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Full Title

Dependability in Healthcare Settings

Keywords

Summary

For the DIRC project healthcare represents a domain in which dependability is of considerable public concern and policy importance. Recent UK healthcare policy announcements make it clear that IT is expected to play an increasingly important role in the delivery of promised service improvements. Policy makers are looking to IT systems to provide major benefits in direct support of patient care; in reporting, organising and locating clinical information; in coordinating and managing patient healthcare; in cost reduction; and in organisational integration.

DIRC research has studied a number of aspects of dependability in healthcare settings.

1. Information management in healthcare settings

Process Modelling - One organisationally popular approach to ensuring time, resources, staff and systems are allocated and used efficiently is process modelling. DIRC shadowed hospital managers as they dealt with the creation and implementation of process models that were used to identify "bottlenecks" in the 'processing' of patients. We noted how process modelling becomes centrally implicated in activities of working towards achieving mutual relevances and co-ordination. Our research suggests that, process maps are locally sensible versions of best practice and problems may arise where such versions are exported to other settings.

Bed management - Our main concern here has been to focus upon how representational artefacts of organisational activities and 'states of play' are oriented to in the everyday work of staff in these settings. We examined the situated character of a representational artefact - a 'beds board'- and the system of calculability that it afforded in the hospital setting. Our view is that such representations must be understood as embedded within the practicalities of the setting, and that any assumed benefits of replacing existing systems must be carefully considered.

2. Patient Records - DIRC research on dependability in healthcare settings has had a particular focus on the issue of information management and integration - in particular looking at patient records - both paper based records and the move towards electronic patient records.

Paper records - with paper records a particular focus of our research has been the trustability of the record - What features of the record and the work that surrounds it and goes into its production, do we need to understand, capture and represent in order to maintain or develop trust?

Electronic Patient Records. Current health and social care policy initiatives in the UK and many other western countries make significant claims about the desirability of integrated services for better health and social care, but DIRC research of information integration in the context of the provision of UK psychiatric healthcare services suggested that, within the particular setting studied and contrary to many expectations, the EPR would do relatively little to further service integration goals. They reveal important discrepancies between the presumptions of the role of the EPR and the ways in which healthcare professionals actually use and communicate information.

EPR project work and the practicalities of implementing an EPR project -This DIRC research considers some of the everyday practicalities of delivering an electronic health record project within an NHS Hospital Trust. We document how the orderly character of project work is achieved.

Integration - DIRC research has focused specifically on the everyday issues involved in integrating new EPR systems into 'workaday' concerns of medical and administrative practices and systems. Our concern was less with a wide range of human and social factors, documenting how issues of integration are addressed.

Contractual issues - DIRC research examined various features of contractual issues in everyday user-designer relations in order to consider what designing with and for users means in the context of electronic patient record (EPR) development.

3. Expert systems in mammography - evaluating a Computer Aided Detection tool. This DIRC research was interested in understanding the implications of introducing a new detection technology into the work setting, in particular understanding the effects of the tool on performance and how it would be actually used in reading looking especially at error rates, differences between detection and diagnosis and trusting the system. We point to ways in which informal practices raise important questions for the design and use of new technologies.

4. Healthcare IT and Failure - This research was concerned with the dependability aspects of a number of healthcare systems that have 'failed' in various ways, examining different classes of healthcare systems and potential types of failures. The case studies covered include The London Ambulance Dispatching System, Therac-25, Anaesthetist' equipment, Respiration Monitoring Device and various accounts of Electronic Hospital Records.

5. Timing and collaboration in the neonatal intensive care unit. The Neonatal Unit at St James's University Hospital in Leeds are developing an expert system (FLORENCE) that will help junior doctors manage changes to the ventilators that are used in treating premature babies with respiratory problems. This case study examined the factors that contribute to the dependability of the existing (pre-FLORENCE) system that implements the delivery of neonatal intensive care. The issues that were identified were analysed to generate requirements for the development and subsequent use of FLORENCE that would help to ensure that the dependability of the system (post-FLORENCE) is at least equal to the dependability of the system prior to FLORENCE's introduction.

