven health interfaces both from patients' and health care professionals' perspectives. We aim to bring together a diverse set of experts and stakeholders to jointly discuss the opportunities and challenges at the intersection of public health care provisioning, patient and caretaker empowerment, monitoring provisioning of health care and its quality. This will require AI-supported, conversational decision-making interfaces that adhere to ethical and privacy standards and address issues around agency, control, engagement, motivation, and accessibility. The goal of the workshop is to create a community around intelligent data-driven interfaces and create a road map for their future research.
... Across the HCI literature [20,40,82,100], or more precisely, from the CHI community [12,19], human-centered evaluation of interactive, DL systems, is an open area of research within clinical environments. Cai et al. [19] created interactive techniques, leading to an increased diagnostic utility and user trust in the predictions from a DL system, used by clinicians in a lab setting. ...
Intelligent agents are showing increasing promise for clinical decision-making in a variety of healthcare settings. While a substantial body of work has contributed to the best strategies to convey these agents’ decisions to clinicians, few have considered the impact of personalizing and customizing these communications on the clinicians’ performance and receptiveness. This raises the question of how intelligent agents should adapt their tone in accordance with their target audience. We designed two approaches to communicate the decisions of an intelligent agent for breast cancer diagnosis with different tones: a suggestive (non-assertive) tone and an imposing (assertive) one. We used an intelligent agent to inform about: (1) number of detected findings; (2) cancer severity on each breast and per medical imaging modality; (3) visual scale representing severity estimates; (4) the sensitivity and specificity of the agent; and (5) clinical arguments of the patient, such as pathological co-variables. Our results demonstrate that assertiveness plays an important role in how this communication is perceived and its benefits. We show that personalizing assertiveness according to the professional experience of each clinician can reduce medical errors and increase satisfaction, bringing a novel perspective to the design of adaptive communication between intelligent agents and clinicians.
... In addition, patients' views were inflexible, requiring long searches. Moreover, some information previously noted by hand did not fit into the formal electronic record [11]. Such difficulties, in particular, reinforce our goal of making the user interface development process as situationally realistic and user-friendly as possible. ...
The market for (intelligent) support systems for nursing of an increasingly aging population has grown rapidly in recent years. Nevertheless, only a few of these systems have found their way into the care of the elderly. An important point, in addition to the lack of refinancing structures in the health care system, is the reservations of those in need of care and those caring for them. With our study, we tried to get an insight into the everyday care work and to better understand the attitudes of caregivers towards the use of technology in elderly care, especially with a focus on artificial intelligence. In our paper, we present the results from a contextual inquiry, interviews, and a workshop for this purpose.
... The CSCW literature has been contributing to health and wellbeing of workers since its inception (Fitzpatrick & Ellingsen, 2013) with CSCW technology facilitating the adoption and implementation of wellbeing programs, including emotional and mental support through digital mediated communication. To date, the wellbeing programs are largely considered externally imposed interventions, rather than initiatives that foster emergence from an individual's capacity. ...
The pandemic has accelerated the adoption of remote Work-Integrated Learning (WIL) programs for Higher Education (HE) students, fostered by advances in digital technologies. Emerging as a new post-covid normal, the ‘remote workplace’ and remote WIL brings further challenges with students expressing anxiety in dealing with this new form of working environment. Having the capacity to talk about wellbeing issues with others is an important wellbeing literacy (WL) skill. This paper addresses the need for a better understanding of wellbeing literacy (WL) skills in remote WIL workplaces. Interpreting WL in remote settings can further the definition of WL by extending it to a digital context. In contributing to Computer-Supported Cooperative Work (CSCW) research and the emerging field of WL, this paper explores how WIL students develop WL skills in a remote setting, which we define as Digital Wellbeing Literacy (DWL). In-depth interviews were held with WIL academics, WIL professionals, WIL students and wellbeing experts on digital and pedagogical factors that support WL in remote work. We found that students proactively use digital communication tools and social media to communicate wellbeing concerns, which in turn helps them practice DWL. We propose four strategies toward improving DWL in HE WIL offerings.
Chronic disease management requires numerous family-based activities. Although HCI has investigated family-based chronic disease management, there is no systematic basis for technology design. Routines support adherence; thus, we used routines theory to investigate chronic disease management activities in families; the roles of family, patients, and artifacts; activity routinization; and routine interrelationships. The two-year study included 38 families managing type 2 diabetes and/or HIV/AIDS. Data collection involved individual and family group interviews, surveys, and home tours. Families performed 14 chronic disease management activities within five interrelated cycles, and one less-connected activity. Most families included both family members and patients in activities—although this could be problematic. Most activities were only moderately routinized and followed cyclical activity patterns joined by sequential or concurrent interdependence. A medication-taking routine ecology had coordination difficulties. Results surface design implications for a potentially powerful new class of technologies to support family-based chronic disease management routines.
