Scientific progress relies on contrarian thinking that questions assumptions shaping how scholars frame, study, or theorize phenomena. Unexamined, such assumptions perpetuate the same views, practices, and explanations, building entrenched research trajectories that limit scholarly debate on understanding the world. If we are interested in a healthy Information Systems (IS) discipline that contributes to a better world, we require precisely this openness to different understandings of the world. Therefore, for this special issue, we invited original submissions that embrace contrarian thinking and engage in value-reflexivity when investigating and theorizing about digital phenomena. In this editorial, we synthesize previous work to define contrarian thinking and link it to value-reflexivity. We then present how the special issue articles embrace such thinking through value-reflexivity. Our contribution to IS research is twofold: first, we illustrate the importance of such thinking for triggering and upholding vigorous debate on phenomena, research methods, and theory; second, we invite and encourage scholars to embrace contrarian thinking through value-reflexivity. By bringing contrarian thinking through value-reflexivity into explicit consideration, we hope to foster the boldness required for new, and even radical ideas for IS research to thrive and contribute to a better world.

Abstract This study explores the generative role of objects in design work. While the CSCW literature includes a range of contributions on infrastructure design and ways of accounting for diverse existing systems, practices and perspectives in design, the focus has typically been on the point of use, rather than the earlier stages of design processes. However, as more worker groups become involved in design there is a need to understand the microdynamics of collaborative design in this phase and the interplay between problem framing and exploration. We examined how the design of an information system in the health sector evolved through the instantiation and exploration of intermediary objects that become generative in the design process. The data comprised observations over 2 years from design meetings with a team of health professionals and software developers mandated to develop a system for the registration and sharing of patient information across primary care units. The analysis showed how intermediary objects formed focal points from which infrastructure design problems were framed and collectively explored. These processes required considerable negotiation and exploration within and between the interdependencies that become relevant in the design process. We identified how intermediary objects take different representational forms and become generative in two ways: By producing new or transformed objects, and by revealing layers of complexity inherent in the design problem. We discussed implications of the analysis as regards aspects of the infrastructure design that can be handled in the design team versus aspects that should be delegated to local adaptation.

Abstract Categorical work in chronic care is increasingly dependent on digital technologies for remote patient care. However, remote care takes many forms and while various types of digital technologies are currently being used, we lack a nuanced understanding of how to design such technologies for specific novel usages. In this paper, we focus on digital technologies for patient-generated health data and how their use changes categorical work in chronic care. Our aim is to understand how categorical work changes, which novel forms of categorical work emerge and what the implications are for the care relation. This paper is based on an ethnographic study of healthcare professionals’ work at a pelvic cancer rehabilitation clinic and their interactions with patients. In this setting, supportive talks between patients and nurses are central. To understand the complexities of categorical work in chronic care when patient-generated health data are introduced, we contrast the traditional supportive talks with supportive talks where the nurses had access to the patients’ patient-generated health data. We identify and analyze challenges connected to novel forms of categorical work. Specifically, we focus on categorical work and how it can undergo changes. Our empirical findings show how changes occur in the way patients’ lived experience of the chronic disease aligns with the categories from chronic care, as well as in the way the nurse works with clinical categories during the talk. These insights help us further understand the implications of patient generated-data use in supportive talks. We contribute to an improved understanding of the use of patient-generated health data in clinical practice and based on this, we identify design implications for how to make categorical work more collaborative.

This paper addresses the design of hybrid information spaces supporting patients and healthcare providers to have information in common and also, patients to manage privately personal health information. We studied efforts to develop such information spaces by following the design of two Personal Health Record applications and focusing particularly on design tensions that relate to their hybrid role. We identified and grouped tensions along three key themes: control allocation, content origination and user environment localization. For the resolution of tensions, functionality-related decisions were taken by professional design teams during the early design phases. These included the introduction of functionality that enables end-users to create regions with custom characteristics and dynamically adjust the regional boundaries. Delegating to end-users some of the regionalization work entailed in the design of such hybrid spaces points to a design strategy of providing generic enabling environments instead of configuring solutions “a priori” by designers that are external to use settings. Prior research on Personal Health Records mostly emphasizes the challenges of bridging patient and provider perspectives, in our research we shift attention to enabling hybridity and to the roles of designers and end-users for regionalization.