CPOE workarounds, boundary objects, and assemblages

Zhou, Xiaomu; Ackerman, Mark S.; Zheng, Kai

doi:10.1145/1978942.1979439

Cited by 56 publications

(51 citation statements)

References 25 publications

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“…In practice, clinicians frequently adopt informal workarounds beyond the standard operations of health applications and HIT (Koppel et al 2008) in order to circumvent problems that emerge when a newly deployed IT system disrupts workflows and interferes with task performance or goal attainment (Azad and King 2008;Zhou et al 2011). These workarounds can be new or reconfigured tools, artifacts, or ways of interacting with an EHR system (Ash et al 2004;Campbell et al 2006;Handel and Poltrock 2011;Park and Chen 2012;Tang and Carpendale 2008).…”

Section: Formal and Informal Workmentioning

confidence: 99%

Design for Supporting Healthcare Teams

et al. 2015

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Healthcare today is a team sport, no longer dominated by the vision of a single nurse or doctor interacting with a patient. Rather, modern healthcare occurs through a coordinated action of many individuals, possessing diverse skills and expertise, sometimes collocated but often distributed in time and space. Obvious examples of healthcare teams include a surgical team performing an operation, emergency department (ED) personnel stabilizing a trauma patient, a "code team" responding to in-hospital cardiac arrest, and daily bedside rounds by multi-disciplinary teams in an intensive care unit. Less obvious are examples of health professional communication and collaboration that do not occur face-to-face. For example, a nurse may notice unexpected symptoms in her patient during night-shift, contact a pharmacist to learn that this is a medication side effect, pass this information on verbally at shift report so other nurses can monitor the effects, record the information in the medical record for all clinicians to be aware of, and perhaps add a paper or electronic "post-it" note for the physician, suggesting a change of the medication order at morning rounds.In these contexts, electronic health records (EHR) and other health information technologies (HIT) can function in ways that support healthcare teams, becoming a

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Section: Formal and Informal Workmentioning

confidence: 99%

Design for Supporting Healthcare Teams

et al. 2015

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“…One notable line of work has examined "workarounds" in clinical practice (i.e. 13,42]. Workarounds are temporary practices used to handle exceptions to workflow.…”

Section: Cscw 2014 • Work In Hospitalsmentioning

confidence: 99%

“…Workarounds are temporary practices used to handle exceptions to workflow. Both unexpected contingencies of work situations and inappropriately designed ICT systems give rise to workarounds [42]. However, this literature does not examine deeply a crucial factor that gives rise to workarounds on the first place: the accounting function of EMR, and the institutional logics that shape the work processes programmed into EMR.…”

Section: Cscw 2014 • Work In Hospitalsmentioning

confidence: 99%

Institutional logics of the EMR and the problem of 'perfect' but inaccurate accounts

Pine

Mazmanian

2014

Proceedings of the 17th ACM Conference on Computer Supported Cooperative Work &Amp; Social Computing

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Electronic Medical Records promise to simultaneously enhance coordination and provide transparency and accountability in work process. As such, EMR are purported to benefit both hospitals and patients. In this paper we use grounded empirical data to explore how this promise plays out in the everyday tasks of healthcare providers. Building on the small body of CSCW literature that suggests that the accounting functions of EMR are impinging on the ability of medical personnel to coordinate work, we draw on the theoretical lens of new institutionalism to outline how certain institutional logics around safety and accountability are shaping the experience of EMR systems in situ. We suggest that the institutional logics that currently characterize U.S. healthcare are embedded in the EMR design itself, structuring how institutional values such as "safety" are achieved and evaluated. Using over one year of ethnographic research in an obstetrical unit, we find that the institutional logics of "safety" embedded in the EMR create negative organizational outcomes, effectively undermining coordination and necessitating inaccurate accounts of work. We provide design implications to address these issues in the current institutional environment and envision how systems might be designed to promote alternate logics of safety that are social, dynamic, and cast humans as expert agents in the system.

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“…There is limited support for making up parts of a medical records for other to pay attention to, and there is very limited support for, e.g., being notified when a patient's data or status is changed. Other studies have similarly revealed the loss of coordinative properties of paper-based medical order after the adoption of electronic systems and how different workarounds are created to address such problem (Zhou et al 2011). Such workarounds include assigning a clerk to monitor new orders in the Computerized Prescribed Order Entry (CPOE) system.…”

Section: Mutual Awarenessmentioning

confidence: 99%

Collaborative Affordances of Medical Records

Bardram

Houben

2017

Comput Supported Coop Work

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Abstract. This article proposes the concept of Collaborative Affordances to describe physical and digital properties (i.e., affordances) of an artifact, which affords coordination and collaboration in work. Collaborative Affordances build directly on Gibson (1977)'s affordance concept and extends the work by Sellen and Harper (2003) on the affordances of physical paper. Sellen and Harper describe how the physical properties of paper affords easy reading, navigation, mark-up, and writing, but focuses, we argue, mainly on individual use of paper and digital technology. As an extension to this, Collaborative Affordances focusses on the properties of physical and digital artifacts that affords collaborative activities. We apply the concept of Collaborative Affordances to the study of paper-based and electronic patient records in hospitals and detail how they afford collaboration through four types of Collaborative Affordances; being portable across patient wards and the entire hospital, by providing collocated access, by providing a shared overview of medical data, and by giving clinicians ways to maintain mutual awareness. We then discuss how the concept of Collaborative Affordances can be used in the design of new technology by providing a design study of a 'Hybrid Patient Record' (HyPR), which is designed to seamlessly blend and integrate paper-based with electronic patient records.

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CPOE workarounds, boundary objects, and assemblages

Cited by 56 publications

References 25 publications

Design for Supporting Healthcare Teams

Design for Supporting Healthcare Teams

Institutional logics of the EMR and the problem of 'perfect' but inaccurate accounts

Collaborative Affordances of Medical Records

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