Nasogastric tubes (NGTs) are feeding tubes that are inserted through the nose into the stomach to deliver nutrition or medication. If not placed correctly, they can cause serious harm, even death to patients. Recent AI developments demonstrate the feasibility of robustly detecting NGT placement from Chest X-ray images to reduce risks of sub-optimally or critically placed NGTs being missed or delayed in their detection, but gaps remain in clinical practice integration. In this study, we present a human-centered approach to the problem and describe insights derived following contextual inquiry and in-depth interviews with 15 clinical stakeholders. The interviews helped understand challenges in existing workflows, and how best to align technical capabilities with user needs and expectations. We discovered the trade-offs and complexities that need consideration when choosing suitable workflow stages, target users, and design configurations for different AI proposals. We explored how to balance AI benefits and risks for healthcare staff and patients within broader organizational, technical, and medical-legal constraints. We also identified data issues related to edge cases and data biases that affect model training and evaluation; how data documentation practices influence data preparation and labelling; and how to measure relevant AI outcomes reliably in future evaluations. We discuss how our work informs design and development of AI applications that are clinically useful, ethical, and acceptable in real-world healthcare services.
Despite recent advancements, real-world use of Artificial Intelligence (AI) in radiology remains low, often due to the mismatch between AI offerings and the situated challenges faced by healthcare professionals. To bridge this gap, we conducted a field study at nine medical sites in Denmark and Kenya with two goals: (1) to understand the challenges faced by radiologists during chest X-ray practice; (2) to envision alternative AI futures that align with collaborative clinical work. This study uniquely grounds the AI design insights in the comprehensive characterisation of diagnostic work across multiple geographical and institutional contexts. Building on ideas articulated by interviewed radiologists (N=18), we conceptualised five visions that transcend the traditional notions of AI support. These visions emphasise that the clinical usefulness of AI-based systems depends on their configurability and flexibility across three dimensions: type of clinical site, expertise of medical professionals, and situational and patient contexts. Addressing these dependencies requires expanding the clinical AI design space by envisioning futures rooted in the realities of practice rather than solely following the trajectory of AI development.
Computational ethnography is an emerging family of methods for conducting human–computer interaction (HCI) studies in healthcare. Computational ethnography often leverages automated and less obtrusive means for collecting in situ data that reflect end users’ true, unaltered behaviors of interacting with a software system or a device in naturalistic settings. In this chapter, we introduce the concept of computational ethnography and common types of digital trace data available in healthcare environments, as well as commonly used approaches to analyzing computational ethnographical data. At the end of the chapter, we use two use cases to illustrate how this new family of methods has been applied in healthcare to study end users’ interactions with technological interventions in their everyday routines.
Access to mortality data is critical for researchers for various reasons, including the development of life-saving medical interventions. However, high-quality mortality data is typically unavailable for researchers to access in a timely manner due to bottlenecks and inefficiencies in the coordination of managing mortality data across a vast information ecosystem. To identify opportunities to improve access to mortality data, we conducted a qualitative interview study with 20 experts with direct knowledge and experience with mortality data systems. From these interviews, we mapped the mortality data ecosystem and found that policy constraints are the main underlying cause of bottlenecks and inefficiencies. We argue that policy intervention is required to optimize the coordination of mortality data between databases and between organizations. To support researcher access to mortality data, we present guiding principles for designers seeking to improve the mortality data ecosystem. These principles contribute to CSCW scholarship focused on the challenges of coordination across large information ecosystems and the tradeoffs between technology and policy when designing such systems.
AI assistants such as Alexa, Google Assistant, and Siri, are making their way into the healthcare sector, offering a convenient way for users to access different healthcare services. Trust is a vital factor in the uptake of healthcare services, but the factors affecting trust in voice assistants used for healthcare are under-explored and this specialist domain introduces additional requirements. This study explores the effects of different functional, personal, and risk factors on trust in and adoption of healthcare voice AI assistants (HVAs), generating a partial least squares structural model from a survey of 300 voice assistant users. Our results indicate that trust in HVAs can be significantly explained by functional factors (usefulness, content credibility, quality of service relative to a healthcare professional), together with security, and privacy risks and personal stance in technology. We also discuss differences in terms of trust between HVAs and general-purpose voice assistants as well as implications that are unique to HVAs.
Smart hospital patient rooms incorporate various smart devices to allow digital control of the entertainment --- such as TV and soundbar --- and the environment --- including lights, blinds, and thermostat. This technology can benefit patients by providing a more accessible, engaging, and personalized approach to their care. Many patients arrive at a rehabilitation hospital because they suffered a life-changing event such as a spinal cord injury or stroke. It can be challenging for patients to learn to cope with the changed abilities that are the new norm in their lives. This study explores ways smart patient rooms can support rehabilitation education to prepare patients for life outside the hospital's care. We conducted 20 contextual inquiries and four interviews with rehabilitation educators as they performed education sessions with patients and informal caregivers. Using thematic analysis, our findings offer insights into how smart patient rooms could revolutionize patient education by fostering better engagement with educational content, reducing interruptions during sessions, providing more agile education content management, and customizing therapy elements for each patient's unique needs. Lastly, we discuss design opportunities for future smart patient room implementations for a better educational experience in any healthcare context.
