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- Text DocumentEvolving relations between the practices of nurses and patients and a new patient portal(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Kensing, Finn; Lomborg, Stine; Moring, CamillaThe paper offers preliminary reflections on a patient portal that is part of a glocal digital infrastructure – an EHR - currently being implemented at 18 hospitals in two of the five Danish regions covering more than half of the population. We focus on the evolving relations between the technology and the practices of nurses and patients in a rehabilitation program after a blood cloth, with a specific interest in how the rehabilitation infrastructure promotes clinical governance and patient empowerment. Our analytical lens is that of patient empowerment, understood broadly as the patient’s capacity for and experience of self-care within the infrastructure. This, we contend, may be seen as a specific and increasingly important aspect of clinical governance.
- Text DocumentCare coordination with a patient centred plan(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Vuokko, Riikka; Mäkelä-Bengs, Päivi; Karsten, HelenaIn Finland, a standardized data structure for continuous health and care planning is implemented as a Health and Care Plan (HCP) module in all electronic health record systems (EHR). The structure was initially published in 2011 and gradually implemented in the various EHR systems. In this study, the focus is on comparing the specifications of the data structure and the responses to a spring 2016 survey. We analyse the HCP as a representation that is interpreted in different contexts and for different purposes by those involved. The interactionist theory by Strauss (1993) is used as the lens to discern dualistic dimensions of interpretations. We found these dimensions: consensus vs. dissent, old vs. new, single vs. multiple, clearly imagined vs. unclear, and unchanging vs. changing. The implications of these for HCP use and development are discussed.
- Text DocumentBuilding an evaluation infrastructure: capturing feedback at the right time and place(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Brandrup, Morten; Østergaard, Kija LinInfrastructuring does not happen by itself; it must be supported. In this paper, we present a feedback mechanism implemented as a smartphone-based application, inspired by the concept of infrastructure probes, which supports the in situ elicitation of feedback. This is incorporated within an evaluation infrastructure which enables clinicians to collaboratively evaluate IT system usage and related work practices. Access to the collected feedback is given through a central online repository presenting the feedback and analysed collaboratively. We describe this through a case where nurses collaborate by the means of electronic whiteboards on the infrastructuring of a procedure of patient transfer from an intensive care unit to a general ward.
- Text DocumentSocio-technical Infrastructures for Healthcare Automation in NHS Primary Care(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Willis, MattAutomation and computerisation technologies are poised to impact some 47 percent of the U.S. labour market. While automation is typically seen as a threat to workers in many economic sectors, it is an opportunity in the current state of NHS England primary care and general practice services. The early findings reported here are from a recently approved research program that employs ethnography to understand the socio-technical interactions of all primary care staff. With a keen eye on the occupational roles, the tasks those occupations perform, and the tasks technologies perform. The concept of junction work is used to discuss opportunities for automation across different task workflows and occupational roles connecting to the infrastructure at each primary care research site. The project aims to better understand questions surrounding the social dynamics of adopting new technologies, detail the existence of current infrastructures, and identify the key features that may resist automation or support the implementation of automative technologies into existing infrastructures. Early findings are from two health centres, one rural and one urban.
- Text DocumentInfrastructuring primary prevention outside healthcare institutions: the governance of a Workplace Health Promotion program(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Piras, Enrico Maria; Miele, Francesco; Fornasini, SilviaWorkplace Health Promotion (WHP) programs are undergoing significant changes mixing the healthy lifestyle promotion with the self-tracking opportunities offered by digital technologies. The shift to more pervasive (or intrusive) forms of primary prevention for chronic diseases requires to justify the existence of healthcare infrastructures in work settings and a redefinition of the role of employers and healthcare institutions. The paper describes and analyses a WHP initiative conducted in Italy to illustrate the infrastructuring of the governance of technologically-enhanced prevention in the workplace.
- Text DocumentDeveloping Rural Healthcare Services: How to Create Efficient Services Using Service Design Methods(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Alhonsuo, Mira; Miettinen, Satu; Marttila, HennaThis paper presents a workshop model that can be used to develop digital healthcare services in rural communities. The workshop model is based on a case study done in South Africa in the context of health-related information and communication services. Participants in this case study were semi-trained home-based health caregivers working in rural communities. The research was structured around design methods drawn mainly from the service design field that enable user participation in the development process and that create a common understanding and mission through increased empathy among participants as well as co-creative flows while working together. The primary outcome from the case study was a workshop model, which focused on investigating and developing solutions to address the most important caregiver needs during a typical working day. This leads to interactions, which increases empathy among the participants. The goal of the case study was to design a mobile application that makes the caregivers’ services more efficient. This research is part of the Critical Communication, Safety and Human-centered Services of the Future (CRICS) project, which runs from 2016–2017, and which is funded by Tekes, the Finnish Funding Agency for Technology and Innovation. It was conducted in cooperation with Cape Peninsula University of Technology (CPUT), Cape Town, South Africa
- Text DocumentInfrastructures for Sense Making(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Tellioğlu, Hilda; Habiger, Michael; Cech, FlorianThis paper is about discussing infrastructures as enablers of users’ sense making. Infrastructures facilitate process-oriented, interactive and socially sense making in case of complex problem settings like care giving. On an example of a platform that is used to support informal care givers, it expresses the importance of different channels in interaction mechanisms of infrastructures that are meant to support non-professional care givers in their daily activities, especially to deal with situations of uncertainty and mental overload.
