Abstract High-quality hospital care requires careful medication management. The infrastructure in place to avert errors in medication management involves formal work procedures, elaborate electronic systems, and, we argue, continual repair work. Repair is the work required to restore things to working order after a breakdown. In this study, we analyze the repair work performed by the healthcare professionals tasked with two electronically supported medication-management processes at hospitals in Norway: medication reconciliation and closed-loop medication management. On the basis of interviews and supplementary material, we find that the repair work involved in these two activities is collaborative, continuous, and critical. It is collaborative in that it is performed by physicians, pharmacists, and nurses and, thereby, neither assigned to a single person nor to a group of designated repairers. It is continuous because the repairs do not fix the causes of the breakdowns but merely restore the individual instance of medication management to working order. It is critical in the double sense that repair work is a requirement for quality medication management and that quality repair work is also a requirement. We discuss the implications of the repair work, including the consequences of variation in the achieved level of repairedness.

Abstract In information infrastructures at hospitals, various stakeholders are responsible for specific information and communications technology (ICT) portfolios. Each portfolio represents a unique digital trajectory with a past, present, and future. This study investigated how stakeholders (in this study, software developers, ICT operations organizations, and users) collaborate to facilitate the convergence of different digital trajectories, thus contributing to the successful evolution of information infrastructures. Empirically, we focused on the preparatory work involved in implementing an app that would enable nurses to register and calculate National Early Warning Scores at Nordland Hospital in northern Norway. Specifically, we examined the collaboration between three stakeholders to align their respective ICT portfolios and prepare for the new solution. These stakeholders were the Finnish software developer Medanets, the Norwegian Electronic Health Record developer DIPS ASA, and the Northern Norway Regional Health Authority, which governed the regional health ICT infrastructure. These stakeholders governed three distinct portfolios that had been developed over many years and, in this sense, represented digital trajectories with a past, a present, and a possible future. This study is positioned within the computer-supported cooperative work field, and the analysis draws upon the theoretical concepts of information infrastructure and trajectories.

Large-scale generic systems are typically adapted to local practice through configuration. This is especially important in healthcare, which involves a plurality of institutions and users. However, the decision to acquire a generic system in public healthcare is typically founded on regional and national health policy goals, which often are translated into various forms of standardization. As a result, national and regional health policy interests may stand in contrast to interests on the local level. Therefore, we analyze how national and local concerns are weighed against each other in the preparations for implementing large-scale generic systems in healthcare. We explore what role configuration plays and what the prospects are for long-term development. We contribute with insight into how the organizational consequences of generic systems are formed already in the preparation phase and point to how configuration easily results in standardization, thereby basically privileging national and regional health goals at the expense of local needs. Empirically, we focus on the preparations for implementing the Epic electronic health record in Central Norway.

Clinical Decision Support (CDS) Systems are considered crucial for diagnosis, treatment and care of patients. However, practical benefits of such systems have been far below expectations. This paper explores how the evolving interdependencies in organizational, clinical, political, and behavioral terms influence the design and implementation of CDS. The paper discusses how these interdependencies complicate clinical use of CDS where cross-departmental patient pathways increasingly dominate approaches to dealing with patients with complex conditions. Empirically, we report from an acute geriatric patient pathway project. The aim was to design and implement a decision-support form for triage of elderly patients in the emergency unit. The study emphasizes the intertwined collaborative nature of healthcare work, and the resulting need to consider the whole context when designing and implementing CDS tools. The contribution is to emphasize the “extended design” perspective to capture how workplace technologies and practices are shaped across multiple contexts and prolonged periods.

In this article, we study the change from oral to computer-mediated handover among nurses in the psycho-geriatric ward at the University Hospital of Northern Norway. We explore what issues are at stake when introducing written handover to a particular nursing practice. At the core of nursing documentation is the electronic care plan, and we discuss its role and interplay vis-à-vis the other information sources in the ward. Furthermore, we examine the inherent tension between the increased pressure (among nurses) to document on the one hand, and the need to discuss patient issues first on the other. Finally, we discuss how the use of the care plan, video-projector and the newly established morning meeting collectively served as a basis for a new and better collaborative setting for the nurses.

In this paper, we contribute with empirical insight into the complexity of establishing and sustaining integration between different information infrastructures in health care. An overall concern is to elaborate on how, despite many obstacles, the integration effort moves forward. We see this as a collective achievement, where users have an essential role in terms of mobilizing and coordinating the other actors as well as maintaining the integration. These activities are not limited to a specific project; they emerge from and are part of day-to-day practice. Empirically, we focus on a large integration initiative between the laboratory systems at the University Hospital of Northern Norway and the electronic patient records used by general practitioners in the Northern health region. Together with the vendor, Well Diagnostics, the hospital initiated a project aimed at establishing a new laboratory requisition system that enabled GPs to send requisitions electronically to the hospital laboratories. Theoretically, we draw on the concept of information infrastructures, and supplement this with Actor Network Theory.

This paper presents an interpretive case study on extraction of disease surveillance data from Electronic Patient Records (EPRs) in primary care. The General Practitioners (GPs) use of the EPR system, and the effect this has on data content, such as symptoms reported by patients and diagnoses reported by GPs, is discussed. The paper contributes to greater understanding of sociotechnical issues related to disease surveillance, and contains illustrative examples of many issues important to CSCW. This includes how data collected in one context may be applied to a different context, and the delicate interplay between organizational and technical design challenges.

Drawing on a critical perspective stemming from socially informed studies of medicine, we analyze an ongoing effort to establish electronic nursing plans at the university hospital of central Norway (St. Olav's hospital). We argue for an alternative interpretation of the relative lack of success to date of making the nurses use the nursing plans. Rather than a preoccupation with the singular artifact the - plan - we emphasize the process of planning as a collective, ongoing and heterogeneous achievement. Our perspective on plans implies that they should be recognized as more of a network and less a singular artifact.

This paper reports from an introduction of the electronic patient record for nurses in a Norwegian hospital. In addition to establish electronic written accounts of nurses' reports, a major aim was to formalize nurses' work, related to handover conferences. Despite the projects proclaimed success, like reduced overtime, improved quality of the written documentation and eliminated redundancy, our analysis demonstrates an opposite effect. Formalizing the nursing handover and thus reduce redundancy, in fact resulted in a reintroduction of redundancy, although at another time and place. We found that work (and redundancy) in fact had moved, to another time (i), into different artifacts (ii), or old artifacts that now were used/annotated differently (iii).