This paper zooms in on a particularly precarious and largely invisibilized group of care workers: middle-aged and less-educated female migrant workers from rural China. Drawing from a mixed-methods study, we specifically examine how the extensive use of data-driven technologies impacts care workers' wellbeing in the workplace. Our findings suggest the extensive use of data-driven healthcare technologies are eroding care workers' workplace wellbeing, especially their sense of identity, agency, and perceived justice. Specifically, in the data-driven workplace, care workers are treated as a servant to data, instead of a human with agency and knowledge. They are no merely care workers who provide various care services for care receivers, but also data workers, whose practices and agency are greatly limited by data. This aggravates preexisting hardship of care workers, and reproduces new social injustice. We suggest CSCW researchers and practitioners take into account how pre-existing social structures shaped the designs of socio-technological systems, and reconceptualize the paradigm of "data-drivenness" for more just and ethical data-driven healthcare technologies.
Many studies of practices involve service exchange, and many service researchers have discovered the central role that sociotechnical practices play in service –in particular, within the service-dominant logic school of thought. In this paper, we propose an analytical lens that builds on this mutual interest to understand complex practices involving service exchange. Practice researchers can gain new insights regarding practices embedded in service ecosystems. At the same time, service researchers can better explain actor behavior by looking deeper at sociotechnical practices. We develop a concept toolbox based on practice and service-dominant logic research literature. We illustrate the usefulness of the toolbox through an interpretative case study of public service to include children with disabilities in leisure activities. Seeing practices as parts of larger multi-stakeholder service ecosystems 1) can help us better explain behavior in those practices and understand how they are affected by other overlapping practices, 2) brings forward the importance of value and how multiple actors need to interact in order to create value for each other, and 3) enriches service-dominant logic with a focus on sociotechnical aspects that are central to many practice studies.
Computer-Supported Cooperative Work (CSCW) is an interdisciplinary research area concerned with developing computing technologies that facilitate, mediate, or regulate interaction between people engaged in cooperative work or similar kinds of sustained social activities. CSCW is a heterogeneous enterprise, addressing a motley of computational technologies and assimilating contributions from a host of scientific disciplines. What unites CSCW research is a shared concern with the fundamental problem of incorporating models of coordinative practices in computational artifacts and to do so in such a way that actors are able to deal with contingencies and are supported in that by the functionalities of the computational artifacts. Reflecting this shared concern, CSCW research is also united in a symmetrical commitment to ground design efforts in studies of actual work practices and to orient studies of actual work practices towards informing the development of collaborative technologies. As a field CSCW focuses on a variety of domains where complex cooperative practices occur. Due to the heterogeneity of the field and of such domains, a range of approaches and frameworks are applied to CSCW research. A notably established approach that has shaped substantial part of CSCW scholarship and had influence beyond the discipline are in-depth ethnographic studies of actual practices in their naturally occurring settings. In this regard CSCW has been influential in championing a hybrid approach to the study of computing systems encompassing concerns for understanding and for designing.
Background:
Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness.
Objective:
In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users.
Methods:
We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store.
Results:
We found that although chatbots' personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information.
Conclusions:
Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings.
Hypotension during perioperative care, if undetected or uncontrolled, can lead to serious clinical complications. Predictive machine learning models, based on routinely collected EHR data, offer potential for early warning of hypotension to enable proactive clinical intervention. However, while research has demonstrated the feasibility of such machine learning models, little effort is made to ground their formulation and development in socio-technical context of perioperative care work. To address this, we present a study of collaborative work practices of clinical teams during and after surgery with specific emphasis on the organisation of hypotension management. The findings highlight where predictive insights could be usefully deployed to reconfigure care and facilitate more proactive management of hypotension. We further explore how the socio-technical insights help define key parameters of machine learning prediction tasks to align with the demands of collaborative clinical practice. We discuss more general implications for the design of predictive machine learning in hospital care.
The acquisition of information and its use in decision making and coping by people with health concerns have garnered much attention in CSCW. This study investigated patients' information behavior during a critical treatment, in vitro fertilization (IVF). Based on in-depth interviews with 29 IVF patients, this study uncovered several underlying drivers and mechanisms accounting for patients' information behavior. Their behavior is shown to be driven by coping concerns - specifically, dealing with the unpredictability of the treatment outcome, overcoming feelings of powerlessness and the sense of being out of control, and managing difficult emotionality. These factors shape patients' information needs and drive their behaviors in seemingly irrational but ultimately logical and adaptive ways. In contrast to the conventional wisdom that patients typically seek information that can help them fill knowledge gaps to resolve treatment uncertainty and foster their positive emotions, we discovered that in response to the desire to control their perceptions of irresolvable uncertainty and the difficult emotional needs of the moment, IVF patients frequently used ?calibrated uncertainty" - a psychological mechanism or state driven by the simultaneous seeking of varying levels and contradictory valences of certainty - to actively conduct targeted searches and actively use the information sought. This behavior has not always been understood by the IVF clinicians, who have assumed that information was primarily for knowledge transfer. This study shows that coping, emotion regulation, and information-seeking are inextricably bound together in the patient experience, and that this intertwining must be considered in the clinical setting for physician-patient communication and for patient-facing information. The findings have several valuable design implications for improved health informatics technology and service delivery systems.
Workarounds are deviations in the execution of designed, de jure, work processes. Process mining research has developed methods for unobtrusive workaround analysis using process-aware systems’ datasets. This study applies process mining for workaround analysis in a medium-sized enterprise (SME). SME contexts can be challenging for workaround mining because SMEs often lack de jure process designs and their process-supportive information systems may have ambiguous semantics. The identification of de jure models and the solving of systems data ambiguities are the first steps in workarounds identification. A semantically well-defined information system may enable factual, de facto, process mining. Comparing the de jure and de facto process models may give candidate workarounds. Our study shows that (1) incomplete de jure models hinder the use of process mining for detecting workarounds, and (2) human interpretation of process mining outcomes is needed to realize a useful triple loop organizational learning from workarounds mining.
