Abstract
In this paper, we analyse physicians’ and nurses’ practices of prescribing and administering medication through the use of paper-based, and digitalized medication plans. Our point of departure is an ethnographic study of the implications of upgrading an electronic medication module (EMM) that is part of an electronic health record (EHR), carried out at an endocrinology department. The upgrade led to a temporary breakdown of the EMM, and a return to paper-based medication plans. The breakdown made visible and noticeable the taken-for-granted capabilities of medication plans in their paper-based and digital versions, and the distribution of functionalities between medication plans and clinicians. We see the case as an opportunity to analyse infrastructuring in health care, the process by which medical practices and artefacts become parts of social and technological networks with longer reaches and more channels through which coordination among distributed actors is enabled and formed. In this case, infrastructuring means an extended scope and intensity of the coordinative capabilities of medication plans, and an increased vulnerability to, and dependency on events outside the immediate loci of interaction. We particularly note the capacity of the EMM to facilitate different kinds of ordering of information and practices, and propose the conceptualizing of such digitalized artefacts as ‘ordering devices’. Ordering devices order information, stipulate action, and coordinate interaction across and within social worlds, and achieve this through the flexible support of different kinds of ordering.
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Notes
An often-used term in health informatics is ‘Computerized Physician Order Entry’ (CPOE). However, since the module discussed here is used not only by physicians when prescribing, but also by nurses when dispensing and administering drugs, the term seems misleading. Another, rarer term is ‘electronic medication administration records’ (eMAR), which, for a similar reason, is also inadequate, since the artefact is also used for prescribing. We therefore use the term ‘EMM’, instead.
This is in keeping with Muniesa et al. (2007), and the concept of ‘market device’, informed by Deleuze’s exploration of what a device might be:
... a tangle, a multi-linear ensemble. It is composed of different sorts of lines. And these lines do not frame systems that would be homogenous as such (e.g. the object, the subject, the language). Instead, they follow directions, they trace processes that are always at disequilibrium, sometimes coming close to each other and sometimes getting distant from each other. Each line is broken, is subjected to variations in direction, bifurcating and splitting, subjected to derivations. (Deleuze (1989, p. 185), in Muniesa et al. (2007, p. 2); their translation, emphasis in original)
References
Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104–112.
Aspden, P., Wolcott, J. A., Bootman, J. L., & Cronenwett, L. R. (Eds.). (2007). Preventing medication errors. Washington: National Academies Press, Quality Chasm Series.
Bardram, J., & Bossen, C. (2005). A web of coordinative artifacts: collaborative work at a hospital ward. In K. Schmidt, M. Pendergast, M. Ackerman, M Mark (Eds), Group ‘05. Proceedings of the Conference on Supporting Group Work, Sanibel Island, 6 to 9 November, 2005 (pp. 168–176). ACM: New York.
Berg, M. (1999). Accumulating and coordinating: occasions for information technologies in medical work. Journal of Computer Supported Cooperative Work, 8(4), 373–401.
Berner, E. S., Detmer, D. E., & Simborg, D. (2005). Will the wave finally break? A brief view of the adoption of electronic medical records in the United States. Journal of the American Medical Informatics Association, 12(1), 3–7.
Bjørn, P., & Balka, E. (2007). Health care categories have politics too: unpacking the managerial agendas of electronic triage systems. In L. Bannon, I. Wagner, C. Gutwin, R. Harper & K. Schmidt (Eds.), ECSCW ‘07. Proceedings of the Tenth European Conference on Computer Supported Cooperative Work (pp. 371–390). Limerick: Springer.
Bossen, C. (2002). The parameters of common information spaces: The heterogeneity of cooperative work at a hospital ward. In E. Churchill, J. McCarthy, C. Neuwirth, & T. Rodden (Eds), CSCW ‘02. Proceedings of the ACM Conference on Computer-Supported Cooperative Work 2002 (pp. 176–186). ACM: New Orleans.
Bossen, C. (2006). Representations at Work: A National Standard for Electronic Health Records. In P. Hinds & D. Martin (Eds), CSCW ‘06. Proceedings of the 2006 20th anniversary conference on Computer Supported Cooperative Work, Banff, Alberta, Canada, 4 to 9 November, 2006 (pp. 69–78), ACM: New York.
Bowker, G. C., & Star, S. L. (1999). Sorting things out. Classification and its consequences. Cambridge: MIT.
Bowker, J. C., & Star, S. L. (2002). How to infrastructure. In L. A. Lievrouw & S. Livingstone (Eds.), The handbook of new media (pp. 230–245). London: Sage.
Cooren, F. (2004). Textual agency: how texts do things in organizational settings. Organization, 11(3), 373–393.
Deleuze, G. (1989). What is a dispositif? In T. J. Armstrong (Ed.), Michel Foucault: Philosopher (pp. 159–168). New York: Routledge.
Ellingsen, G., & Monteiro, E. (2003). A patchwork planet: integration and cooperation in hospitals. Journal of Computer Supported Cooperative Work, 12(1), 71–95.
Ellingsen, G., & Monteiro, E. (2006). Seamless integration: standardisation across multiple local settings. Journal of Computer Supported Cooperative Work, 15(5–6), 443–466.
