Organizing visions for data-centric management: how Norwegian policy documents construe the use of data in health organizations

PURPOSE

Norway, like other welfare states, seeks to leverage data to transform its pressured public healthcare system. While managers will be central to doing so, we lack knowledge about how specifically they would do so and what constraints and expectations they operate under. Public sources, like the Norwegian policy documents investigated here, provide important backdrops against which such managerial work emerges. This article therefore aims to analyze how key Norwegian policy documents construe data use in health management.

DESIGN/METHODOLOGY/APPROACH

We analyzed five notable policy documents using a "practice-oriented" framework, considering these as arenas for "organizing visions" (OVs) about managerial use of data in healthcare organizations. This framework considers documents as not just texts that comment on a topic but as discursive tools that formulate, negotiate and shape issues of national importance, such as expectations about data use in health management.

FINDINGS

The OVs we identify anticipate a bold future for health management, where data use is supported through interconnected information systems that provide relevant information on demand. These OVs are similar to discourse on "evidence-based management," but differ in important ways. Managers are consistently framed as key stakeholders that can benefit from using secondary data, but this requires better data integration across the health system. Despite forward-looking OVs, we find considerable ambiguity regarding the practical, social and epistemic dimensions of data use in health management. Our analysis calls for a reframing, by moving away from the hype of "data-driven" health management toward an empirically-oriented, "data-centric" approach that recognizes the situated and relational nature of managerial work on secondary data.

ORIGINALITY/VALUE

By exploring OVs in the Norwegian health policy landscape, this study adds to our growing understanding of expectations towards healthcare managers' use of data. Given Norway's highly digitized health system, our analysis has relevance for health services in other countries.

Feasibility and acceptability of patient- and clinician-level antithrombotic stewardship interventions to reduce gastrointestinal bleeding risk in patients using warfarin (Anticoagulation with Enhanced Gastrointestinal Safety): a factorial randomized controlled pilot trial

Background

Overuse of antiplatelet therapy and underuse of gastroprotection contribute to preventable bleeding in patients taking anticoagulants.

Objectives

(1) Determine the feasibility of a factorial trial testing patient activation and clinician outreach to reduce gastrointestinal (GI) bleeding risk in patients prescribed warfarin-antiplatelet therapy without proton pump inhibitor gastroprotection and (2) assess intervention acceptability.

Methods

Pragmatic 2 × 2 factorial cluster-randomized controlled pilot comparing (1) a patient activation booklet vs usual care and (2) clinician notification vs clinician notification plus nurse facilitation was performed. The primary feasibility outcome was percentage of patients completing a structured telephone assessment after 5 weeks. Exploratory outcomes, including effectiveness, were evaluated using chart review, surveys, and semistructured interviews.

Results

Among 47 eligible patients, 35/47 (74.5%; 95% CI, 58.6%-85.7%) met the feasibility outcome. In the subset confirmed to be high risk for upper GI bleeding, 11/29 (37.9%; 95% CI, 16.9%-64.7%) made a medication change, without differences between intervention arms. In interviews, few patients reported reviewing the activation booklet; barriers included underestimating GI bleeding risk, misunderstanding the booklet's purpose, and receiving excessive health communication materials. Clinicians responded to notification messages for 24/47 patients (51.1%; 95% CI, 26.4%-75.4%), which was lower for surgeons than nonsurgeons (22.7% vs 76.0%). Medical specialists but not surgeons viewed clinician notification as acceptable.

Conclusion

The proposed trial design and outcome ascertainment strategy were feasible, but the patient activation intervention is unlikely to be effective as designed. While clinician notification appears promising, it may not be acceptable to surgeons, findings which support further refinement and testing of a clinician notification intervention.

Adopting Artificial Intelligence in Public Healthcare: The Effect of Social Power and Learning Algorithms

Although the use of artificial intelligence (AI) in healthcare is still in its early stages, it is important to understand the factors influencing its adoption. Using a qualitative multi-case study of three hospitals in China, we explored the research of factors affecting AI adoption from a social power perspective with consideration of the learning algorithm abilities of AI systems. Data were collected through semi-structured interviews, participative observations, and document analysis, and analyzed using NVivo 11. We classified six social powers into knowledge-based and non-knowledge-based power structures, revealing a social power pattern related to the learning algorithm ability of AI.

Contradictions and Interventions in Health IS

The study analyzes data collected in two case studies in the healthcare industry, which is characterized by a variety of social and technical elements forming an activity system where all elements interact with each other. The findings indicate that many problems emerging during the implementation of a health information system can be traced back to contradictions between elements of the activity systems that are created or amplified by the new IS. The authors find that some contradictions are latent and become salient when introducing a new IS, while other contradictions are (unintentionally) newly created. Also, the study shows that contradictions are more complex than hitherto assumed and often concern more than two elements of a healthcare activity system. In a similar vein, effective interventions geared toward countering these contradictions are found to account for additional complexity while not always achieving their goal. Drawing on activity theory, the authors develop a framework to coherently synthesize the findings. The study can help increase the understanding of the IS’s role within an activity system and help guide IS implementation projects aimed at avoiding unintended consequences.

