Evaluating healthcare information systems through an “enterprise” perspective

Here we reflect upon the design and implementation of large-scale healthcare IS, noting the tendency of such systems to gravitate from a delivery (clinical) to a control (managerial) emphasis. Drawing on the concept of the ‘enterprise model’, we examined how adopting different perspectives of the enterprise might inform both design and evaluative criteria.     

Main and interactive effects of shiftwork, age and work stress on health in an Italian sample of healthcare workers

Among healthcare workers, shiftwork (mostly if nightwork is also included), ageing and work-related stress may be factors leading to impaired health. Such risk factors may also operate in interaction, resulting in an even increased harm for health. The present study aims at evaluating these relationships in a sample of 1842 hospital workers in Northern Italy. Subjects were mainly women, 33.1% were aged > or = 45 yr, and they were almost evenly distributed between dayworkers and rotating shiftworkers (nights included). Shiftwork was associated with poor sleep, while it was protective against gastrointestinal disorders, poor work ability and job dissatisfaction. Work stress was the risk factor with the highest relevance for poor health. Ageing was associated with lower physical health. Few significant interactions were observed. Shiftwork with nights and high work stress significantly interacted in increasing the risk for poor sleep. The "healthy worker effect" may have played a strong role in study findings.     

Implementing information systems with project teams using ethnographic-action research

Architecture, engineering, and construction (AEC) projects are characterized by a large variation in requirements and work routines. Therefore, it is difficult to develop and implement information systems to support projects. To address these challenges, this paper presents a project-centric research and development methodology that combines ethnographic observation of practitioners working in local project organizations to understand their local requirements and the iterative improvement of information systems directly on projects in small action research implementation cycles. The paper shows the practical feasibility of the theoretical methodology using cases from AEC projects in North America and Europe. The cases provide evidence that ethnographic-action research is well suited to support the development and implementation of information systems. In particular, the paper shows that the method enabled researchers on the cases to identify specific problems on AEC projects and, additionally, helped these researchers to adapt information systems accordingly in close collaboration with the practitioners working on these projects.     

The social organisation of communication in the home of the twenty-first century: an analysis of the future of paper-mail and implications for the design of electronic alternatives

This paper reports ongoing investigations into the use and role of paper-mail communications in domestic environments. It utilises ethnographically informed data to analyse how paper-mail supports various social roles within the home, particularly a division of labour whereby women tend to be largely responsible for what may be called "managing the home". Implications for the future of paper-mail are considered, as well as suggestions made about how email tools may be designed to reflect the patterns of social organisation within the home. Electronic Publication     

Ergonomics and human factors: the paradigms for science,engineering, design,technology and management of human-compatible systems

This paper provides a theoretical perspective on human factors and ergonomics (HFE), defined as a unique and independent discipline that focuses on the nature of human-artefact interactions, viewed from the unified perspective of the science, engineering, design, technology and management of human-compatible systems. Such systems include a variety of natural and artificial products, processes and living environments. The distinguishing features of the contemporary HFE discipline and profession are discussed and a concept of ergonomics literacy is proposed. An axiomatic approach to ergonomics design and a universal measure of system-human incompatibility are also introduced. It is concluded that the main focus of the HFE discipline in the 21st century will be the design and management of systems that satisfy human compatibility requirements.     

Representing older and disabled people in virtual user trials: data collection methods

A database was developed to support the creation of a computer-based tool which will support design teams in evaluating the usability of a design during early prototyping and indicate which individuals are effectively excluded or designed out. Methods are described for the collection of multivariate data on 100 real individuals covering a range of physical characteristics and capabilities. These data were tested to ensure a breadth of representation of individuals (particularly older and disabled people) in terms of anthropometry, joint constraints, postural capabilities and task behaviours. The concept of the design tool itself is explored by conducting virtual user trials in the computer-aided design environment. The novel approach of the research encourages empathy with individual users and allows generic abilities, such as bending, reaching and lifting to be assessed.     