The paper discusses the conventions used by medical practitioners to improve their collaboration mediated by Clinical Records. The case study focuses on the coordinative conventions identified in two wards of an Italian hospital and highlights their role and importance in the definition of the requirements of any system supportive of collaborative work practices. These requirements are expressed in terms of the provision of artifact-mediated information that promotes collaboration awareness. The study identified several kinds of Awareness Promoting Information (API): the paper discusses how they can be conveyed both in the web of documental artifacts constituting a Clinical Record and in its computer-based counterpart, the Electronic Patient Record (EPR). The paper ends with the implications for the design of EPRs and for their integration with Hospital Information Systems in light of the findings.
Despite the widespread introduction of information technology into primary health care within the United Kingdom, medical practitioners continue to use the more traditional paper medical record often alongside the computerized system. The resilience of the paper document is not simply a consequence of an impoverished design, but rather a product of the socially organized practices and reasoning which surround the use of the record within day to day consultative work. The practices that underpin the use of the medical records may have a range of important implications, not only for the general design of systems to support collaborative work, but also for our conceptions of `writers', `readers', `objects' and `records' utilized in those designs.
The UK General Practice Research Database (GPRD) is a valuable source of information for health services research. It contains coded data supplemented by free text (physicians' notes and letters). However, due to the difficulty of extracting useful information and the cost of anonymisation, this text is seldom utilised in epidemiological research. We annotated the records of 344 women in the year prior to a diagnosis of ovarian cancer and developed a method for automatically detecting mentions of symptoms in text. We estimated the incidence of five commonly presenting symptoms using: (1) coded symptoms, (2) codes augmented by symptoms automatically extracted from text, and (3) a 'gold standard' dataset of codes and text tagged by three clinically trained annotators. The estimates of incidence of each symptom increased by at least 40% when coded information was enhanced using the manually tagged free text. Our automatic method extracted a significant proportion of this extra information. Our straightforward approach should be extremely useful for medical researchers who wish to validate studies based on codes, or to accurately assess symptoms, using information that can be automatically extracted from unanonymised free text.
Despite technical advances over the past few years in the area of systems support for cooperative work there is still relatively little understanding of the organisation of collaborative activity in real world, technologically supported, work environments. Indeed, it has been suggested that the failure of various technological applications may derive from their relative insensitivity to ordinary work practice and situated conduct. In this paper we discuss the possibility of utilising recent developments within sociology, in particular the naturalistic analysis of organisational conduct and social interaction, as a basis for the design and development of tools and technologies to support collaborative work. Focussing on the Line Control Rooms in London Underground, a complex multimedia environment in transition, we begin to explicate the tacit work practices and procedures whereby personnel systematically communicate information to each other and coordinate a disparate collection of tasks and activities. The design implications of these empirical observations, both for Line Control Room and technologies to support cooperative work, are briefly discussed.
This paper calls for a re-specification of IT systems design and development practice as co-realisation. Co-realisation is an orientation to technology production that develops out of a principled synthesis of ethnomethodology and participatory design. It moves the locus of design and development activities into workplace settings where technologies will be used. Through examples drawn from case studies of IT projects, we show how co-realisation, with its stress on design-in-use and the longitudinal involvement by IT professionals in the 'lived work' of users, helps to create uniquely adequate, accountable solutions to the problems of IT-organisational integration.
Based on a comparative study of cooperative work practices at two oncology clinics, the paper shows that work practices across these otherwise comparable settings vary significantly. Asking, how can ethnographic studies of local work practices then provide a dependable basis for design, the paper discusses how we may conceive of the relationship between ethnographic studies and systems development and suggests that a way out of the dilemma might be found in developing an analysis of the 'higher-order' practices of endless combination and recombination of artifacts, formats, notations, etc. that are found across such sites.
In this paper, I discuss the affordances offered by media spaces for collaboration, contrasting their properties with those of the everyday medium and exploring the implications for perception and interaction. Collaboration is situated in a physical environment which supports or constrains the various forms social interactions might take. An analysis of the affordances of the environment – the properties that offer actions and interactions to those within it – thus complements analyses which emphasize social and cultural factors. Examining the "physics" of media space systems is helpful both in understanding how people use them to collaborate and in suggesting possibilities for design.
One of the five regions in Denmark has initiated a remark-able and alternative strategy for the development of Elec-tronic Patient Record (EPR) systems. This strategy is driven by Participatory Design (PD) experiments and based on evidence of positive effects on the clinical practice when using EPR systems. We present this PD strategy and our related research on evidence-based IT development. We report from a newly completed PD experiment with EPR in the region conducted through a close collaboration compris-ing a neurological stroke unit, the region's EPR unit, the vendor, as well as the authors.
While the area of Computer Supported Cooperative Work, or CSCW, appears to have established itself as a research field in
its own right over the last few years, judging from the wealth of conferences and papers devoted to the topic, confusions
concerning the very nature of the field continue to surface.
