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Objective: The introduction of health information technologies (HIT) can lead to unintended consequences. We studied a newly introduced electronic messaging (e-messaging) system for communication between homecare providers and general practitioners (GPs) in Norway. The objective of this paper is to identify and discuss unintended consequences of the introduction of e-messaging, particularly how it affected collaboration between the groups., Methods: Qualitative data from interviews with homecare staff (23), GPs (11), medical secretaries (5) and project managers (4), lasting in average 45min. Data was analysed using an interpretative approach., Results: We highlight three unintended consequences, which broadly led to changes in work practices for homecare nurses and GPs. (1) Communicating via e-messaging led to less face-to-face contact between homecare nurses and GPs. Even though e-messaging meant the opportunity to communicate more efficiently both groups emphasised the need for sustaining interpersonal relations via face-to-face communication to collaborate efficiently. (2) E-messaging made it easy to be proactive and send information. Consequently, tasks and responsibilities were sometimes reconfigured in unexpected ways. (3) Nurses said that the fact that e-messages were automatically documented in the patient's electronic patient record (EPR) system gave more weight to their requests. Nurses experienced e-messages as a more powerful means of communication vis-à-vis GPs than other means of communication, thus making e-messaging a tool for empowering them in their collaboration with GPs., Conclusion: Unintended consequences of HIT affect collaboration between healthcare workers. The consequences may be both desirable and undesirable. Previous research has mostly focused on the undesirable unintended consequences. We show that the introduction of e-messaging led to both desirable and undesirable unintended consequences for interprofessional collaboration. More insight into positive unintended consequences can be a resource in the reorganisation of work that often accompanies the implementation of HIT., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Clinical work is increasingly fragmented and requires extensive articulation and coordination. Computer systems may support such work. In this study, we investigate how instant messaging functions as a tool for supporting articulation work at the hospital., Purpose: This paper aims to describe the characteristics of instant messaging communication in terms of number and length of messages, distribution over time, and the number of participants included in conversations. We also aim to determine what kind of articulation work is supported by analysing message content., Methods: Analysis of one month's worth of instant messages sent through the perioperative coordination and communication system at a Danish hospital., Results: Instant messaging was found to be used extensively for articulation work, mostly through short, simple conversational exchanges. It is used particularly often for communication concerning the patient, specifically, the coordination and logistics of patient care. Instant messaging is used by all actors involved in the perioperative domain., Conclusion: Articulation work and clinical work are hard to separate in a real clinical setting. Predefined messages and strict workflow design do not suffice when supporting communication in the context of collaborative clinical work. Flexibility is of vital importance, and this needs to be reflected in the design of supportive communication systems., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Introduction: In surgical work there is a need for 'continuous planning' among staff to handle the frequently occurring variations from the planned patient treatment. In this paper, we present how three hospital information systems have support for three common patient trajectory variations., Purpose: Highlight how deviations from a plan cause different information needs and implications for design of awareness supporting computer systems., Methods: Participant observations and semi-structured interviews with stakeholders involved in peri-operative work., Results: When trajectories progress according to plan, information needs of staff seem to be minimal, as everything is "running to plan". However, when variations occur the information need increases. In order to provide better support for variations, awareness-support systems need to inform colleagues and other stakeholders about deviations from the plan. Plans and trajectories also need to be connected by projecting estimations of incidental time of ongoing relevant events. Additionally, end-users should have the option to switch between information-sparse and information-rich computer support., (Published by Elsevier Ireland Ltd.)

Objective: The purpose of this study was to investigate how staff working in the perioperative domain copes with unforeseen events and in what way, if at all; they are supported in this by formal systems such as information systems., Design: Case study. We conducted our study in the Department of Surgery in a large academic hospital in Norway. The department consists of eight operating rooms for planned surgery. The study included observations and interviews, in addition to one design workshop with health personnel. We focused on planned surgery., Results: Our observations showed that unforeseen events that cause deviations from plans are characteristic and that staff apply different coping strategies to make the plan work regardless. Support of these coping strategies by formal systems is poor., Discussion: We used the concept of high-reliability organisations as proposed by Weick and Sutcliffe, 2007, to analyse the observed coping strategies. The coping strategies can be seen as examples of the principles for managing the unexpected that Weick and Sutcliffe propose. IT support for this must include both awareness-creating systems and systems that enable workers to control the effects of unforeseen events once they have occurred., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)