The rise and ‘fall’ of expert systems in medicine

Heathfield, Heather

doi:10.1111/1468-0394.00107

Cited by 28 publications

(24 citation statements)

References 35 publications

(40 reference statements)

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“…When hospital information systems were first introduced, it was found that the greatest difficulties in their deployment lay not with technical issues but with the end-users, on whom new demands were being placed (Harrison, 1991). Recent health informatics research also reveals that social and organizational factors can determine the success or failure of healthcare IT developments (Harrison, 1991;Heathfield, 1999). Heathfield (1999) suggests that this is due to the complex, autonomous nature of the medical discipline and the specialized approaches to system development (which are typically led by either a clinician or a software engineer).…”

Section: Communities Of Practice and The Clinical Domainmentioning

confidence: 99%

“…Recent health informatics research also reveals that social and organizational factors can determine the success or failure of healthcare IT developments (Harrison, 1991;Heathfield, 1999). Heathfield (1999) suggests that this is due to the complex, autonomous nature of the medical discipline and the specialized approaches to system development (which are typically led by either a clinician or a software engineer). The diverse organizational culture of hospital structures, made up of many different professions with their own specific social identifiers, can often produce conflicts between those professions (Morgan, 1991).…”

Section: Communities Of Practice and The Clinical Domainmentioning

confidence: 99%

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Bridging the gap between organizational and user perspectives of security in the clinical domain

Adams

Blandford

2005

International Journal of Human-Computer Studies

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Abstract:An understanding of 'communities of practice' can help to make sense of existing security and privacy issues within organisations; the same understanding can be used proactively to help bridge the gap between organisational and end-user perspectives on these matters. Findings from two studies within the health domain reveal contrasting perspectives on the 'enemy within' approach to organisational security. Ethnographic evaluations involving in-depth interviews, focus groups and observations with 93 participants (clinical staff, managers, library staff and IT department members) were conducted in two hospitals. All of the data was analysed using the social science methodology 'grounded theory'. In one hospital, a community and user-centred approach to the development of an organisational privacy and security application produced a new communication medium that improved corporate awareness across the organization. User involvement in the development of this application increased the perceived importance, for the designers, of application usability, quality and aesthetics. However, other initiatives within this organisation produced clashes with informal working practices and communities of practice. Within the second hospital, poor communication from IT about security mechanisms resulted in their misuse by some employees, who viewed them as a socially controlling force. Authentication mechanisms were used to socially exclude users who were formally authorised to access systems but whose access was unacceptable within some local communities of practice. The importance of users' security awareness and control are reviewed within the context of communities of practice.

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Section: Communities Of Practice and The Clinical Domainmentioning

confidence: 99%

Section: Communities Of Practice and The Clinical Domainmentioning

confidence: 99%

Bridging the gap between organizational and user perspectives of security in the clinical domain

Adams

Blandford

2005

International Journal of Human-Computer Studies

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Section: Health Informatics Journalmentioning

confidence: 99%

“…When hospital information systems were first introduced, it was found that the greatest difficulties in deployment lay not with technical issues but with the users, through their reactions to systems introduction and the demands of acquiring new skills [26]. Recent health informatics research also reveals that social and organizational factors can determine the success or failure of healthcare IT developments [1,27,28]. Negative reactions to these systems are often due to inappropriate system design and poor implementation.…”

Section: Clinical Domain and Communities Of Practicementioning

confidence: 99%

“…Users therefore need support in obtaining a shared understanding of corporate perspectives and establishing productive collaborations across an organization. This is especially true within the clinical domain where the complex, autonomous and hierarchical nature of the medical discipline can isolate users from organizational issues [1].A range of communication and awareness tools has been used to counteract the growing isolation of users and groups: the telephone, e-mail, video conferencing, shared workspaces, chatrooms and public information boards. Awareness technologies allow distributed workers to be aware of their co-workers' activities and of their potential for collaboration.…”

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confidence: 99%

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Organizational communication and awareness: a novel solution for health informatics