The topic of Computer Supported Cooperative Work (CSCW) has attracted much attention in the last few years. While the field is obviously still in the process of development, there is a marked ambiguity about the exact focus of the field. This lack of focus may hinder its further development and lead to its dissipation. In this paper we set out an approach to CSCW as a field of research which we believe provides a coherent conceptual framework for this area, suggesting that it should be concerned with thesupport requirements of cooperative work arrangements. This provides a more principled, comprehensive, and, in our opinion, more useful conception of the field than that provided by the conception of CSCW as being focused on computer support for groups. We then investigate the consequences of taking this alternative conception seriously, in terms of research directions for the field. As an indication of the fruits of this approach, we discuss the concept of articulation work and its relevance to CSCW. This raises a host of interesting problems that are marginalized in the work on small group support but critical to the success of CSCW systems in the large, i. e., that are designed to meet current work requirements in the everyday world.
For many years the introduction of Electronic Health Records (EHRs) in medical practice has been considered the best way to
provide efficient document sharing among different organizational settings. The actual results of these technologies, though,
do not seem to have matched expectations. The issue of document sharing has been lately readdressed by proposing the creation
of patient-controlled information and communication technologies, Personal Health Records (PHRs), providing laypeople the
tools to access, manage and share their health information electronically by connecting to the existing EHRs and other institutional
information systems. In this scenario, patients are called to play a major role in coordinating healthcare professionals by
providing them the information they need. From a CSCW perspective the PHR offers an interesting case to reflect on cooperative
work that requires new infrastructures that intersect organizational settings and extend into domestic environments. So far
though, there has not been enough research to shed light on the self-care activities carried out in the households and how
these integrate with the organizational practices of doctors and institutions. Our analyses show that health record keeping
is an articulation work necessary for meetings with doctors to proceed smoothly. To do so, people integrate the information
contained in medical documents by working on them with annotations, underlinings and integrations. Moreover, we show that
health record keeping is a spatialized activity that is inextricably interwoven with the everyday routine and objects. Finally,
we provide a tentative classification of three different strategies laypeople use to sort out health records: minimum effort,
adaptive, networking.
KeywordsPersonal health record-Healthcare infrastructures-Health record management-Invisible work-Self-care-Qualitative research-Electronic health record
The notion that the design of technology is only fully completed when in use [23] is shared by many who now investigate user participation in design and the domestication of new technologies. Taking this idea as our starting point, we developed a research to action project with a major Canadian hospital. Our goals were to address technology implementation issues that arose as most units in the hospital moved to a new building, in which most technology (ranging from wired beds to drug dispensing machines) was new. This paper reports our findings from this project. Emphasis is placed on how institutional arrangements influenced the range of socio-technical possibilities that could be pursued [7]. Work practice problems are discussed in relation to the meso or organizational contexts, including organizational, vendor and staff actor networks.
In this paper we analyse an apparently simple collaborative activity, that of passing an implement from one person to another. The particular case we consider is surgical operations where nurses and surgeons routinely pass instruments to one an- other. Through fine-grained analysis of specific instances we address,- the preparatory work engaged in prior to passing, the ways in which the layout of artefacts is organised with respect to the temporal ordering of the activity, and how this arrangement can be reconfigured in the light of problems and circumstances that arise in an operation. We examine how passing an implement is finely shaped within the course of its articulation with regard to emerging actions of the participants. We suggest that an analysis of fine details of seemingly simple activities with objects may have implications for our under- standing of collaborative work, and a one or two key concepts that have informed the design of advanced solutions.
The constructs of "common ground" and "grounding" are frequently invoked in the CSCW literature as a mechanism by which participants engaged in joint activity coordinate their respective understandings of matters at hand. These constructs arise from a model of conversation developed by Herbert Clark and sometimes referred to as "contribution theory." We describe here the basic features of this theory and attempt to apply it in analyzing a fragment of enacted interaction. The interaction was recorded during an abdominal surgery performed with the aid of an endoscopic camera. We encountered difficulties, however, in applying contribution theory as an analytic framework within this concrete setting. We found further that the notion of common ground represents a confusing metaphor rather than a useful explanatory mechanism. We conclude with a suggestion that researchers in the future seek ways of constructing descriptions of joint activity that do not rely on the troublesome notions of grounding and common ground.
Information technology has changed the way health care is delivered. Electronic health records which are prevalently deployed
to replace or supplement paper documentations have made distributed information access at various points of care and work
activity achievable with the use of mobile information devices. Our particular concern is with nurse's information flow, where
nurse's notes and observations taken at the point of care feed into the electronic record. In these cases, digital technology
has not yet entirely replaced paper and pen, because the latter still provide greater ease and flexibility of use when compared
to current digital technologies. Even when mobile digital technology is available, clinicians still prefer creating handwritten
notes, and then later manually transposing them into the digital medium. Within this context, we created a prototype that
integrated digital paper with electronic health charts to retain the benefits of paper and pen, as well as digital medium.
A focus group evaluation of this prototype demonstrated promise and potential for its value in a medical environment.
