skip to main content
10.1145/2531602.2531620acmconferencesArticle/Chapter ViewAbstractPublication PagescscwConference Proceedingsconference-collections
research-article

How physicians 'achieve overview': a case-based study in a hospital ward

Published:15 February 2014Publication History

ABSTRACT

Clinicians' work in hospitals is safety- and time-critical, and often stressful due to the number and complexity of patient cases they must attend to. Therefore, how clinicians gather information, identify problems and make decisions concerning patients is a crucial concern, a process that can be labelled 'achieving overview'. In the process, clinicians use various artefacts amongst which medical records are central. Decades of experience is embedded in the structure and use of paper-based records. However, the development of electronic patient records (EPR) will change both structure and use of medical records, including 'achieving overview'. We conducted an ethnographic study in a hospital ward using paper-based medical records in order to understand how clinicians achieve overview. Inspired by the approach of exnovation, we elicit the use of paper-based records in order to inform the design of EPRs. We propose five axes which span out the process of achieving overview and describe implications for design of EPRs.

References

  1. Bardram, J. and C. Bossen Mobility Work: The Spatial Dimension of Collaboration at a Hospital. Journ. of Computer Supported Cooperative Work. 14(2005), 131160. Google ScholarGoogle ScholarDigital LibraryDigital Library
  2. Berg, M. Accumulating and Coordinating: Occasions for Information Technologies in Medical Work. Journ. of Computer Supported Cooperative Work. 8(4) (1999), 373--401. Google ScholarGoogle ScholarDigital LibraryDigital Library
  3. Berg, M. and P. Toussaint The Mantra of Modeling and the Forgotten Powers of Paper: A Sociotechnical View on the Development of Process-Oriented ICT in Health Care. International Journ. of Medical Informatics 69(23) (2002), 223--34.Google ScholarGoogle Scholar
  4. Bossen, C. Representations at Work: A National Standard for Electronic Health Records. Proc. of CSCW 06, 2006, ACM Press (2006), 69--78. Google ScholarGoogle ScholarDigital LibraryDigital Library
  5. Bourgeault, I., R. Dingwall, R. de Vries, Eds. Handbook of Qualitative Methods in Health Research. Los Angeles, SAGE (2010).Google ScholarGoogle ScholarCross RefCross Ref
  6. Büscher, M., J. O'Neill, J. Rooksby. Designing for Diagnosing: Introduction to the Special Issue on Diagnostic Work. Journ. of Computer Supported Cooperative Work, 18(2--3) (2009), 109--12 Google ScholarGoogle ScholarDigital LibraryDigital Library
  7. Crabtree, A. Designing Collaborative Systems. A Practical Guide to Ethnography. London, Springer (2003). Google ScholarGoogle ScholarDigital LibraryDigital Library
  8. Gross, T. Supporting Effortless Coordination: 25 Years of Awareness Research. Journ. of Computer Supported Cooperative Work, Online June 2013, 1--50. Google ScholarGoogle ScholarDigital LibraryDigital Library
  9. Hartswood, M., R. Procter, M. Rouncefield, R. Slack. Making a Case in Medical Work: Implications for the Electronic Medical Record. Journ. of Computer Supported Cooperative Work, 12(3) (2003), 241 - 266. Google ScholarGoogle ScholarDigital LibraryDigital Library
  10. Hollan, J., E. Hutchins, D. Kirsch. Distributed Cognition: Toward a New Foundation for HumanComputer Interaction Research. ACM Transactions on Computer-Human Interaction 7(2) (2000), 174--196. Google ScholarGoogle ScholarDigital LibraryDigital Library
  11. Hutchins, E. Cognition in the Wild. Cambridge, Mass & London, MIT Press (1995).Google ScholarGoogle Scholar
  12. Luff, P. and C. Heath. Mobility in Collaboration. Proc. of CSCW'98, ACM (1998): 305-- Google ScholarGoogle ScholarDigital LibraryDigital Library
  13. Luff, P., C. Heath, D. Greatbatch. Tasks-in-interaction: Paper and Screen based Documentation in Collaborative Activity. Journ. of Computer Supported Cooperative Work, ACM (1992). Google ScholarGoogle ScholarDigital LibraryDigital Library
  14. Mattingly, C. The Narrative Nature of Clinical Reasoning. The American Journ. of Occupational Therapy 45(11) (1991), 998--1005.Google ScholarGoogle ScholarCross RefCross Ref
  15. Mattingly, C. The concept of therapeutic 'emplotment'. Social Science & Medicine 38(6) (1994), 811--822.Google ScholarGoogle ScholarCross RefCross Ref