Flick, U. (2006). An introduction to qualitative research. London: SAGE.
Fujimura, J. (1992). Crafting science: Standardized packages, boundary objects, and ‘Translation’. In A. Pickering (Ed.), Science as culture and practice (pp. 168–211). University of Chicago Press: Chicago.
Hammersley, M., & Atkinson, P. (1997). Ethnography. Principles in practice. London: Routledge.
Hartswood, M., Procter, R., Rouncefield, M., & Slack, R. (2003). Making a case in medical work: implications for the electronic medical record. Journal of Computer Supported Cooperative Work, 12(3), 241–266.
Hughes, T. P. (1983). Networks of power: Electrification in western society, 1880–1930. Baltimore: Hopkins.
Kirsh, D. (1995). The intelligent use of space. Artificial Intelligence, 73(1–2), 31–68.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (1999). To err is human—building a safer health system. Washington: Institute of Medicine, National Academy Press.
Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., et al. (2005). Role of computerized physician order entry systems in facilitating medication errors. Journal of the American Medical Association, 293(10), 1197–1203.
Latour, B. (1992). Where are the missing masses? The sociology of a few mundane artifacts. In W. E. Bijker & J. Law (Eds.), Shaping technology/building society (pp. 225–58). Cambridge: MIT.
Law, J. (1994). Organizing modernity. Oxford: Blackwell.
Lee, C. P. (2007). Boundary negotiating artifacts: unbinding the routine of boundary objects and embracing chaos in collaborative work. Journal of Computer Supported Cooperative Work, 16(3), 307–339.
Luff, P., & Heath C. (1998). Mobility in Collaboration. In S. Poltrock & J. Grudin (Eds), Proceedings of the 1998 Conference on Computer Supported Cooperative Work (pp. 305–314). ACM: Seattle.
Markussen, R., & Olesen, F. H. (2004). Reconfigured medication—writing medicine in a sociotechnical practice. Configurations, 11(3), 351–381.
Muniesa, F., Millo, Y., & Callon, M. (2007). An introduction to market devices. In M. Callon, Y. Millo, & F. Muniesa (Eds.), Market devices (pp. 1–12). Norwich: Blackwell.
Østerlund, C. S. (2006). Documents in place: demarcating places for collaboration in healthcare settings. Journal of Computer Supported Cooperative Work, 17(2–3), 195–225.
Power, M. (1997). The audit society. Rituals of verification. Oxford: Oxford University Press.
Rolland, K. H., & Monteiro, E. (2002). Balancing the local and the global in infrastructural information systems. The Information Society, 18(2), 87–100.
Rosenberg, C. E. (1987). The care of strangers. The rise of America's hospital system. New York: Basic Books.
Schmidt, K. (1997). Of maps and scripts. The status of formal constructs in cooperative work. In S.C. Hayne, W. Prinz, M. Pendergast, K. Schmidt (Eds): Group ‘97. Proceedings of Conference on Supporting Group Work, Phoenix, Arizona, 16 to 19 November 1997 (pp. 138–147). ACM: New York.
Schmidt, K., & Simone, C. (1996). Coordination mechanisms: towards a conceptual foundation of CSCW systems design. Journal of Computer Supported Cooperative Work, 5(2–3), 155–200.
Schmidt, K., & Wagner, I. (2004). Ordering systems: coordinative practices and artifacts in architectural design and planning. Journal of Computer Supported Cooperative Work, 13(5–6), 349–408.
Star, S. L., & Griesemer, J. R. (1989). Institutional ecology, ‘Translations’ and boundary objects: amateurs and professionals in berkeley’s museum of vertebrate zoology, 1907–39. Social Studies of Science, 19(3), 387–420.
Strauss, A. (1993). The continual permutations of action. New York: Aldine de Gruyter.
Weick, K. E., Sutcliffe, K. M., & Obstfeld, D. (2005). Organizing and the process of sensemaking. Organization Science, 16(4), 409–421.
Winthereik, B. R., & Vikkelsø, S. (2005). ICT and integrated care: some dilemmas of standardising inter-organisational communication. Journal of Computer Supported Cooperative Work, 14(1), 43–67.
Xiao, Y., Lasome, C., Moss J., Mackenzie C. F., & Faraj S. (2001). Cognitive properties of a whiteboard: A case study in a trauma centre. In W. Prinz, M. Jarke, Y. Rogers, K. Schmidt & V. Wulf (Eds) ECSCW ‘01. Proceedings of the Seventh European Conference on Computer-Supported Cooperative Work, Bonn, Germany, 16 to 20 November, 2001 (pp. 259–178). Klüver: Dordrecht.
Yin, R. K. (1994). Case study research. Design and methods. Thousand Oaks: Sage.
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Bossen, C., Markussen, R. Infrastructuring and Ordering Devices in Health Care: Medication Plans and Practices on a Hospital Ward. Comput Supported Coop Work 19, 615–637 (2010). https://doi.org/10.1007/s10606-010-9131-x
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DOI: https://doi.org/10.1007/s10606-010-9131-x