Today computers are widely used in hospitals and other health care institutions for a variety of purposes:
They are part of many medical devices in the diagnosis (e.g. PACS – picture archiving and communication systems) and treatment (e.g. assistive technology) of diseases. They enable care from remote locations via communication technology, i.e. telecare or telemedicine. Electronic patient record (EPR) systems are used to share data across institutions enhancing integrated care. One major advantage of computer systems is their ability to store huge amounts of data and make them accessible to a wide range of involved persons. They enable different representations of patient-related information and evaluations for research or management purposes.
The design and implementation of computer systems in health care poses major challenges and raises some questions, for example:
The tensions between local ways of working and the standards that are implemented in the product:
Computer systems are often built on views that are distant from actual work practice and hence do not fit locally established work practices.
Standardization versus tolerance for variation:
Computer systems can either impose strict standard procedures or allow for variation, e.g. by supporting free text entries in documentation systems.
Data availability and representation:
How does system design influence what data we have and what data we lack? How does the system process/represent data?
Configurability of space and technology (hardware and software):
Is the system adaptable to individual needs, e.g. by offering different views for doctors and nurses?
Cooperation and allocation of tasks:
Are there changes in the allocation of tasks and responsibilities (e.g. tasks that have been performed by doctors that are now in the responsibility of nurses, such as entering data)?
Seamless care delivery:
Does the system ensure the continuity of care? Does it enable people to share information across boundaries?
How can special requirements be communicated?
Care process and patients:
Does data entry interrupt the care process and communication with the patient?
Is access to data enhanced or inhibited?
Where are data displaying devices positioned?
Do they support a common shared view on information?
Ethical and legal issues:
Are users provided with a valid and simple model of what the system does? Are they made aware when their activity has an effect on the system?
Where lies the responsibility for the data entered and generated by the system? How are decisions linked to the output of the system?
Does the EPR system augment people’s work loads at the expense of care?
Privacy, confidentiality of recorded data
The main research methods used are ethnographic studies of work practices. Their goal is a thorough understanding of the practices in health care work as they are actually performed by the personnel (i.e. situated action as opposed to the procedures that are described in formal descriptions like work plans). They analyze the processes in ample detail as to reflect the contextual richness of everyday work with various kinds of contingencies and dependencies. Participant observations are combined with interviews with the different stakeholders (medical and care personnel as well as management and IT personnel).