Boundary factors and contextual contingencies: configuring electronic templates for healthcare professionals

Boundary Objects as Dialogical Learning Accelerators for Social Change in Design for Health: Systematic Review

Background

Boundary objects can add value for innovative design and implementation research in health care through their organizational focus and the dynamic structure between ill-structured and tailored use. However, when innovation is approached as a boundary object, more attention will need to be paid to the preimplementation phase. Research and design thinking pay attention to the preimplementation stage but do not have a social or organizational focus per se. The integration of boundary objects in design methodologies can provide a more social and organizational focus in innovative design projects by mapping out the mechanisms that occur at boundaries during design. Four dialogical learning mechanisms that can be triggered at boundaries have been described in the literature: identification, coordination, reflection, and transformation. These mechanisms seem suitable for integration in innovative design research on health.

Objective

Focusing on innovation in health, this study aims to find out whether the different learning mechanisms can be linked to studies on health innovation that mention boundary objects as a concept and assess whether the related mechanisms provide insight into the stage of the design and implementation or change process.

Methods

The following 6 databases were searched for relevant abstracts: PubMed, Scopus, Education Resources Information Center, PsycINFO, Information Science and Technology Abstracts, and Embase. These databases cover a wide range of published studies in the field of health.

Results

Our initial search yielded 3102 records; after removing the duplicates, 2186 (70.47%) records were screened on the title and abstract, and 25 (0.81%) papers were included; of the 13 papers where we identified 1 mechanism, 5 (38%) described an innovation or innovative project, and of the 12 papers where we identified more mechanisms, 9 (75%) described the development or implementation of an innovation. The reflective mechanism was not identified solely but was present in papers describing a more successful development or implementation project of innovation. In these papers, the predetermined goals were achieved, and the process of integration was relatively smoother.

Conclusions

The concept of boundary objects has found its way into health care. Although the idea of a boundary object was introduced to describe how specific artifacts can fulfill a bridging function between different sociocultural sites and thus have a social focus, the focus in the included papers was often on the boundary object itself rather than the social effect. The reflection and transformation mechanisms were underrepresented in the included studies but based on the findings in this review, pursuing to trigger the reflective mechanism in design, development, and implementation projects can lead to a more fluid and smooth integration of innovation into practice.

“Truly holistic?” Differences in documenting physical and psychosocial needs and hope in Portuguese palliative patients

Objective

Palliative care (PC) aims to improve patients' and families' quality of life through an approach that relieves physical, psychosocial, and spiritual suffering, although the latter continues to be under-assessed and under-treated. This study aimed to describe the prevalence of physical, psychosocial, and hope assessments documented by a PC team in the first PC consultation.

Method

The retrospective descriptive analysis of all first PC consultations registered in our anonymized database (December 2018–January 2020), searching for written documentation regarding (1) Edmonton Symptom Assessment Scale (ESAS) physical subscale (pain, tiredness, nausea, drowsiness, appetite, shortness of breath, constipation, insomnia, and well-being), (2) the single question “Are you depressed?” (SQD), (3) the question “Do you feel anxious?” (SQA), (4) feeling a burden, (5) hope-related concerns, (6) the dignity question (DQ), and (7) will to live (WtL).

Results

Of the 174 total of patients anonymously registered in our database, 141 PC home patients were considered for analysis; 63% were male, average age was 70 years, the majority had malignancies (82%), with a mean performance status of 52%. Evidence of written documentation was (1) ESAS pain (96%), tiredness (89%), nausea (89%), drowsiness (79%), appetite (89%), shortness of breath (82%), constipation (74%), insomnia (72%), and well-being (52%); (2) the SQD (39%); (3) the SQA (11%); (4) burden (26%); (5) hope (11%); (6) the DQ (33%); and (7) WtL (33%).

Significant differences were found between the frequencies of all documented items of the ESAS physical subscale (29%), and all documented psychosocial items (SQD + SQA + burden + DQ) (1%), hope (11%), and WtL (33%) (p = 0.0000; p = 0.0005; p = 0.0181, respectively).

Significance of results

There were differences between documentation of psychosocial, hope, and physical assessments after the first PC consultation, with the latter being much more frequent. Further research using multicenter data is now required to help identify barriers in assessing and documenting non-physical domains of end-of-life experience.

Investigating Knowledge Flows between Information Systems and Other Disciplines:

Information systems (IS) is one of the most rapidly changing disciplines in the social science field, and it is currently facing a new academic shift. The prevailing concepts, such as big data and Internet of things (IoT), imply that there is a plethora of research opportunities for IS researchers. Since these opportunities lie mostly in conjunction with other disciplines closely related to IS, it is essential to identify the interaction between IS and those disciplines. A few studies using bibliometric analysis have been published regarding this topic. However, we have identified several limitations in them: (i) inclusion of only a small journal basket, (ii) focus on a very restricted area of discipline, and (iii) a methodological limitation that can lead to the failure to capture the authentic knowledge flow between IS and other disciplines. We attempt to extend previous studies by proposing a comprehensive analysis model with the largest journal basket and areas of disciplines. As a result of our analysis, a knowledge flow structure different from that of past research is identified. In addition, through the discussion on emerging reference disciplines, we discover new research opportunities into which IS researchers can delve.