6. Healthcare and Residential homes - Designing for care settings must not only take account of the usability of applications, but also how such technologies and their uses are integrated into a range of social contexts. In amongst the technical challenges are issues concerning the moral and ethical components of the design enterprise in a complex application domain. The challenge for design in these settings therefore, is not just to acknowledge a range of moral dilemmas but to attempt to embody a philosophy of care into design guidelines. This DIRC research examined various aspects of the use, design and provision of healthcare technologies in residential homes. One early project designed a 'medication manager' for the use of residents in a hostel for former psychiatric patients. Another concerned the development of a method, a framework, for evaluating needs and technologies prior to deployment in care settings.

Links

Electronic Patient Records

Dependability and Failure

Neonatal stuff

Cultural Probes

Papers

1. Procter, R. and Rouncefield. M. (2001) (Eds.) Dependability in Healthcare Informatics: Proceedings of the First Dependability IRC Workshop. Edinburgh, March 22nd-23rd, 2001.

2. Crabtree, A, Hemmings T and Rouncefield, M.(2001). (eds) Proceedings of the 1st Equator Workshop on Ubiquitous Computing in Domestic Environments Nottingham, September 13-14th 2001. Nottingham University.

3. Procter, R and Rouncefield M. (2002)(eds) 'The future looks smart' Health Informatics Journal Vol 8/No 2. June 2002. ISSN 1460-4582.

4. Stewart Kember, Keith Cheverst, Karen Clarke, Guy Dewsbury, Terry Hemmings, Tom Rodden & Mark Rouncefield, (2002) "'Keep taking the medication': Assistive technologies for medication regimes in care settings", in Keates S, Langdon P, Clarkson PJ & Robinson P, (2002) Universal Access and Assistive Technology, Springer-Verlag, London LTD, p285-294, ISBN 1-85233-595-5

5. Keith Cheverst, Karen Clarke, Guy Dewsbury, Terry Hemmings, John Hughes and Mark Rouncefield, (2003) 'Design with Care: Technology, Disability and the Home', in Harper R (Ed) Inside the Smart Home, Springer-Verlag, London Ltd, pp 163-180. ISBN: 1852336889.

6. Karen Clarke, John Hughes, Mark Rouncefield and Terry Hemmings. (2003) When a bed is not a bed: The situated display of knowledge on a hospital ward in O'Hara, K., Perry, M., Churchill, E. and Russell, D. (Eds) (2003) Public and Situated Displays. Social and interactional aspects of shared display technologies. Kluwer (2003)

7. Clarke, K, Hartswood, M., Procter, R., And Rouncefield, M (2001). Hospital Managers Closely Observed: Some Features of New Technology and Everyday Managerial Work. Journal of New Technology in the Human Services, vol. 14 (1/2), p. 48-57, 2001.

8. Cheverst, K., Cobb, S., Hemmings, T., Kember. S., Mitchell, K., Phillips, P., Procter, R., Rodden, T. And Rouncefield, M (2001) 'Design with Care' .Journal of New Technology in the Human Services, vol. 14 (1/2), p. 39-47, 2001.

9. Hartswood, M., Procter, R., Rouncefield, M. And Slack, R. (2001) Performance Management in Breast Screening: A Case Study of Professional Vision and Ecologies of Practice in Johnson, C. (Ed.) Special edition on Human Error and Medical Work, Journal of Cognition, Technology and Work, Springer, 2001.

10. Clarke, K.M., M. J. Hartswood, M., Procter, R.N., Rouncefield, M. (2001). 'The Electronic Medical Record and Everyday Medical Work'. Health Informatics Journal Vol 7. No 3/4 September/December 2001. Pp168-170.

11. Clarke, K., Harstwood, M., Procter, R., Rouncefield, M., Slack, R. And Williams, R.(2002) Improving 'Knife to Skin Time': Process Modelling and New Technology in Medical Work. Health Informatics Journal, 8(1). Sheffield Academic Press, p. 41-44, 2002.

12. Guy Dewsbury, Karen Clarke, Mark Rouncefield, and Ian Sommerville (2002) 'Home Technology Systems', Housing Care and Support Journal, Pavilion, Vol 5 Number 4, November 2002

13. Stewart Kember, Keith Cheverst, Karen Clarke, Guy Dewsbury, Terry Hemmings, Tom Rodden and Mark Rouncefield (2003) Designing Assistive Technologies for Medication Regimes in Care Settings, Journal for Universal Access in the Information Society (UAIS) Special Issue Simeon Keates and John Clarkson (eds) "Countering Design Exclusion".