Digital homes on wheels: designing for the unimagined home

Design for the digital home is often predicated on an ideal, imagined domestic space that is expansive, stable, occupied by a “busy” nuclear family, and does not always match existing, real-life digital homes. Using American retirees living full time in recreational vehicles as our case study of actual digital homes, we argue that designing suitable and appropriate technologies for the home must be done with particular attention to the home as embodied, rather than the home as ideal. The challenges and advantages of designing for embodied homes are detailed in this paper. We contend that appropriate design must seriously engage not only the material body of the house, but the social fabric—the complex sets of social relationships and identities and practices they support—that make a house a home. An analysis of the salient aspects of the material body and social fabric of full time retired RVer household leads to bespoke design considerations for these real-life digital homes.

The `adequate' design of ethnographic outputs for practice: some explorations of the characteristics of design resources

The community of `appliance design' rests generally upon a successful use of multidisciplinary user-centred design and often draws on an ethnographic component. Much has been made of the need for a multidisciplinary team and of the difficulties of making good use of ethnographic outputs in such a team. Discussions often centre upon the precise placement of the boundary between ethnography and design and the possibilities of hybridisation of these disciplines. Another way of looking at the issues of multidisciplinary teams is to look at the nature of the representational devices used to encapsulate and aid the communication of the ethnographic work in coherent and useful ways. Taking lessons from existing design practice, we look at how such representational devices actually work and propose some possible features important in the realisation of future best practice.     

Patterns of home life: Informing design for domestic environments

This paper considers how we may provide support for the development of general design principles in domestic environments. In particular, we examine the potential for usingdesign patterns as a means of presenting ethnographic material and outlining design solutions. The paper reports on the development of an initial pattern language based on our studies of a number of domestic, environments and offers a general structure for presenting these patterns. Finally, we briefly reflect on our experiences of developing an on-line set of patterns for this class of environment.     

Using an ethnographic process to conduct requirements analysis for agile systems development

Since the late 1990s, agile or lightweight software development methodologies have experienced a meteoric rise of interest among systems developers who consider traditional systems development methodologies (such as Structured Systems Development, Information Engineering, and Rational Unified Process) too inflexible for building systems having unpredictable and changing requirements. Agile methodologies try to adapt to rapid requirement changes by having short, iterative development cycles and by encouraging frequent, open communication with customers. However, agile methodologies are still in the process of devising systematic approaches on how to be adaptive to unpredictable and changing requirements and how to incorporate customers into the systems development process. In this study, we show how an ethnographic research process called Strip Resolution can be applied as a systematic complement to projects applying agile development principles. We illustrate, in detail, how the Strip Resolution Process (SRP) enabled us, in the role of systems developers, to adapt to changing and unpredictable user requirements and to incorporate customers into the systems development process.     

Cognitive ergonomics, socio-technical systems, and the impact of healthcare information technologies

The United States healthcare system is transitioning from paper-based to computer-based systems. In this process, it is vitally important to focus on optimizing the role of human factors in systems design. This review examines a wide range of cognitive ergonomics and socio-technical systems issues that impact the successful implementation of healthcare information technologies (HIT). We review evidence on the impact of HIT on medication errors, electronic health records and clinical support, copying clinical exams and notes, computerized-provider order entry and clinical decision support system, and bar-code medication administration systems. We examine research on barriers to successful HIT implementation and also on user workarounds of systems’ limitations. The review concludes by summarizing a series of important human factors design considerations that must be considered for successful systems implementation. This information is presented in a manner that should allow HIT system designers and implementers to readily incorporate these principles into their future developments.Relevance to industry: Evidence from a comprehensive review of the impact of HIT on a wide variety of important healthcare issues is presented and a series of human factors design considerations that are critical to successful HIT systems design is summarized.     

How can ergonomics influence design? Moving from research findings to future systems

Ergonomics design is about the creation of future work. So how can ergonomics research support and inform design if its findings are cast in a language oriented towards current work derived from field observations or laboratory settings? In this paper we assess instances of three different strands (experimental, ethnomethodological, and surveys) of ergonomics research on paper flight strips in air traffic control, for how they analytically confront future work and how they make the findings relevant or credible with respect to future work. How these justifications come about, or how valid (or well argued for) they are, is rarely considered in the ergonomics literature. All three strands appear to rely on rhetoric and argument as well as method and analysis, to justify findings in terms of their future applicability. Closing the gap between research results and future work is an important aim of the ergonomic enterprise. Better understanding of the processes necessary to bridge this gap may be critical for progress in ergonomics research and for the use of its findings in actual design processes.     