This paper investigates an important, yet under-researched topic in CSCW, namely shared, or common, information spaces. Precisely what is meant by this term, however, is not always obvious. We provide some background to work in the area, and then proceed to examine features of such spaces through examples. The work involved in both putting information in common, and in interpreting it, has often not been sufficiently recognized. We show how, in various ways, it often requires added work to place items in common, and open up the question of how this might affect use of the WWW, often seen as the ultimate common information space. While there is still a need for further elaboration of many dimensions of the concept, and linkage to related ideas, we believe that the issues raised by this exploration are of importance to the CSCW field.
Local mobility is a central aspect of collaborative work that is in need of close analysis. Between the face-to-face interaction of offices or control rooms and long- distance interaction facilitated through e.g. telephones, e-mail, the www or teleconfer- ences lie a number of work-settings in which actors move about continuously in order to accomplish their work. They do so because they need to get access to knowledge, re- sources, persons and/or places. We analyze the integral nature of mobility to this kind of work practice from the ethnographic description of a hospital department, and the chal- lenges that actors have to face to accomplish their work. Based on this ethnographic case, we propose a set of concepts for understanding local mobility as an intermediate field of distributed cooperation between centres of coordination and remote collaboration. Finally, we introduce the concept of 'mobility work' as complementary to the concept of 'articulation work'.
While investigating the resistance to the electronic triage system, ETRIAGE, at the emergency department of British Columbia Children's Hospital, we revisit the well- known CSCW-debate about THE COORDINATOR concerning the politics of standardized categories. Examining the history as well as the design of ETRIAGE, we reveal four basic assumptions about triage work in emergency departments, which are reflected in the de- sign of the ETRIAGE application and related to the managerial agenda of controlling costs in hospitals. We find that ETRIAGE has an embedded surveillance-capability, which challenges the professional authority of nurses' work and removes discretion from the individual. We argue that the resistance towards ETRIAGE should be understood in terms of experienced nurses' disputing the assumptions about their professional practice that are embodied within such systems rather than general resistance to change or resis- tance to technology.
Medical care involves intense collaboration amongst a number of practitioners including physicians, nurses, and pharmacists Their work is concentrated on a single patient, and yet their activities, motivations, and concerns are very different. We explore the use of a shared information system in helping these individuals coordinate their work. In particular, we use the idea of a common information space to explore how the shared information is incorporated into the diverse work practices of an intensive care unit. In addition to physical co-location, we found that providing information in many specialised representations is critical to managing their coordination. Unlike paper records, computer systems offer the ability to decouple information from its representations. This decoupling opens up a rich design space for systems that allow people with different interests, concerns and work practices to work together effectively.
Cooperation and collaboration are generally an inherent part of everyday practice, and particularly among nurses. However,
the technologies that support these practices are still inadequate. In this study, we present and discuss the use of classifications
in nursing practice, and highlight the collective re-construction of classifications that emerge over time. Specifically,
we study how the negotiation between global classifications and local practice takes place with long-term use, and depict
this dynamic interaction as a pendulum movement. Furthermore, we characterize this standardization as a collective re-construction
grounded in everyday practice. This paper contributes to the body of research on this topic by doing the following: (i) characterizing the process of standardization as a pendulum
movement; (ii) drawing out theoretical perspectives for standardization as a collective, emerging accomplishment; (iii) stating
the practical implications of our perspective. Finally, we compare the local adjustment (local classifications) discussed
in this study with social classifications (social tagging), and suggest how social classification may lead to increased flexibility
in the use of classifications.
Objectives: This paper describes differences in the way general practitioners in Denmark, The Netherlands and Great Britain make codes fit into the local conditions under which they work.
Methods: An ethnographic study method has been used to collect data in Dutch, British and Danish general practices.
Results and Conclusions: The paper argues that what counts as “accurate data” is locally constructed. As codes are produced in local networks of human and technological actors, the way accuracy is constructed is dependent on the extra work that is carried out (by actors inside the clinic as well as outside of it). On the basis of differences between coding practices and classification systems the paper discusses how inherent tensions between coding for primary and secondary purposes can be solved. The paper concludes that instead of evaluating data in terms of how accurate they are in general, they should be looked at in terms of pertinence to specific research questions.
Formal tools (Le., tools that operate on circumscribed input using rules, and that contain a model of the workplace in which are to function) are attributed central roles in organizing work within many modern workplaces. How to comprehend the power of these tools? Taking the (electronic) medical record as an example, this paper builds upon recent calls to overcome the dichotomy between the Formal and the Informal and proposes an understanding of the generative power of such tools which does not attribute mythical capacities to either tool or human work. The concrete, real-time use of formal tools is the starting point. These steps towards a sociology of the formal are crucial for a more comprehensive understanding and evaluation of such systems.
Maintaining an awareness of the working context of fellow co-workers is crucial to successful cooperation in a workplace. For mobile, non co-located workers, however, such workplace awareness is hard to maintain. This paper investigates how context-aware computing can be used to facilitate workplace awareness. In particular, we present the concept of Context-Based Workplace Awareness, which is derived from years of in-depth studies of hospital work and the design of computer supported cooperative work technologies to support the distributed collaboration and coordination of clinical work within large hospitals. This empirical background has revealed that an awareness especially of the social, spatial, temporal, and activity context plays a crucial role in the coordination of work in hospitals. The paper then presents and discusses technologies designed to support context-based workplace awareness, namely the AWARE architecture, and the AwarePhone and AwareMedia applications. Based on almost 2 year’ deployment of the technologies in a large hospital, the paper discuss how the four dimension of context-based workplace awareness play out in the coordination of clinical work.