- Text DocumentChallenges and Opportunities of Health and Care Co-production with Social Media: a Qualitative Study(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Daneshvar, Hadi; Anderson, StuartFuture of health in EU faces the triple challenges of ageing, fiscal restriction and inclusion. Co-production offers ways to manage informal care resources to help them cater for the growing needs of elderly people. We investigate the opportunities and the challenges in use of Social Media (SM) as an enabler of co-production in health and care. In order to do this, we conducted a qualitative study using interviews and online observations of activities of professional carers, voluntary organisations and informal carer. We found that particular types of SM are currently used to enable co-production through coordination and communication across boundaries. Particularly Twitter and Facebook are used to connect carers, disseminate information and invite volunteers. However, there are still many other types of SM which are rarely used in this sector due to their limitations. Nevertheless, carers showed interest in using systems which help them to engage people in shaping of services, sharing of experiences and encouraging care activities.
- Text DocumentThe Complexity of Governing a Regional EPR System(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Ulriksen, Gro-HildeThis paper focus on the complexity of governing a regional EPR system. This is done directing the following research question: what is the role of the regional archetype governance organization, and how does it relate to the other actors in the ongoing infrastructuring process of establishing a regional EPR system? The paper builds on infrastructuring and boundary work theory. Empirically it follows the work of governing a new openEHR based EPR system, and the governance structures connected to the system. Some important issues are the interrelation between the governance organizations, the boundaries between them, and if the archetype governance organization can work as a bridge builder between technical and clinical governance.
- Text DocumentSimulation Sessions as Engines of Improved Hospital Care Quality(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Boulard,Cecile; Falzon, Cecile; Rozier, David; Grasso, M. AntoniettaWith increasingly complex practices, improving the quality of hospital care must include infrastructures to support communities of practice. We argue simulation sessions are ideal opportunities, if managed well, to create successful communities of practice.
- Text DocumentManeuvering a Pilot Implementation to Align Agendas Across Sectors(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Mønsted, Troels; Hertzum, Morten; Søndergaard, JensA prerequisite for pilot implementations in complex organizational settings is that the agendas of the stakeholders of the system are maneuvered into alignment. In this paper we present a study of the pilot implementation of the IT-supported, preventive intervention TOF (Tidlig Opsporing og Forebyggelse). A core element of TOF is an IT system that stratifies citizens into risk groups on the basis of self-reported lifestyle information and data retrieved from the medical records of the general practitioners (GPs). In addition, the system facilitates cross-sectoral coordination between preventive offers at the GP and at municipal health centers. We find that TOF succeeded in maneuvering the agendas of the involved stakeholders by gaining the foothold, legitimacy, and GP motivation required to carry out the pilot implementation.
- Text DocumentExamining practices for remote care in in different infrastructural configurations(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Grisot, Miria; Kempton, Alexander Moltubakk; Aanestad, MargunnIn this paper, we report from ongoing research on two cases on the use of telecare solutions for remote patient monitoring in Norway. Our analytical focus is on the practices of the nurses working in the remote care services and how the practices relate to the infrastructural configurations in which they are situated. By infrastructural configuration we refer to the organizational structure, service design, and technological solution. Specifically, we focus on three aspects emerging from the analysis of nurses’ practices: the interrelation of care and coordination of work, the fragmentation of information and the constitution of patients.
- Text DocumenteScience Insights to Inform Infrastructure for Accountability of Healthcare(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Pine, Kathleen H.Healthcare organizations and providers are being held accountable for the care they give and for their processes of improving care safety and quality to an unprecedented degree. In countries around the world, there is a pressing need to develop infrastructure for accountability of healthcare to support performance measurement and reporting activities. Yet, little research exists on the design, development, management, or governance of infrastructure for accountability in healthcare, nor on practices of data sharing and reuse that are central to healthcare performance measurement. This paper draws on literature on data sharing and cyberinfrastructure for eScience to identify key concepts from research on supporting collaborative scienctific practice to inform research on practices and infrastructure for healthcare accountability.