14. Guy Dewsbury, Karen Clarke, and Mark Rouncefield (2003) 'Designing dependable systems', hometoys: Home Automation and Home Networking emagazine, Volume 8, Issue 2, April/May 2003.

15. Karen Clarke, Guy Dewsbury, John Hughes, Mark Rouncefield, and Ian Sommerville (2003) 'Designing Technology in Homes to Meet the Needs of Disabled People', Technology and Disability, Spring 2003. Volume 15, Number 3, pp191-200, ISSN 1055-4181

16. Hartswood, M., Procter, R.N., Rouncefield, M., Slack, R. (2003). 'Making a Case in Medical Work: Implications for the Electronic Medical Record'. - in Computer-Supported Cooperative Work (CSCW) Journal.Vol 12, Issue 3, pp241-266.

17. Clarke, K., Hartswood, M., Procter, R. And Rouncefield, M. (2003) 'Trusting The Record. Methods of Information in Medicine, 2003. 42: pp 345-352.

18. Hartswood, M., Procter, R. And Rouncefield, M. Information Technology and Managerial Work in a Hospital Trust. In Proceedings of the Conference on Sharing the Experience: Informatics and Research in Healthcare Practice. Foundation of Nursing Studies/British Computer Society Nursing SIG, London, 13th February, 2001.

19. Clarke, K, Hartswood, M., Procter, R. And Rouncefield, M (2001) The Electronic Medical Record and Everyday Medical Work. In Proceedings of the 6th International Symposium on Health Information Management Research, Greece, May, 2001, p. 279-83.

20. Keith Cheverst, Adrian Friday, Peter Philips and Mark Rouncefield (2001). 'Design For Digital Care' - in Proceedings of the 1st Equator Workshop on Ubiquitous Computing in Domestic Environments Nottingham, September 13-14th 2001

21. Cheverst, K., Cobb, S., Hemmings, T., Kember, S., Mitchell, K., Phillips, P., Procter, R.N., Rodden, T., Rouncefield, M. (2001). 'Design with Care'. In Proceedings of EDRA 32/2001. Published as: Old World, New Ideas: Environmental and Cultural Change in a Shrinking World., H.M. Edge (ed). ISBN 0939922-26-6.

22. Clarke, K.M., Hartswood, M., Procter, R.N., Rouncefield, M. (2001). 'NHS Managers Closely Observed: Some Features of New Technology and Everyday Managerial Work'. Proceedings of EDRA 32/2001. Published as: Old World, New Ideas: Environmental and Cultural Change in a Shrinking World., H.M. Edge (ed). ISBN 0939922-26-6. Also to be reprinted in Social Computing. R. Williams (ed.)

23. Hartswood, M., Procter, R., Rouncefield, M and Slack, R. Order in the Machine: Evaluating Computer Aided Detection Tools in Mammography. In Johnson, C. (Ed.) Proceedings of 21st European Annual Conference on Human Decision Making and Control, Glasgow, July 15th-16th, 2002, 205-8.

24. Clarke, K., Hartswood, M., Procter, R., Rouncefield, M. And Sharpe, M. The Electronic Medical Record and Healthcare Integration: Some Observations of Inter-organisational Working. In Bryant, J. (Ed.) Proceedings of the BCS Conference on Healthcare Computing, Harrogate, March 18th-20th, 2002. Pp 205-211.

25. Clarke, K., Hartswood, M., Procter, R., Rouncefield, M. And Slack, R. "Minus nine beds": Some Practical Problems of Integrating and Interpreting Information Technology in a Hospital Trust. In Bryant, J. (Ed.) Proceedings of the BCS Conference on Healthcare Computing, Harrogate, March 18th-20th, 2002. pp219-225

26. Keith Cheverst, Guy Dewsbury, Dan Fitton and Mark Rouncefield (2002) 'Getting the Message': SMS Messaging and Community Care, In Proceedings of the 2nd EQUATOR conference, October 2002

27. K. Cheverst, K. Clarke, G. Dewsbury, T. Hemmings, and M. Rouncefield. (2002) "When Geography Matters - Location Awareness and Community Care". In Richard Harper, editor, The Social Shaping of Mobile Futures - Proceedings of the Third Wireless World Conference, pages 69--83. Digital World Research Centre, University of Surrey, July 2002.