The topic of Computer Supported Cooperative Work (CSCW) has attracted much attention in the last few years. While the field is obviously still in the process of development, there is a marked ambiguity about the exact focus of the field. This lack of focus may hinder its further development and lead to its dissipation. In this paper we set out an approach to CSCW as a field of research which we believe provides a coherent conceptual framework for this area, suggesting that it should be concerned with thesupport requirements of cooperative work arrangements. This provides a more principled, comprehensive, and, in our opinion, more useful conception of the field than that provided by the conception of CSCW as being focused on computer support for groups. We then investigate the consequences of taking this alternative conception seriously, in terms of research directions for the field. As an indication of the fruits of this approach, we discuss the concept of ‘articulation work’ and its relevance to CSCW. This raises a host of interesting problems that are marginalized in the work on small group support but critical to the success of CSCW systems ‘in the large’, i. e., that are designed to meet current work requirements in the everyday world.
The prevalence of chronic disease along with the technologies to develop these diseases, have altered the organizational structure of health care. Through documented case studies, the authors demonstrate how health workers confront these issues, guiding the reader through various work sites, the interactions of staff members with each other and with patients, and the overall patient treatment and response. Focusing on the concept of illness trajectory, this book vividly illustrates the complex, contingent nature of modern medical work.
This paper focuses on time management as a cooperative task. Based on an analysis of the cultural complexity of scheduling surgical operations in a large clinic, possibilities of using information technology are explored. A computer system can be used to facilitate and change the negotiation of resource deployment in complex organizations by a) providing an integrated view of time management problems and decision-making within a complex organization, and b) by improving coordination. The paper discusses some design options for such a system which combines negotiation support with an auromatic sheduling device and critically examines the rationale for an organization to accept and implement such a system.
An abstract is not available.
Background: There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care.
A revealing and surprising look at how classification systems can shape both worldviews and social interactions.
What do a seventeenth-century mortality table (whose causes of death include "fainted in a bath," "frighted," and "itch"); the identification of South Africans during apartheid as European, Asian, colored, or black; and the separation of machine- from hand-washables have in common? All are examples of classification—the scaffolding of information infrastructures.
In Sorting Things Out, Geoffrey C. Bowker and Susan Leigh Star explore the role of categories and standards in shaping the modern world. In a clear and lively style, they investigate a variety of classification systems, including the International Classification of Diseases, the Nursing Interventions Classification, race classification under apartheid in South Africa, and the classification of viruses and of tuberculosis.
The authors emphasize the role of invisibility in the process by which classification orders human interaction. They examine how categories are made and kept invisible, and how people can change this invisibility when necessary. They also explore systems of classification as part of the built information environment. Much as an urban historian would review highway permits and zoning decisions to tell a city's story, the authors review archives of classification design to understand how decisions have been made. Sorting Things Out has a moral agenda, for each standard and category valorizes some point of view and silences another. Standards and classifications produce advantage or suffering. Jobs are made and lost; some regions benefit at the expense of others. How these choices are made and how we think about that process are at the moral and political core of this work. The book is an important empirical source for understanding the building of information infrastructures.
We conducted a field-based study examining informal nursing information. We examined the use of this information before and after the adoption of a CPOE (Computerized Provider Order Entry) system in an inpatient unit of a large teaching hospital. Before CPOE adoption, nurses used paper working documents to detail psycho-social information about patients; after the CPOE adoption, they did not use paper or digital notes as was planned. The paper describes this process and analyses how several interlocked reasons contributed to the loss of this information in written form. We found that a change in physical location, sufficient convenience, visibility of the information, and permanency of information account for some, but not all, of the outcome. As well, we found that computerization of the nursing data led to a shift in the politics of the information itself – the nurses no longer had a cohesive agreement about the kinds of data to enter into the system. The findings address the requirements of healthcare computerization to support both formal and informal work practices, respecting the nature of nursing work and the politics of information inherent in complex medical work.
Technology acquisition is an important but neglected issue within the social science analysis of technology. The limited number of studies undertaken reproduce a schism between rationalist (e.g., economic) forms of analysis, where the assumption is that choice is the outcome of formal assessment, and cultural sociological approaches which see choice as driven by the micro-politics of the organisational setting, interests, prevalent rhetorics, fads, etc. While sympathetic to the latter critical view, we are dissatisfied with the relativist portrayal of technology selection: that decisions beset with uncertainties and tensions are divorced from formal decision making criteria. Influenced by Michel Callon’s writing on the ‘performativity’ of economic concepts and tools, we argue that formal assessment has a stronger relationship to technology decisions than suggested by cultural sociologists. We focus on a procurement which is characterised by high levels of organisational tension and where there is deep uncertainty about each of the solutions on offer. We show how the procurement team are able to arrive at a decision through laboriously establishing a ‘comparison’. That is, they attempt to drag the choice from the informal domain onto a more formal, accountable plane through the mobilisation and performance of a number of ‘comparative measures’ and criteria. These measures constituted a stabilised form of accountability, which we describe through the metaphor of a ‘scaffolding’, erected in the course of the procurement. Our argument is threefold: first, we argue that comparisons are possible but that they require much effort; second, that it is not the properties of the technology which determines choice but the way these properties are given form through the various comparative measures put in place; and finally, whilst comparative measures might be imposed by one group upon others in a procurement team, these measures remain relatively malleable.
