IT in Healthcare - Artefacts, Infrastructures and Medical Practices

Sammanfattning: Globally, health care is making huge investments in information technology. Several studies illustrate that IT implementations have been fraught with problems. Everywhere, the problems appear to be similar, irrespective of the national health care system. The full potential of these technologies is not achieved, and their use is thus limited. At the same time, it is reported that 60 % of the radiology departments in Sweden are planning to introduce Picture Archiving and Communication Systems (PACS) by the year 2002. The overall research question in this study was; how can we improve the design, implementation and use of PACS by studying the complex interrelationships between the medical staff, the technologies, the work practice and the Healthcare community as a whole? Four ethnographic field studies at different radiology departments in Sweden were conducted. These involved interviews, video documentation and observations of radiological practice and social interaction. As the theoretical framework, various concepts from Actor Network Theory and the concept of Borderline issues were applied to explore the complex interrelationship between medical staff, medical staff and technologies, and various technologies within Healthcare. The study illustrates that when analog films were replaced with PACS images, not only technical devices were integrated, but the people, work practices and organizations as well. It also shows that by studying how the properties of artefacts are used in work practice, we get an idea of the essential resources and prerequisites for the work being done. This knowledge helps us to understand what resources the new information technology should and could replace in a transformation, even if there is no guarantee that it will be used as expected. Furthermore, the study concludes that the larger the socio-technical medical network implementing PACS the harder it will be to coordinate the actions of all actors in a change. Therefore, the study suggests that the infrastructures and work practices can only be changed in a process where smaller parts, are replaced by new ones bit-by-bit. To achieve the “real” opportunities of PACS technology will take time. It is suggested that one way to improve PACS use is to consider it as a “work oriented infrastructure” (WOI). This term is supposed to draw our attention to the fact that these systems are developed to support specific work tasks. These infrastructures should be designed and implemented primarily by their users, based on their actual use of the technology. WOIs are constructed by linking artefacts together. The old and the new sociotechnical networks must be linked through interfaces, enabling networks with different technical solutions to communicate and interact. To summarize, firstly, to improve the application of PACS and RIS in medical practice, the design of computer systems has to be informed by a better understanding of all the roles and meanings of the x-ray films and paper request forms in work. Secondly, there is a great potential for improvements in performance of these systems through relatively simple means, by implementing the achieved knowledge in the medical actor network.