Our study delves into the pivotal role of policies in the success of digital transformation initiatives, focusing on a case study of digitizing patient records at a general hospital. We aim to bridge the research gap on how policies are interpreted and applied in such projects, using a qualitative approach to understand the motivations and actions of the involved parties. By transitioning from paper to digital formats for clinical letters and test results, the project sought to optimize space and improve document access. Our findings, drawn from field notes and observations, highlight the diverse interests in digitization, from space management to policy compliance. We conclude with insights on the importance of policies in digital transformations, offering valuable lessons for future projects and digital archiving efforts.

The results of CSCW studies should be more effectively incorporated into software engineering practices. This paper focuses on two concepts supporting software component choice and development in IS architecture: artifact ecologies and data work. Using a case study in telemedicine, we propose MADRAE, an extension of the UML component diagram, for modeling practice-based artifact ecologies that emphasize the necessary data work. In the hospital where we tried MADRAE, it was considered helpful by the head of the IS department to analyze existing artifact ecologies and generate design and architecture proposals.

Creating an overview of a patient’s situation is essential for medical work, particularly for care actors participating in integrated care pathways. While we notice the failure of national initiatives to create systems to support care actors’ practices, our research focuses on investigating the actual practices held by care actors to build these overviews. Our study shows that care actors document their patients’ cases and communicate about them. We, therefore, imply that systems supporting integrated care pathways should couple documents and discussions and permit their visualization according to three dimensions: the problems that occur, the source of information (the care actor), and the time.

The growing use of teleconsultation, especially since the start of the Covid-19 pandemic, changes physicians' work at the hospital. In this paper, we set out to study how physicians have integrated teleconsultation into their healthcare practices. Moreover, we are interested in how teleconsultation software contributes to developing new medical practices and how the design of teleconsultation software can better support them. Based on 16 months of fieldwork in a general hospital that offers two different teleconsultation software, we have investigated teleconsultation practices through interviews and observations involving ten physicians doing teleconsultation and a telemedicine secretary. Unlike the existing informal remote care by phone, we observe that teleconsultation supports new formal healthcare practices, particularly for patient care management and inter-organizational cooperation. While analyzing the integration of teleconsultation in physicians' practices, we highlight that both pieces of software do not support those practices on equal terms according to their design. We argue that teleconsultation software design can limit the spread of these new healthcare practices and that the artifact ecology of physicians should be considered during the design process.

In this paper, we compare two cases of collaboration within healthcare in two European countries, Denmark and France respectively. In each of these two cases, we conducted a design case study, and we found that collaboration is ad hoc, temporary, and shifting with regards to collaborators, aims, and processes. We argue for the relevance of knotworking and its analytic potential for investigating the kind of collaborative work we observed. We also argue that our two cases present a higher complexity level than how knotworking has previously been described in the literature. We describe complex knotworking as having three characteristics: 1) collaboration happens between a dynamic number of actors (who are usually loosely connected), 2) collaboration happens in episodes, and 3) cooperative work arrangements are constantly negotiated. Using the concept of complex knotworking for a comparative analysis of our two design solutions, we outline generic design guidelines for developing computer support to manage complex knotworking situations.

Telemedicine is presented by the French government and regional authorities in France as key to guaranteeing equal access to healthcare. Research on telemedicine has highlighted how it impacts the work practices of healthcare professionals and how its adoption is challenging. In this context, we are interested in understanding how the discourses and policy on equal access to healthcare are implemented and how they impact the deployment of telemedicine solutions in practice. We are currently studying the deployment of a teleconsultation solution for nursing homes inside a group of hospitals in Northeast France. On the basis of on-site visits at four nursing homes and interviews with the different stakeholders, we analyzed the domestication of the teleconsultation solution. Our first results highlight that the defined policy is useful to support the deployment of the technology but does not appear as sufficient for its incorporation into regular work practices. Our hypothesis to understand this obstacle is that nursing homes would need to endorse a new role to engage in further incorporation and later stage of domestication, which may be prevented by their existing ecosystem.