Evaluation of health information systems research in information systems research: A meta-analysis

Given the importance of the health-care industry and the promise of health information systems, researchers are encouraged to build on the shoulders of giants as the saying goes. The health information systems field has a unique opportunity to learn from and extend the work that has already been done by the highly correlated information systems field. As a result, this research article presents a past, present and future meta-analysis of health information systems research in information systems journals over the 2000–2015 time period. Our analysis reviewed 126 articles on a variety of topics related to health information systems research published in the “Senior Scholars” list of the top eight ranked information systems academic journals. Across the selected information systems academic journals, our findings compare research methodologies applied, health information systems topic areas investigated and research trends. Interesting results emerge in the range and evolution of health information systems research and opportunities for health information systems researchers and practitioners to consider moving forward.

Infrastructures for healthcare: From synergy to reverse synergy

The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.

Radio frequency identification-enabled capabilities in a healthcare context: An exploratory study

Increasingly, the adoption and use of radio frequency identification systems in hospital settings is gaining prominence. However, despite the transformative impact that radio frequency identification has in healthcare settings, few studies have examined how and why this change may occur. The purpose of this study is to systematically understand how radio frequency identification can transform work practices in an operational process that directly impacts cost and operational efficiency and indirectly contributes to impacting patient safety and quality of care. We leverage an interdisciplinary framework to explore the contextual characteristics that shape the assimilation of radio frequency identification in healthcare settings. By linking the use of radio frequency identification with specific contextual dimensions in healthcare settings, we provide a data-driven account of how and why radio frequency identification can be useful in inventory management in this setting. In doing so, we also contribute to recent work by information systems scholars who argue for a reconfiguration of conventional assumptions regarding the role of technology in contemporary organizations.

Hybridity as a process of technology's 'translation': customizing a national Electronic Patient Record

This paper explores how national Electronic Patient Record (EPR) systems are customized in local settings and, in particular, how the context of their origin plays out with the context of their use. It shows how representations of healthcare organizations and of local clinical practice are built into EPR systems within a complex context whereby different stakeholder groups negotiate to produce an EPR package that aims to meet both local and generic needs. The paper draws from research into the implementation of the National Care Record Service, a part of the National Programme for Information Technology (NPfIT), in the English National Health Service (NHS). The paper makes two arguments. First, customization of national EPR is a distributed process that involves cycles of 'translation', which span across geographical, cultural and professional boundaries. Second, 'translation' is an inherently political process during which hybrid technology gets consolidated. The paper concludes, that hybrid technology opens up possibilities for standardization of healthcare.

Infrastructures in healthcare: the interplay between generativity and standardization

OBJECTIVE

To investigate how the design, development and implementation process of a new patient-centered portal unfolds by focusing on its evolutionary infrastructural development.

DESIGN

We conducted a case study on a patient-centred portal in Norway. We used qualitative data collection techniques including observations, interviews and attendance of design workshops with users. We performed an interpretive analysis of the data through the lens of technology enactment.

RESULTS

The case analysis reveals that the patient-centred portal has a strong generative character. However, for the enactment of the technology continuous sociotechnical negotiations take place. Grounded in the empirical data and their analysis we complement and expand the existing understanding of generativity.

DISCUSSION

We characterize generativity as sociotechnical and resulting from negotiations for technology enactment. We discuss in detail such negotiations and show how they shape the evolution of infrastructures that are generative while standardized.

Integration of a nationally procured electronic health record system into user work practices

BACKGROUND

Evidence suggests that many small- and medium-scale Electronic Health Record (EHR) implementations encounter problems, these often stemming from users' difficulties in accommodating the new technology into their work practices. There is the possibility that these challenges may be exacerbated in the context of the larger-scale, more standardised, implementation strategies now being pursued as part of major national modernisation initiatives. We sought to understand how England's centrally procured and delivered EHR software was integrated within the work practices of users in selected secondary and specialist care settings.

METHODS

We conducted a qualitative longitudinal case study-based investigation drawing on sociotechnical theory in three purposefully selected sites implementing early functionality of a nationally procured EHR system. The complete dataset comprised semi-structured interview data from a total of 66 different participants, 38.5 hours of non-participant observation of use of the software in context, accompanying researcher field notes, and hospital documents (including project initiation and lessons learnt reports). Transcribed data were analysed thematically using a combination of deductive and inductive approaches, and drawing on NVivo8 software to facilitate coding.

RESULTS

The nationally led "top-down" implementation and the associated focus on interoperability limited the opportunity to customise software to local needs. Lack of system usability led users to employ a range of workarounds unanticipated by management to compensate for the perceived shortcomings of the system. These had a number of knock-on effects relating to the nature of collaborative work, patterns of communication, the timeliness and availability of records (including paper) and the ability for hospital management to monitor organisational performance.

CONCLUSIONS

This work has highlighted the importance of addressing potentially adverse unintended consequences of workarounds associated with the introduction of EHRs. This can be achieved with customisation, which is inevitably somewhat restricted in the context of attempts to implement national solutions. The tensions and potential trade-offs between achieving large-scale interoperability and local requirements is likely to be the subject of continuous debate in England and beyond with no easy answers in sight.