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Mental health home treatment is a service where patients with severe mental illnesses are visited by a multiprofessional psychiatric care team at their homes. In Germany, inpatient-equivalent home treatment as a specialized form of home treatment has been offered by hospitals since 2018. In its early stage, the shift of care activities out of the hospital toward the patient's home opened up a new set of problems and blurred the existing boundaries. This ethnographic study follows two home treatment teams and provides an in-depth description of their work. The findings are presented by three themes from our data analysis: (i) closeness and familiarity; (ii) bridging the distance; and (iii) tensions of proximity and distance. We then discuss the findings with the guiding lens of Becoming a Guest, which refers to the ambiguity of proximity and distance. The contribution for computer-supported cooperative work (CSCW) is twofold; on the one hand, we provide a detailed account of mental health home treatment, and on the other hand, we outline a conceptual model that helps to describe and analyze similar cases. We conclude the paper with directions for further research. [ABSTRACT FROM AUTHOR]

Patient records are central, constitutive parts of health care and hospitals. Currently, substantial sums are being invested in making patient records electronic, in order to take advantage of IT's ability to quickly accumulate, compute, and propagate data to multiple sites, to enhance coordination of health care services and cooperation among staff, and make patient records immediately accessible to distributed actors. Investors also aim to increase health care services' accountability and integration, and improve quality and efficiency. This paper analyses a Danish national standard for electronic health records, on the basis of an application prototype test designed to that standard. The analysis shows that, inscribed in the standard is an ambition to increase the accountability of staff and health care services at the cost of increased work, loss of overview, and fragmentation of patient cases. Significantly, despite the standard having been conceived and developed in a process of co-construction involving clinicians, clinicians did not find it adequate for their work. This analysis argues this was the result of the model of work embedded in the standard coming from a stance external to practice. Subsequently, a flip-over effect occurred, in which the model of work became a model for work. Hence, this paper argues that co-construction processes should not only include users as representatives of a profession, but strive to produce experiences and knowledge intrinsic to practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper reports our findings from a study of multidisciplinary team meetings for the treatment and ongoing management of breast cancer patients. The focus of the fieldwork was the meetings within and between a large group of multidisciplinary health professionals from two hospitals in Sydney, a large public teaching hospital and a much smaller private hospital. The paper examines the common work of the meetings and the variation within and between local practices and sites in the doing of this work, both in the local settings of each hospital and in the video-mediated setting when the local meetings are linked. Variations in the physical setup of the meetings, the presentation of the patient cases and the preparation of images used in patient discussion are identified, traced to their various sources and examined within their particular sociotechnical context. This is followed by a discussion of how local variation contributed to the particular challenges of the video-mediated meetings as experienced by the participants and how they might be addressed. Our motivations are to contribute both to the growing case studies of multidisciplinary team meetings within healthcare settings and to the important work being done to generate conceptual and design approaches that can support the development and successful use of CSCW technologies across highly variable local settings. [ABSTRACT FROM AUTHOR]

The aim of this paper is to contribute to strategies applicable to vendors who want to move their locally designed and highly integrated systems to a larger market. A further aim is to explore how such systems developed for a local practice, and tightly integrated with the existing infrastructure, can be adapted to a larger market. We analyse the socio-technical mechanisms in play, the roles that the vendor and the users have in order to facilitate this, and the delicate interplay in relation to the other vendors. The analysis draws on the CSCW field, notions of generification of packaged software products, and boundary work. We argue that this process involves boundary work in relation to the installed base, as well as to other vendors and users. We also argue that the roles of the actors involved change during this process. The case described in this paper is the evolution of a system in which general practitioners can order laboratory services from the hospital electronically. The system integrates the general practitioners’ information systems with the laboratory information system in the hospital. The development of the system started out in close cooperation with one customer, but as it evolved more customers bought the system. The system has been designed in an iterative and evolutionary way using agile development methods. [ABSTRACT FROM AUTHOR]

This paper presents a workplace study of triage work practices within an emergency department (ED). We examine the practices, procedures, and organization in which ED staff uses tools and technologies when coordinating the essential activity of assessing and sorting patients arriving at the ED. The paper provides in-depth empirical observations describing the situated work practices of triage work, and the complex collaborative nature of the triage process. We identify and conceptualize triage work practices as comprising patient trajectories, triage nurse activities, coordinative artefacts and exception handling; we also articulate how these four features of triage practices constitute and connect workflows, organize and re-organize time and space during the triage process. Finally we conceptualize these connections as an assessing and sorting mechanism in collaborative work. We argue that the complexities involved in this mechanism are a necessary asset of triage work, which calls for a reassessment of the concept of triage drift. [ABSTRACT FROM AUTHOR]

As health care IT gradually develops from being stand-alone systems towards integrated infrastructures, the work of various groups, occupations and units is likely to become more tightly integrated and dependent upon each other. Hitherto, the focus within health care has been upon the two most prominent professions, physicians and nurses, but most likely other non-clinical occupations will become relevant for the design and implementation of health care IT. In this paper, we describe the cooperative work of medical secretaries at two hospital departments, based on a study evaluating a comprehensive electronic health record (EHR) shortly after implementation. The subset of data on medical secretaries includes observation (11 hours), interviews (three individual and one group) and survey data (31 of 250 respondents were medical secretaries). We depict medical secretaries' core task as to take care of patient records by ensuring that information is complete, up to date, and correctly coded, while they also carry out information gatekeeping and articulation work. The importance of these tasks to the departments' work arrangements was highlighted by the EHR implementation, which also coupled the work of medical secretaries more tightly to that of other staff, and led to task drift among professions. Medical secretaries have been relatively invisible to health informatics and CSCW, and we propose the term 'boundary-object trimming' to foreground and conceptualize one core characteristic of their work: maintenance and optimization of the EHR as a boundary object. Finally, we reflect upon the hitherto relative invisibility of medical secretaries which may be related to issues of gender and power. [ABSTRACT FROM AUTHOR]

This paper discusses a research project in which social scientists were involved both as analysts and supporters during a pilot with a new wireless nursing call system. The case thus exemplifies an attempt to participate in developing dependable health care systems and offers insight into the challenges of developing and supporting such systems. The analysis proposes that while dependability is not simply a technical issue, neither is it something, which can be improved merely by adding a social dimension. Instead, it argues that dependability is a relative concept, which may mean different things conditional on how it is specified in practice and who gets to do this. This relativity makes it important to relate the question of how to support dependable health care systems to an analysis of both the politics of technology within specific projects and to the politics of discourse, through which the researcher becomes involved in such projects. [ABSTRACT FROM AUTHOR]

This paper uses a case study of collaborative work practices within the radiology department of a hospital, for examining the usefulness of spatial approaches to collaboration. It takes a socio-political perspective on understanding the shaping effects of spatial arrangements on work practices, and seeks to identify some of the key CSCW issues that can be addressed in spatial terms. We analyse the spatial settings or layers (physical, digital and auditory) within which work takes place, and the qualities of connections between them, examining in how far they support (professional) boundaries or help maintain a sense of context. Guiding themes are the relationships between space and the visibility of work, and how to accommodate social world needs through spatial arrangements. [ABSTRACT FROM AUTHOR]