A Deep Learning Approach for Recognizing Activity of Daily Living (ADL) for Senior Care: Exploiting Interaction Dependency and Temporal Patterns

Ensuring the health and safety of senior citizens who live alone is a growing societal concern. The Activity of Daily Living (ADL) approach is a common means to monitor disease progression and the ability of these individuals to care for themselves. However, the prevailing sensor-based ADL monitoring systems primarily rely on wearable motion sensors, capture insufficient information for accurate ADL recognition, and do not provide a comprehensive understanding of ADLs at different granularities. Current healthcare IS and mobile analytics research focuses on studying the system, device, and provided services, and is in need of an end-to-end solution to comprehensively recognize ADLs based on mobile sensor data. This study adopts the design science paradigm and employs advanced deep learning algorithms to develop a novel hierarchical, multiphase ADL recognition framework to model ADLs at different granularities. We propose a novel 2D interaction kernel for convolutional neural networks to leverage interactions between human and object motion sensors. We rigorously evaluate each proposed module and the entire framework against state-of-the-art benchmarks (e.g., support vector machines, DeepConvLSTM, hidden Markov models, and topic-modeling-based ADLR) on two real-life motion sensor datasets that consist of ADLs at varying granularities: Opportunity and INTER. Results and a case study demonstrate that our framework can recognize ADLs at different levels more accurately. We discuss how stakeholders can further benefit from our proposed framework. Beyond demonstrating practical utility, we discuss contributions to the IS knowledge base for future design science-based cybersecurity, healthcare, and mobile analytics applications.

Why online medical teams disband? The role of team diversity and leadership type

Purpose

Online medical teams (MTs), involving collaboration between remote healthcare workers, can provide comprehensive and rapid healthcare to patients. The growth in MTs is continuing, with popularity growing among doctors and patients, but some MTs disband, which could break the continuity of healthcare services provided. We aim to address this pressing issue by exploring the effects of team diversity and leadership types on team status (i.e. team disbandment (TD)). This paper systematically investigates the influences of team diversity, including separation, variety and disparity diversity and the effects of leadership types, including strong, equal and weak types.

Design/methodology/approach

A data set consisting 1,071 online MTs was collected from the Good Doctor website, a leading Chinese online health community (OHC), on January 10, 2018. The data captured included 206 teams which disbanded after 3 months collaboration. Logistic regression and maximum likelihood estimation (MLE) were used to examine their effects.

Findings

The results show that variety diversity, related to departments, positively affects TD, but disparity diversity, referring to clinician titles, negatively affects TD. Separation diversity, in terms of team member attitudes, exerts a negligible influence on disbandment. Although strong and equal leadership types negatively influence TD, they are seen to strengthen the positive effect of variety diversity, suggesting stable structure combinations of strong or equal-type leadership and low department diversity, as well as the match of weak-type leadership and high department diversity.

Originality/value

This paper extends the current understanding of virtual teams and OHCs by examining the role of leadership types and team diversity, and their influencing role on team status. The pairwise combinations are obtained to effectively reduce the disbandment probability of medical teams operating in OHCs, which could help platform managers, team founders and those connected with MTs deal with the team-disbandment crisis, providing both theoretical and practical implications to healthcare providers and researchers alike.

Interdisciplinary eHealth Practice in Cancer Care: A Review of the Literature

This review aimed to identify research that described how eHealth facilitates interdisciplinary cancer care and to understand the ways in which eHealth innovations are being used in this setting. An integrative review of eHealth interventions used for interdisciplinary care for people with cancer was conducted by systematically searching research databases in March 2015, and repeated in September 2016. Searches resulted in 8531 citations, of which 140 were retrieved and scanned in full, with twenty-six studies included in the review. Analysis of data extracted from the included articles revealed five broad themes: (i) data collection and accessibility; (ii) virtual multidisciplinary teams; (iii) communication between individuals involved in the delivery of health services; (iv) communication pathways between patients and cancer care teams; and (v) health professional-led change. Use of eHealth interventions in cancer care was widespread, particularly to support interdisciplinary care. However, research has focused on development and implementation of interventions, rather than on long-term impact. Further research is warranted to explore design, evaluation, and long-term sustainability of eHealth systems and interventions in interdisciplinary cancer care. Technology evolves quickly and researchers need to provide health professionals with timely guidance on how best to respond to new technologies in the health sector.

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.

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.

