ICT In Healthcare Research Articles

Using actor network theory to understand network centric healthcare operations

The adoption and diffusion of e-health and the application of ICT in healthcare is being heralded as the panacea with both European and US governments making e-health a priority on their agendas. In this context, a model of networkcentric healthcare operations has been proffered as the best way to maximise the benefits of ICT use in healthcare. We suggest that, before we can move forward and realise such a state, it is vital to examine the critical issues, likely barriers and facilitators and, most importantly, the critical success factors. To do this however, we need an appropriate cognitive lens through which we can capture all the complexities of healthcare dynamics. In this paper we suggest why Actor Network Theory (ANT) should be this lens.

Special Section: Assessing Information Technologies for Health: Evaluation and Implementation: A Call for Action

SummaryTo raise awareness for actions that are urgently needed to accompany the large scale implementations of ICT in Health Care that are currently taking place in many countries around the world.An analysis of a few studies that have recently been described in the literature guided by recent suggestions for research and development of evaluation of health ICT.Six specific recommendations for action are specified:Development of good implementation practice,Development of an experience base of implementation of ICT in health care,Setting up a surveillance system for unintended effects,Build an evidence base of best evaluation practice,Developing guidelines for proper reporting of evaluation studies,Education of clinicians and decision makers.

Fluids or flows? Information and qualculation in medical practice

PurposeSeeks to explore the assumptions and limitations of current programmes for the creation of electronic patient records by comparing ICT programme statements with hospital uses of information.Design/methodology/approachCompares qualitative data from medical ICT programmes statements with data from ethnographic studies of hospital decision making. Uses actor‐network theory to develop a performative definition of information as that which secures a decision or “qualculation”, whether in the form of calculation or judgement.FindingsShows that decision making depends on a mix of formal and informal considerations that are, however, always restricted in scope and number. Shows that some of these are locally and organisationally contingent.Research limitations/implicationsThe ethnographic findings illustrate the character of information rather than offering data about the character of decisions in different clinical locations.Practical implicationsCaution is needed in the face of claims about ICT programmes in health care. It is possible to anticipate neither all the uses of information nor what will count as information in advance.Originality/valueThe paper develops a performative definition of information. This is whatever secures a decision in practice. Information thus reflects a situated process of simplification and bounding of relevancies. This suggests that information not only flows (which is assumed in ICT programme statements) but also is fluid, unpredictably changing its form and character. This claim is relevant both to the design and use of ICT in health care and to the theory of information.

ICT in Health Care: Sociotechnical Approaches

The importance of the social sciences for medical informatics is increasingly recognized. As ICT requires inter-action with people and thereby inevitably affects them, understanding ICT requires a focus on the interrelation between technology and its social environment. Sociotechnical approaches increase our understanding of how ICT applications are developed, introduced and become a part of social practices. Socio-technical approaches share several starting points: 1) they see health care work as a social, 'real life' phenomenon, which may seem 'messy' at first, but which is guided by a practical rationality that can only be overlooked at a high price (i.e. failed systems). 2) They see technological innovation as a social process, in which organizations are deeply affected. 3) Through in-depth, formative evaluation, they can help improve system design and implementation.

The mantra of modeling and the forgotten powers of paper: a sociotechnical view on the development of process-oriented ICT in health care

The recognition that restructuring care processes is central to effective and efficient health care will result in the emergence of process-oriented electronic patient records (EPRs). How will these technologies come into being? Within informatics, it is often stated that to informate something, we should first model it. This paper queries whether a detailed modeling of work processes and data flows is the primary step that needs to be completed before such EPRs can be developed or tailored. Building upon a sociotechnical understanding of ICT development, we argue for a reinterpretation of ‘models’ in such development processes. We do so through a reverse engineering of parts of the paper-based medical record, which has received little attention in medical informatics. In process-oriented EPR design, we argue, modeling should not be conceived as the crucial first step in this design, but rather as an intervention in the organizational change-processes that constitute proper ICT development.

Health care and ICT, partnership is a must

This article comments on the article ‘Health Care in the Information Society; A Prognosis for the Year 2013’ by Reinhold Haux et al. It is emphasised that besides the driving forces as identified in that article, the changes in the composition of the population will lead to a structural shortage of health professionals. So, despite the willingness of both individual patients and the society as a whole to pay more for health care no significant change will occur in the percentage of the gross domestic product spent on health care. By consequence we can not meet the challenges health care is facing by ‘more of the same’. New forms of health care delivery have to be invented and implemented that lead to higher efficiency. The question is discussed whether health care is lagging behind other sectors of society in the application of ICT, the answer to that question is negative. It is explained why the percentage of the budget spent on ICT is no valuable yardstick. Comments are made to the quantitative expectations of Haux et al. Finally it is recommended that IMIA takes the initiative to organise in co-operation with international associations of health professionals a multidisciplinary working conference on the future role of ICT in health care.

Medical informatics: quo vadis?

In this contribution some comments are given regarding an article of Haux et al., which is published in the same issue. After discussing some general aspects of the paper, the comments focus on patient-centred care and genomics. Trends that are observed today are used to predict the situation with respect of the use of ICT in healthcare in the year 2013. It is postulated that a shared electronic patient record in which both healthcare provider and patient enter and retrieve data will be available. The role of the patient in the management of her disease will be much larger than it is now. The impact of new knowledge coming from the field of genomics will be large. It is not possible to predict the impact on functionality and the use of healthcare information systems in 2013.

Patients and professionals in the information society: what might keep us awake in 2013

This commentary of Haux’ prognosis of the state of affairs in health care and information technology in the year 2013 argues the importance of standing up against the many high-tech, utopian dreams that are often associated with ICT in health care. Discussing many of the themes that Haux brings up, three issues are particularly focused upon: the importance of ‘patient-centered’ care, the changing position of the professional in current health care, and the nature of health care information. In all these issues, cliches threaten to hide several real and possibly painful issues, which, if unaddressed, will hamper any real progress. In all these issues, moreover, medical informatics plays an important role, and is a core actor in the future shaping of our health care systems. This responsibility should not be taken lightly.