This paper examines the scope of participatory design on the basis of the case of a national standard for electronic patient records (EPR) in Denmark. The relationship between participatory methods and techniques on the one hand and critical and emancipatory aims on the other is discussed within the framework of participatory design. Some argue that participation in itself entails striving towards democracy; others argue that the tendency to focus upon tools, techniques and the arena of single projects should be supplemented by emancipatory aims such as technology assessment and a critique of dominance. These issues are discussed through the controversies surrounding the test of a prototype application based on BEHR in late 2004, a standard for EPRs (Basic Structure for Electronic Health Records). I argue that participation is valuable, but that the scope of participatory design should also include critical conceptualizations of participation, power, methodology and knowledge. Finally, standards can be crucial cases to examine for participatory design, since they affect the work of many people and call for a focus on arenas beyond the single design project.
The aim of this paper is to contribute to an understanding of how PD plays out in emerging large-scale IS projects. We argue that even if many of these projects start out on a well-founded small-step methodological basis, such as agile methods, XP, etc. organizational politics and maneuvering will inevitably be part of the process, especially as the scope and size of the system increases. More specifically, we discuss this implicated organizational complexity; the increasingly unclear user roles, as well as critically examine the traditional neutral vendor role which is an assumption of agile engineering methods.
This paper presents an ethnographic study investigating how nurses assemble information to start their shift's work. We examined this process before and after the adoption of a Computerized Prescriber Order Entry (CPOE) system in an inpatient unit of a large teaching hospital. Before the CPOE adoption, nurses used several collaboratively-created group working documents to assist in this information assembling process; after the CPOE adoption, they mainly used the CPOE itself for their information needs. We found while computerization facilitated medical data assembling process and improved order handling practice, it also resulted in some information gaps in understanding patients in their larger care context. We analyzed what it means when the computerization of medical information turns local knowledge into more readily available and public information objects, as well as what that means for patients and patient care.
Technology acquisition is an important but neglected issue within the social science analysis of technology. The limited number of studies undertaken reproduce a schism between rationalist (e.g., economic) forms of analysis, where the assumption is that choice is the outcome of formal assessment, and cultural sociological approaches which see choice as driven by the micro-politics of the organisational setting, interests, prevalent rhetorics, fads, etc. While sympathetic to the latter critical view, we are dissatisfied with the relativist portrayal of technology selection: that decisions beset with uncertainties and tensions are divorced from formal decision making criteria. Influenced by Michel Callon’s writing on the ‘performativity’ of economic concepts and tools, we argue that formal assessment has a stronger relationship to technology decisions than suggested by cultural sociologists. We focus on a procurement which is characterised by high levels of organisational tension and where there is deep uncertainty about each of the solutions on offer. We show how the procurement team are able to arrive at a decision through laboriously establishing a ‘comparison’. That is, they attempt to drag the choice from the informal domain onto a more formal, accountable plane through the mobilisation and performance of a number of ‘comparative measures’ and criteria. These measures constituted a stabilised form of accountability, which we describe through the metaphor of a ‘scaffolding’, erected in the course of the procurement. Our argument is threefold: first, we argue that comparisons are possible but that they require much effort; second, that it is not the properties of the technology which determines choice but the way these properties are given form through the various comparative measures put in place; and finally, whilst comparative measures might be imposed by one group upon others in a procurement team, these measures remain relatively malleable.
subsequently published, in revised form as
Neil Pollock and Robin Williams (2007) Technology Choice and its Performance: Towards a Sociology of Software Package Procurement, Information and Organization, Volume 17, Issue 3, 2007, Pages 131-16.
The main contribution of the paper is to present challenges relating to the use of new healthcare technology, the eDiary,
which seeks to create a better integration between home and hospital. To minimise risks of malformations and other complications,
pregnant women with diabetes are enrolled in an extensive treatment regime, which requires frequent visits to an outpatient
clinic as well as a high degree of self-care. The eDiary is designed to assist the women in this work, primarily by allowing
the women to register their glucose values, record video consultations, and support video-tele-consultations. This paper reports
on a pilot study during which pregnant women with diabetes and their healthcare providers make use of the eDiary. The pilot
study indicates that such healthcare technology not only allows the women to achieve a better integration of the management
of their diabetes into their everyday life, but may also challenge existing power relations between patients and healthcare
providers.
The notion of Common Information Spaces (CIS) is extensively used as a framework to analyse cooperative work. Drawing on recent
contributions to the discourse on CIS, this paper develops a perspective on how information is shared in heterogeneous contexts.
We study the introduction of an electronic nursing plan in the psychogeriatric ward at the University Hospital of North Norway.
The plan was expected to improve information sharing among the healthcare practitioners and in that sense contribute to their
CIS. However, although the nursing plan was regularly updated, it was less used in practice than initially expected. We suggest
that this can be ascribed to the temporal and evolving character of both medical information and work. Drawing on the notion
of trajectories, we elaborate on these findings and develop a perspective on CIS, emphasising its situated, temporal and negotiated
character.