28. Guy Dewsbury, Karen Clarke, Mark Rouncefield and Ian Sommerville (2002) Appropriate home technology: Depending on dependable technology systems, In Proceedings CD ROM of the European Network Housing Research (ENHR)2002, Housing and Health Workshop, Vienna, Austria, 1 July - 5 July 2002

29. Guy Dewsbury, Mark Rouncefield, Karen Clarke, and Ian Sommerville (2002) Designing appropriate assistive technology for home users: Developing dependable networks. In Proceedings of the CIB Working Group W084 - Building Non-Handicapping Environments "Inclusive Design and Mobility Response in Indoor/Outdoor Public Buildings and Facilities" , Viale Marx, 43 - 00137 Roma, Italy, 21st and 22nd October 2002, Proceedings can be download from http://www.itc.cnr.it/italiano/11_testo.htm

30. Guy Dewsbury, Ian Sommerville, Karen Clarke and Mark Rouncefield, (2003) A Dependability Model for Domestic Systems, In Anderson, Felici and Littlewood (eds), Computer Safety, Reliability, and Security, Computer Safety, Reliability and Security: Proceedings, SAFECOMP Lecture Notes in Computer Science, Springer-Verlag Heidelberg, Volume 2788, pp103-115, ISSN 0302-9743.

31. Guy Dewsbury, Karen Clarke, John Hughes, Mark Rouncefield, and Ian Sommerville (2003) Designing Dependable Digital Domestic Environments, In Proceedings of HOIT 2003, 'The Networked Home and the Home of the Future', April 6-8 2003, in Irvine, California

32. Guy Dewsbury, Karen Clarke, John Hughes, Mark Rouncefield, and Ian Sommerville (2003) Growing older digitally: Designing technology for older people, In Proceedings of INCLUDE 2003, 'Inclusive Design for Society and Business', Helen Hamlyn Research Centre, Royal College of Art, 25-28 March 2003, p57-64, ISBN 1 874175 94 2

33. Hartswood, M., Procter, R., Rouncefield, M., Slack, R. and Soutter, J. The Work of Reading Mammograms and the Implications for Computer-Aided Detection Systems. In Barber, D, Brady, J. and Berry, E. (Eds.) Proceedings of the Seventh Medical Image Understanding and Analysis Conference, Sheffield, July. British Machine Vision Association, 2003, 89-92.

34. Guy Dewsbury, Ian Sommerville, Karen Clarke & Mark Rouncefield, (2003) A dependability model for domestic systems, Safecomp 2003, 22nd International conference, Computer Safety, Reliability and Security, 23-26 September 2003, Edinburgh, UK

35. Keith Cheverst, Karen Clarke, Dan Fitton, and Mark Rouncefield; Andy Crabtree and Terry Hemmings (2003) SPAM on the Menu: the practical use of remote messaging in community care. CUU 2003 ACM Conference on Universal Usability Vancouver, Canada. Pp23-29. ISBN 1-58113-701-X.

36. Hartswood, M, Procter, R., Slack, R. Soutter, J, Voss, A and Rouncefield, M, (2003) Healthcare Technology and Professional Vision. 3rd International Conference on the Management of Healthcare and Medical Technology, Warwick 2003

37. Dewsbury G, Rouncefield M, Sergeant E & Sommerville I (2003) 'EAT at home: a simple recipe?' Paper Presented to RAATE 2003, Botanical Gardens, Birmingham, November 10-11 2003.

38. Hartswood, M, Procter, R., Rouncefield, M., Slack, R. and Voss, A. (2003) 'Repairing' the Machine: A Case Study of Evaluating Computer Aided Detection Tools in Breast Screening. In Dourish, P and Fitzpatrick, G. (Eds.) Proceedings of the European Conference on Computer Supported Cooperative Work, Helsiniki, September, 2003. Pp375-394

39. Cheverst, K., Fitton, D and Rouncefield, M. (2004) 'HEAT & SPAM: SMS messaging and community care. In Proceedings of HEAT 2004- The Home and Electronic Assistive Technology. York March 2004. Pp 61-68

40. Dave Martin and Mark Rouncefield 'That's How The Bastille Got Stormed': Issues of Responsibility in User-Designer Relations In Mackie, J and Rouncefield. M. (2005) (eds) Proceedings of the 5th Annual DIRC Research Conference.

 

 
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