Understanding Clinical Work Practices for Cross-Boundary Decision Support in e-Health

Abstract

One of the major concerns of research in integrated healthcare information systems is to enable decision support among clinicians across boundaries of organizations and regional workgroups. A necessary precursor, however, is to facilitate the construction of appropriate awareness of local clinical practices, including a clinician's actual cognitive capabilities, peculiar workplace circumstances, and specific patient-centered needs based on real-world clinical contexts across work settings. In this paper, a user-centered study aimed to investigate clinical practices across three different geographical areas-the U.K., the UAE and Nigeria-is presented. The findings indicate that differences in clinical practices among clinicians are associated with differences in local work contexts across work settings, but are moderated by adherence to best practice guidelines and the need for patient-centered care. The study further reveals that an awareness especially of the ontological, stereotypical, and situated practices plays a crucial role in adapting knowledge for cross-boundary decision support. The paper then outlines a set of design guidelines for the development of enterprise information systems for e-health. Based on the guidelines, the paper proposes the conceptual design of CaDHealth, a practice-centered framework for making sense of clinical practices across work settings for effective cross-boundary e-health decision support.

The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients

“…Usability issues including lack of integration into the clinical work is cited as a main barrier to broad adoption [9, 11–13]. This includes lack of integration with the EHR, which is important in order to trigger relevant patient information at appropriate points in the cognitive workflow and to prevent double entry of data, to both the DSS and EHR [14, 15].…”

Exploiting Geo-Distributed Clouds for a E-Health Monitoring System With Minimum Service Delay and Privacy Preservation

“…E-health monitoring systems have attracted great attention recently, and their applications have been developed widely [17], [18]. Due to the surging computing and storage demands from these applications, geo-distributed clouds have been regarded as promising solutions [6], [19].…”

Supporting practice-centered awareness in computer-mediated collaboration across communities of practice

“…All 9 participants took part in a previous questionnaire study [30]. A correspondence established in the questionnaire-based study heightened the interviewees' interest in the study and trust in the researcher, and led them to speak with considerable openness about certain practice-related issues, e.g.…”

“…Quota and snowball sampling techniques were used to purposefully identify, from a previous questionnaire study sample [30], potential interviewees for this study. Though the techniques are potentially prone to bias; the use of quota sampling allowed us to target, from each of our three sample zones, those participants who are responsible for clinical decisions and have had the experience of participating in clinical decisions in hospitals in different regions, while the snowball technique allowed us to select future respondents from among the social network of existing respondents with a focus on maximizing opportunities for exploring emerging concepts.…”