Norwegian Centre for Integrated Care and Telemedicine at the University Hospital of North Norway, Norway.
Int J Med Inform. 2011 Sep;80(9):631-45. doi: 10.1016/j.ijmedinf.2011.06.007. Epub 2011 Jul 23.
The purpose of this study was to learn about factors that influence the design and implementation of situated computing solutions that support hospital work. This includes social and technical aspects of the actual systems that will be implemented, as well as the appropriate design methodology for developing these systems.
Staff at a surgical department at a University hospital were engaged in a participatory design (PD) process to help solve a problem that was presented by the staff: scheduling of patients and surgery rooms, and creating awareness of the status of ongoing surgeries. The PD process was conceptually aided by a model that describes Medical Informatics Systems as comprising of three components, a service component, a technical component and a social component. The process included the use of ethnographic field work and iterative redesign of both technical and social components of the system after it had been implemented into day-to-day work practice.
The PD process resulted in the creation of a system that was iteratively created over a period of about 2 years, and which then handed over to the IT department of the hospital and used by the surgical department for a period of about 1 additional year. The first version of the prototype that was implemented contained usability flaws that made the system difficult to use in time critical situations. As a result of observations and a redesign of the technical component and social component of the system a new version was possible to implement that managed to overcome this problem. A key feature of this second version of the system was that some responsibility for data entry validation was shifted from the technical component of the system to the social component of the system. This was done by allowing users to input poor data initially, while requiring them to fix this data later on. This solution breaks from "traditional" usability design but proved to be quite successful in this case. A challenge with the solution, however, was that the IT department could not understand the concept of systems being described as comprising of both social components and technical components, and thus they had difficulty in understanding the overall design of the system during the handover process.
Situated computing can present a number of design challenges that may not be easy for designers and hospital workers to understand before a system has been implemented. Situated computing development may thus need to be aided by PD that includes both ethnographic observations and iterative redesign of the system after it has been implemented. Traditional data validation mechanisms may create poor system performance in cases where users are rushed to input data into the computer due to pressures created by other more critical work activities. In this case it may be better to rely on social mechanisms for correcting errors later on, rather than error catching mechanisms that reject incorrect data. It can be challenging, however, to maintain such systems over time, as IT-departments may lack skills and interest in social components.
本研究旨在了解影响支持医院工作的情境计算解决方案设计和实施的因素。这包括实际系统的社会和技术方面，以及开发这些系统的适当设计方法。
在大学医院的外科部门，工作人员参与了参与式设计（PD）过程，以帮助解决工作人员提出的问题：患者和手术室的安排，以及对正在进行的手术状态的认识。PD 过程在概念上得到了一个模型的帮助，该模型将医学信息系统描述为由三个组件组成，即服务组件、技术组件和社会组件。该过程包括使用民族志实地考察和对系统的技术和社会组件进行迭代重新设计，然后将其实施到日常工作实践中。
PD 过程导致创建了一个系统，该系统在大约 2 年的时间内进行了迭代创建，然后移交给医院的 IT 部门，由外科部门使用了大约 1 年。最初实施的原型版本存在可用性缺陷，使得系统在时间关键情况下难以使用。由于对系统的技术组件和社会组件进行了观察和重新设计，因此可以实施新版本来解决这个问题。该系统的第二个版本的一个关键特征是，将数据输入验证的一些责任从系统的技术组件转移到了系统的社会组件。这是通过允许用户最初输入不良数据，同时要求他们稍后修复这些数据来实现的。这种解决方案打破了“传统”可用性设计的概念，但在这种情况下被证明是非常成功的。然而，该解决方案的一个挑战是，IT 部门无法理解系统被描述为由社会组件和技术组件组成的概念，因此在移交过程中，他们很难理解系统的整体设计。
情境计算可能会带来一些设计挑战，在系统实施之前，设计者和医院工作人员可能不容易理解。因此，情境计算的开发可能需要通过 PD 来辅助，该 PD 包括对系统实施后的民族志观察和迭代重新设计。在由于其他更关键的工作活动而给输入数据带来压力的情况下，传统的数据验证机制可能会导致系统性能不佳。在这种情况下，依赖于以后纠正错误的社会机制可能会更好，而不是拒绝错误数据的错误捕获机制。然而，随着时间的推移，维护这样的系统可能会具有挑战性，因为 IT 部门可能缺乏对社会组件的技能和兴趣。