A baseline security policy for distributed healthcare information systems

In this paper, the need for identifying and analyzing the generic security characteristics of a healthcare information system is, first, demonstrated. The analysis of these characteristics is based upon a decision-support roadmap. The results from this profiling work are then analyzed in the light of the fact that more than 1000 accidental deaths happened due to computer system failures. As a result of this analysis, a set of recommendations is drawn up, leading to the development of a baseline security policy for healthcare institutions. Such a policy should be flexible enough to reflect the local needs, expectations and user requirements, as well as strict enough to comply with international recommendations. An example of such a baseline policy is then provided. The policy refers to a given security culture and has been based upon an abstract approach to the security needs of a healthcare institution.     

特殊人群远程健康监护系统的研究和实践

随着社会逐步向老龄化发展,老年人患慢性病,特别是高血压、糖尿病、心脑血管、肿瘤等疾病的人数增加;另一方面,“看病难、看病贵”的问题也日益凸显.通过养老院和社区的老年人中慢性病人的调查,关注他们的健康服务和预警需求,建立基于物联网技术的健康服务平台,逐步补充和完善老年人健康档案、并探索第三方健康服务的新型模式,实现医疗资源的跨院共享.     

土木工程专业《道路勘测设计》课程教学与实践研究

摘要：道路勘测设计课程的特点是实践性强、主观性强、涉及学科门类多,因此该课程教学与实践改革应以人为本,加大实践性、应用性的教学力度,理论结合工程实践,培养学生发现问题、建立问题、分析问题并解决问题的能力,提高学生素质和培养学生创新意识及自觉获取知识的能力。     

Collaboration and controlCrisis management and multimedia technology in London Underground Line Control Rooms

Despite technical advances over the past few years in the area of systems support for cooperative work there is still relatively little understanding of the organisation of collaborative activity in real world, technologically supported, work environments. Indeed, it has been suggested that the failure of various technological applications may derive from their relative insensitivity to ordinary work practice and situated conduct. In this paper we discuss the possibility of utilising recent developments within sociology, in particular the naturalistic analysis of organisational conduct and social interaction, as a basis for the design and development of tools and technologies to support collaborative work. Focussing on the Line Control Rooms in London Underground, a complex multimedia environment in transition, we begin to explicate the tacit work practices and procedures whereby personnel systematically communicate information to each other and coordinate a disparate collection of tasks and activities. The design implications of these empirical observations, both for Line Control Room and technologies to support cooperative work, are briefly discussed.The research discussed in this paper is supported in part through a project grant from the ESRC/MRC/SERC Joint Initiative on Cognitive Science and Human Computer Interaction and part by Rank Xerox, Cambridge EuroPARC. The authors have greatly benefitted from discussions with Jens Rasmussen, John Gardner, Bernard Conein, Isaac Joseph, Marina Jirotka and Liam Bannon concerning a number of the issues addressed in this paper. The authors are alone responsible for the contents of the piece.     

艺术设计实践教学模式的探寻与创新实践——以环境艺术设计实践改革为例

本文简述欧美艺术设计实践教学模式的发展及优秀经验,阐述我国艺术设计实践教学模式的现状。以我校环境艺术设计实践教学创新改革为切入点,介绍两个实践案例。     

Human factors systems approach to healthcare quality and patient safety

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety.     

Working relations of technology production and use

This paper explores the relevance of recent feminist reconstructions of objectivity for the development of alternative visions of technology production and use. I take as my starting place the working relations that make up the design and use of technical systems. Working relations are understood as networks or webs of connections that sustain the visible and invisible work required to construct coherent technologies and put them into use. I outline the boundaries that characterize current relations of development and use, and the boundary crossings required to transform them. Three contrasting premises for design-the view from nowhere, detached engagement, and located accountability — are taken to represent incommensurate alternatives for a politics of professional design. From the position of located accountability, I close by sketching aspects of what a feminist politics and associated practices of system development could be.I am deeply grateful to Phil Agre, Jeanette Blomberg, Andrew Clement, Mike Hales, Susan Newman, Leigh Star, Randy Trigg, and Ina Wagner for their careful readings and critical suggestions on earlier versions of this paper.