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Background

Nationally mandated information and communication technology (ICT) systems are often locally resented and little used. This problem is sometimes framed in behaviourist terms, depicting the intended user of technology as a rational actor whose resistance stems from Luddism and/or ignorance, and viewing solutions in terms of training, incentives and sanctions. The implication is that if we get the ‘rewards’ and ‘punishments’ right, people will use technologies. Previous research in the social sciences, notably sociotechnical systems theory, actor–network theory and normalisation process theory, have considered the human, social and organisational context of technology use (and non-use). However, these have all had limitations in explaining the particular phenomenon of resistance to nationally mandated ICT systems.

Objective

To develop a sociologically informed theory of resistance to nationally mandated ICT systems.

Theoretical approach

We drew on Anthony Giddens’ notion of expert systems (comprising bureaucratic rules and classification systems delivered through technology) as well as theories of professional roles and ethical practice. A defining characteristic of expert systems is that they can produce ‘action at a distance’, allowing managerial control to be exerted over local practice. To the extent that people use them as intended, these systems invariably ‘empty out’ social situations by imposing rules and categories that are insensitive to local contingencies or the unfolding detail of social situations.

Study design and setting

Secondary analysis of data from case studies of three nationally mandated ICT systems in the English NHS, collected over the period 2007–10.

Results

Our analysis focused mainly on the Choose and Book system for outpatient referrals, introduced in 2004, which remained unpopular and little used throughout the period of our research (i.e. 2007–13). We identified four foci of resistance: to the policy of choice that Choose and Book symbolised and purported to deliver; to accommodating the technology’s sociomaterial constraints; to interference with doctors’ contextual judgements; and to adjusting to the altered social relations consequent on its use. More generally, use of the mandated system tended to constrain practice towards a focus on (the efficiency of) means rather than (the moral value of) ends. A similar pattern of complex sociological reasons for resistance was also seen in the other two technologies studied (electronic templates for chronic disease management and the Summary Care Record), though important differences surfaced and were explained in terms of the policy inscribed in the technology and its material features.

Conclusion

‘Resistance’ is a complex phenomenon with sociomaterial and normative components; it is unlikely to be overcome using atheoretical behaviourist techniques. To guide the study of resistance to ICT systems in health care, we offer a new theoretical and empirical approach, based around a set of questions about the policy that the technology is intended to support; the technology’s material properties; the balance between (bureaucratic) means and (professional) ends; and the implications for social roles, relationship and interactions.

We suggest avenues for future research, including methodology (e.g. extending the scope and scale of ethnographic research in ICT infrastracture), theory development (e.g. relating to the complexities of multi-professional team working) and empirical (e.g. how our findings might inform the design and implementation of technologies that are less likely to be resisted).

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital

This article considers changes in healthcare professional work afforded by technology. It uses the sociology of professionals’ literature together with a theory of affordances to examine how and when technology allows change in healthcare professional work. The study draws from research into the introduction of a national electronic patient record in an English hospital. We argue that electronic patient record affords changes through its materiality as it interacts with healthcare professional practice. Its affordances entail some level of standardisation of healthcare professional conduct and practice, curtailment of professional autonomy, enlargement of nurses’ roles and redistribution of clinical work within and across professional boundaries. The article makes a contribution to the growing literature advocating a cultural approach to the study of technological affordances in organisations and to studies that explore healthcare professional practice in conjunction with the materiality of technology. Two main lines of argument are developed here. First, that technological affordances do not solely lie with the materiality of technology nor with individual perceptions, but are cultivated and nurtured within a broader cultural–institutional context, in our case a professional context of use. Second, that technological affordance of change is realised when healthcare professionals’ (individual and collective) perceptions of technology (and of its materiality) fit with their sense of (professional) self. In this respect, the article shows the extent to which the materiality of technology plays out with professional identity and frames the level and extent to which technology can and cannot afford restructuring of work and redistribution of power across professional groups.

Distributed Leadership in Policy Formulation: A Sociomaterial Perspective

Leadership in public policy making is challenging. There is tension in gaining commitment from competing stakeholder groups, in sustaining public engagement in technically complex areas and securing broad-based support. Our paper illuminates these challenges through a case study of health policy development in the UK. We go beyond individual roles and leader–follower exchange relationships to develop the concept of distributed leadership using a sociomaterial approach to reveal how and why leadership is distributed across sociomaterial practices which together (re)configure policy coalitions and context. In so doing we also show how legitimacy and trust are sociomaterially enacted and shape leadership in public policy.

Use of Diffusion of Innovations Theory in Medical Informatics Research

The authors examine the use of tenets of diffusion of innovations theory in the medical informatics literature to reveal how the theory has and can continue to provide a basis for scholars seeking to align their research with the theory. A content analysis method was used to examine over 2,000 journal articles from the fields of medical informatics, medicine, and information systems. The authors found that tenets of diffusion of innovations theory were prevalent in the literature. Although several theories are useful in explaining phenomenon in the domain of medical informatics, diffusion of innovation is one such theory that can be applicable to a vast amount of medical informatics research that is focused on new technologies or work processes.