  16. Mesman, J. Uncertainty in Medical Innovation. Houndsmill, Palgrave Macmillan (2008).Google ScholarGoogle ScholarCross RefCross Ref
  17. Mønsted, T., M. C. Reddy, J. P. Bansler. The Use of Narratives in Medical Work: A Field Study of Physician-Patient Consultations. Proc of ECSCW'11, Springer (2011).Google ScholarGoogle Scholar
  18. Palen, L. and S. Aaløkke. Of pill boxes and piano benches: "home-made" methods for managing medication. Proc. of CSCW´06, New York, ACM (2006), 79--88. Google ScholarGoogle ScholarDigital LibraryDigital Library
  19. Reddy, M. and P. Dourish. A Finger on the Pulse: Temporal Rythms and Information Seeking in Medical Work. Proc. of the CSCW'02. New Orleans, ACM Press (2002), 344--53. Google ScholarGoogle ScholarDigital LibraryDigital Library
  20. Reddy, M., P. Dourish, W. Pratt. Coordinating Heterogeneous Work: Information and Representation in Medical Care. Proc. of ECSCW'07, Klüver (2001), 239--58. Google ScholarGoogle ScholarDigital LibraryDigital Library
  21. Reddy, M. C. and P. R. Spence. Collaborative information seeking: A field study of a multidisciplinary patient care team. Information Process & Management. 44(1) (2008), 242--255. Google ScholarGoogle ScholarDigital LibraryDigital Library
  22. Rind, A., T. D. Wang, W. Aigner, S. Miksh, K. Wongsuphasawat, C. Plaisant, B. Schneiderman. Interactive Information Visualization to Explore and Query Electronic Health Records. Foundations and Trends in HCI 5(3) (2011), 207--298. Google ScholarGoogle ScholarDigital LibraryDigital Library
  23. Rogers, Y. and J. Ellis Distributed Cognition: an Alternative Framework for Analysing and Explaining Collaborative Working. Journ. of Information Technology 9(1994), 119--128.Google ScholarGoogle Scholar
  24. Sarcevic, A., I. Marsic,R. S. Burd. Teamwork Errors in Trauma Resuscitation. ACM Transaction on ComputerHuman Interaction. 19(2) (2012), 1--30. Google ScholarGoogle ScholarDigital LibraryDigital Library
  25. Schmidt, K. The Problem with 'Awareness'. Journ. of Computer Supported Cooperative Work 11(3) (2002), 285--298. Google ScholarGoogle ScholarDigital LibraryDigital Library
  26. Sellen, A. J. and R. Harper The Myth of the Paperless Office, MIT Press (2002). Google ScholarGoogle ScholarDigital LibraryDigital Library
  27. Stead, W. W. and H. S. Lin Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. Washington, DC, USA, National Academies Press (2009).Google ScholarGoogle Scholar
  28. Strauss, A., S. Fagerhaugh, B. Suczek, C. Wiener. Social Organization of Medical Work. Chicago & London, University of Chicago Press (1985).Google ScholarGoogle Scholar
  29. Weed, L. L. Medical Records, Medical Education, and Patient Care. The Problem-Oriented Record as a Basic Tool. Chicago, Year Book Medical Publishers (1969).Google ScholarGoogle Scholar
  30. Weick, K. E. Sensemaking in organizations. Thousand Oaks, Sage (1995).Google ScholarGoogle Scholar
  31. Weick, K. E., K. M. Sutcliffe, D. Obstfeld. Organizing and the Process of Sensemaking. Organization Science 16(4) (2005), 409--421. Google ScholarGoogle ScholarDigital LibraryDigital Library
  32. Østerlund, C. S. Documents in Place: Demarcating Places for Collaboration in Healthcare Settings. Journ. of Computer Supported Cooperative Work 17(2--3) (2006), 195--225. Google ScholarGoogle ScholarDigital LibraryDigital Library

Index Terms

  1. How physicians 'achieve overview': a case-based study in a hospital ward

    Recommendations

    Comments

    Login options

    Check if you have access through your login credentials or your institution to get full access on this article.

    Sign in
    • Published in

      cover image ACM Conferences
      CSCW '14: Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing
      February 2014
      1600 pages
      ISBN:9781450325400
      DOI:10.1145/2531602

      Copyright © 2014 ACM

      Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected]

      Publisher

      Association for Computing Machinery

      New York, NY, United States

      Publication History

      • Published: 15 February 2014

      Permissions

      Request permissions about this article.

      Request Permissions

      Check for updates

      Qualifiers

      • research-article

      Acceptance Rates

      CSCW '14 Paper Acceptance Rate134of497submissions,27%Overall Acceptance Rate2,235of8,521submissions,26%

      Upcoming Conference

      CSCW '24

    PDF Format

    View or Download as a PDF file.

    PDF

    eReader

    View online with eReader.

    eReader