- Text DocumentTranslating value-based healthcare into practice(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Bonde, Morten; Bossen, Claus; Danholt, PeterIn this paper, we report from an experiment into healthcare governance called ‘new governance in the patient’s perspective’ (NG) initiated by a Danish Region. The experiment was inspired by principles of value-based health care (VBHC), and initiated to transform governance from a productivity-regime, allegedly incentivizing clinical conduct in ‘perverse’ and counter-productive ways, towards a new regime focusing on value for the patient. Pursuing this ambition the Region exempted nine hospital departments from activity-based financing based on Diagnosis-Related Groups (DRG), and asked instead the departments to develop self-chosen indicators to measure and account for ‘value for the patient’. Drawing on the notion of ‘translation’ (Latour, 1987) we analyse how NG was put into practice in the departments, and how their indicators were accounted for. Relating to literature on performance indicators, our case seemingly confirms a wellestablished distinction between indicators for internal improvement vs. external accountability. However, in pointing out the dialogues facilitated by the indicators between the Region and the departments, this distinction is challenged. Our analysis provides inspiration for healthcare governance to think of indicators as means, not for purely data-driven governance, but for dialogical practices in which concerns with accountability and local quality improvement conflate.
- Text DocumentThe Quantified Doctor/Nurse: How Quantification Infrastructures ‘redo’ Care(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Wallenburg, Iris; Bal, RolandThis paper explores how accountability metrics are enacted in unfolding healthcare practices. We examine the socio-technical infrastructures that underpin and enable quantification of care, and how users of quantified data not only react to quantitative practices and underlying infrastructures, but also actively give shape to them through practices of gamification. In the paper, we elucidate three ways of gamification: adjusting to quantification infrastructures, ignoring quantification infrastructures, and playing with quantification infrastructures. Such games, we show, are played within the context of, and give shape to emerging infrastructures of measuring healthcare. This opens up to a diversity of ontological practices in relation to quantification infrastructures, as well as to unfolding identities of the professional quantified self.
- Text DocumentPHR governance requirements leading to patient selection(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Zanutto, Alberto; Piras, Enrico MariaPersonal Health Record (PHR) projects have been supported in recent years by several health institutions. The aim has been to involve patients, the idea being that patients must become more significant in health infrastructure policy. The paper presents some results concerning a PHR system implemented in a region of North Italy. The system has been active since 2011, and more than 10% of the region’s residents use it. The purpose of this paper is to highlight how an extensive PHR infrastructure planned for everybody has become an interesting ‘‘tool’’ for specific intensive health situations. Drawing on the results of 20 interviews with the most frequent users of the system, we have identified three categories of users: individual or family health controllers, therapy driven managers, and complex illness managers. These diverse ways to adopt the infrastructure only partially meet governance expectations.
- Text DocumentGenerification in change: the complexity of modelling the healthcare domain(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Silsand, Line; Christensen, BenteIn this paper we explore the concept of ”generification” through a Model-Driven Development (MDD) approach. We claim that the concept of generification is in change as the MDD approach, exemplified by the openEHR framework, gives a network of voluntary clinical users a prominent role in the generification process. The customization is no longer ”in the hands” of the vendor, and needs to be formalized for the public healthcare service to take the ownership of the generification process and the standarization of clinical information. Empirically, we have followed the development of a new EPR system adhering to MDD methodology from 2012 to 2016.
- Text DocumentTaking care of sensitive milieus: a story about dialogical interviews(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Ceschel, Francesco; Di Fiore, Angela; Casati, FabioTo be engaged in design processes in healthcare organizations often implies to deal with sensitive contexts, which, in turn, deal with a unique and delicate emotional setting. In this paper, we address reflections related to our research experience adopting dialogical interviews in sensitive design contexts. These reflections arise from a field work carried out within a network of nursing homes, within which we conducted 27 dialogical interviews with family members of patients in severe end-of-life conditions. With this contribution, we want to address the importance of taking care of the human relationships while working with sensitive participants, as a way to comprehend to which direction the design of a new technology should be driven.
- Text DocumentEmerging versions of patient involvement with Patient Reported Outcomes(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Langstrup, HenrietteIt is a central argument in the growing Danish PRO-arena, that a large-scale collection of PRO from patients in the Danish Healthcare system will pave the way for more genuine patient involvement in clinical decision-making, quality management and governance of the health services. In this paper I discuss how patient involvement is being (re)configured when increasingly connected to national visions of participatory healthcare. A central discussion centers on ‘meaningful use’ of patient-generated data promoting patients’ expectations and experiences as a criterion for how to proceed with the national use of PRO. But how do assumptions of what constitutes meaning for patients interact with the kinds of roles that patients are expected to take on with PROtools? What forms of participation are assumed to be meaningful and thus good and which are not? In sketching emerging versions of patient involvement with PRO, I want to point to the need for further empirical exploration of how patients and professionals engage with PRO in specific daily practices and to stimulate a general discussion of all too simple normativities of the so-called ‘participatory turn’ in healthcare. I draw on empirical insights from an ongoing study of establishment of a national initiative for systematic collection of PROs in Denmark.
- Text DocumentComplex integrations in health care(Infrahealth 2017 - Proceedings of the 6th International Workshop on Infrastructure in Healthcare 2017, 2017) Bjørnstad, Camilla; Christensen, Bente; Ellingsen, GunnarIntegrations in health care are hard to manage in practice due to their complex organizational realities. To categorise the integrations as syntactic, semantic or pragmatic may help to better plan the process in developing them, and deciding how to manage them in a good way and hence obtain well-functioning integrations.