Adams

Blandford²,

Budd³

et al. 2005

Health Informatics J

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As organizations grow larger and more distributed, the problems of maintaining corporate awareness and effective communication channels escalate. The clinical domain poses particular challenges to maintaining good corporate communications because users have limited time to access information and often have negative technology perceptions. This article highlights how a screen saver application, initially designed to increase privacy and security, developed into a new communication medium improving corporate communication across the organization. An ethnographic study of the application within a hospital setting, analysed using grounded theory methods, details the iterative and organic development of the design through 'community of practice' involvement. This application and the evolutionary process through which it was developed were found to not only increase awareness of resources, activities and hospital changes but also positively influence users' perceptions of, involvement in and ownership of general IT developments. User involvement also raised the importance, for the designers, of application usability, quality and aesthetics. Keywords communication, communities of practice, organizational awareness, social issues IntroductionAs an organization grows and spreads to separate geographic locations, it becomes hard for staff to retain an awareness of community activities, events and resources across that organization. Without organizational awareness, activities are likely to be duplicated or go unnoticed by those who would appreciate them. Joint resources can be left unused, Health Informatics Journalreducing the likelihood of a collective outlook. Users therefore need support in obtaining a shared understanding of corporate perspectives and establishing productive collaborations across an organization. This is especially true within the clinical domain where the complex, autonomous and hierarchical nature of the medical discipline can isolate users from organizational issues [1].A range of communication and awareness tools has been used to counteract the growing isolation of users and groups: the telephone, e-mail, video conferencing, shared workspaces, chatrooms and public information boards. Awareness technologies allow distributed workers to be aware of their co-workers' activities and of their potential for collaboration. The applications range from video/audio links and sensors that locate and detect workers' current activities to a range of tools that increase awareness of collaborative activities such as meetings, seminars, shared tasks, etc. However, these tools can simply lead to information overload and overlooked resources, as users lack the time or ability to scan for relevant information or to set up mechanisms (e.g. intelligent agents) to search for them.Peripheral awareness interfaces provide awareness without interrupting the primary task or requiring a secondary task (i.e. initiating awareness tool) to occur. These applications have been of increasing importance in the literature but, as ...

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Computer‐aided diagnosis with potential application to rapid detection of disease outbreaks

Burr

Koster

Picard

et al. 2007

Statistics in Medicine

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Our objectives are to quickly interpret symptoms of emergency patients to identify likely syndromes and to improve population-wide disease outbreak detection. We constructed a database of 248 syndromes, each syndrome having an estimated probability of producing any of 85 symptoms, with some two-way, three-way, and five-way probabilities reflecting correlations among symptoms. Using these multi-way probabilities in conjunction with an iterative proportional fitting algorithm allows estimation of full conditional probabilities. Combining these conditional probabilities with misdiagnosis error rates and incidence rates via Bayes theorem, the probability of each syndrome is estimated. We tested a prototype of computer-aided differential diagnosis (CADDY) on simulated data and on more than 100 real cases, including West Nile Virus, Q fever, SARS, anthrax, plague, tularaemia and toxic shock cases. We conclude that: (1) it is important to determine whether the unrecorded positive status of a symptom means that the status is negative or that the status is unknown; (2) inclusion of misdiagnosis error rates produces more realistic results; (3) the naive Bayes classifier, which assumes all symptoms behave independently, is slightly outperformed by CADDY, which includes available multi-symptom information on correlations; as more information regarding symptom correlations becomes available, the advantage of CADDY over the naive Bayes classifier should increase; (4) overlooking low-probability, high-consequence events is less likely if the standard output summary is augmented with a list of rare syndromes that are consistent with observed symptoms, and (5) accumulating patient-level probabilities across a larger population can aid in biosurveillance for disease outbreaks.

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The rise and ‘fall’ of expert systems in medicine

Cited by 28 publications

References 35 publications

Bridging the gap between organizational and user perspectives of security in the clinical domain

Bridging the gap between organizational and user perspectives of security in the clinical domain

Organizational communication and awareness: a novel solution for health informatics

Computer‐aided diagnosis with potential application to rapid detection of disease outbreaks

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