The paper discusses the conventions used by medical practitioners to improve their collaboration mediated by Clinical Records. The case study focuses on the coordinative conventions identified in two wards of an Italian hospital and highlights their role and importance in the definition of the requirements of any system supportive of collaborative work practices. These requirements are expressed in terms of the provision of artifact-mediated information that promotes collaboration awareness. The study identified several kinds of Awareness Promoting Information (API): the paper discusses how they can be conveyed both in the web of documental artifacts constituting a Clinical Record and in its computer-based counterpart, the Electronic Patient Record (EPR). The paper ends with the implications for the design of EPRs and for their integration with Hospital Information Systems in light of the findings.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
In a private communication with one of the authors, K. Schmidt pointed to the misleading nature of this expression, since awareness relates more to a state of mind, rather than to the provision of data in a specific context and for a specific purpose.
In what follows, we adopt the naming convention that each API is characterized by an attributive noun indicating what information actors need to become aware of.
Nothing reported in the CR can be deleted but only amended by addition.
Only seldom who reports a clinical intervention is not the same person who has performed it (e.g., chemotherapeutic drug preparation, rachiocentesis).
Alvarez, G. and E. Coiera (2005): Interruptive Communication Patterns in the Intensive Care Unit Ward Round. International Journal of Medical Informatics, (74), pp. 791–796.
Arts, D., N.D. Keizer and G. Scheffer (2002): Defining and Improving Data Quality in Medical Registries. Journal of American Medical Informatics Association, vol. 9(6), pp. 600–611.
Ash, J.S., M. Berg and E. Coiera (2004): Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors. Journal of the American Medical Informatics Association, vol. 11, pp. 104–112.
Balka, E., N. Kahnamou and K. Nutland (2007): Who’s in Charge of Patient Safety? Work Practice, Work Processes and Utopian Views of Automatic Drug Dispensing Systems. International Journal of Medical Informatics.
Bang, M., A. Larsson and H. Eriksson (2003). NOSTOS: A Paper-Based Ubiquitous Computing Healthcare Environment to Support Data Capture and Collaboration. In 2003 AMIA Annual Symposium, pp. 46–50, Washington DC.
Bardram, J.E. and T.R. Hansen (2004): The Aware Architecture: Supporting Contextmediated Social Awareness in Mobile Cooperation. In CSCW’04: Proceedings of the 2004 International ACM Conference on Computer Supported Cooperative Work, pp. 192–201. USA, New York, NY.
Bardram, J. and C. Bossen (2005a): Mobility Work: The Spatial Dimension of Collaboration at a Hospital. Computer Supported Cooperative Work, vol. 14(2), pp. 131–160.
Bardram, J.E. and C. Bossen (2005b): A Web of Coordinative Artifacts: Collaborative Work at a Hospital Ward. In GROUP ’05: Proceedings of the 2005 International ACM SIGGROUP Conference on Supporting Group Work, pp. 168–176. USA: New York, NY.
Bates, D. and A. Gawande (2003): Improving Safety with Information Technology. New England Journal of Medicine, (348), pp. 2526.
Batini, C. and M. Scannapieco (2006). Data Quality: Concepts, Methods, and Techniques. Springer.
Berg, M. (1999): Accumulating and Coordinating: Occasions for Information Technologies in Medical Work. Computer Supported Cooperative Work. The Journal of Collaborative Computing, vol. 8(4), pp. 373–401.
Bringay, S., C. Barry and J. Charlet (2006): Annotations: A functionality to Support Cooperation, Coordination and Awareness in the Electronic Medical Record. In COOP’06: Proceedings of the 7th International Conference on the Design of Cooperative Systems. France: Provence.
Busbach, U. (1996): Docman: A Document management system for cooperation support. In Proceedings of 29th IEEE Hawaii International Conference on System Sciences, volume III, Maui, pp. 3–6.
Cabitza, F. and C. Simone (2006): “You Taste Its Quality”: Making Sense of Quality Standards on Situated Artifacts. In MCIS’06: Proceedings of the First Mediterranean Conference on Information Systems, Venice, Italy. Association for Information Systems.
Cabitza, F. and C. Simone (2007): “. . . And Do It the Usual Way”: Fostering Awareness of Work Conventions in Document-mediated Collaboration. In ECSCW’07: Proceedings of the Tenth European Conference on Computer Supported Cooperative Work, Limerick, Ireland, pp. 119–138.
Cabitza, F. and C. Simone (2008): Supporting Practices of Positive Redundancy for Seamless Care. In CBMS’08: Proceedings of the 21th IEEE International Symposium on Computer-Based Medical Systems. Finland: Jyväskylä.
Cabitza, F., M. Sarini, C. Simone and M. Telaro (2005): “When Once Is Not Enough”: The Role of Redundancy in a Hospital Ward Setting. In M. Pendergast, K. Schmidt, G. Mark and M. Ackerman (eds): GROUP’05: Proceedings of the 2005 International ACM SIGGROUP Conference on Supporting Group WorkU.S.A.: Sanibel Island, Florida, pp. 158–167.
Cabitza, F., M. Sarini, C. Simone and M. Telaro (2006): Torres, A Conceptual Framework for Articulation Work Across Boundaries. In COOP’06: Proceedings of the 7th International Conference on the Design of Cooperative Systems. France: Provence.
Cabitza, F., M. Sarini and C. Simone (2007). Providing awareness through situated process maps: the hospital care case. In GROUP’07: Proceedings of the 2007 International ACM SIGGROUP Conference on Supporting Group Work, pp. 41–50. USA: New York, NY.
Cabitza, F., C. Simone and M. Sarini (2008): Knowledge Artifacts as Bridges Between Theory and Practice: The Clinical Pathway Case. In KMIA’08: Proceedings of the International Conference on Knowledge Management In Action, Milan, Italy.
Carayon, P. (2006): Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. USA: Lawrence Erlbaum Associates Inc. Mahwah, NJ.
Clark, H. H. (1996): UsingLanguage. Cambridge University Press.
Clarke, K., M. Hartswood, R. Procter and M. Rouncefield (2003): Trusting the record. Methods of Information in Medicine, vol. 42, pp. 345–352.
Cohen, M. (ed) (1999). Medication Errors. USA: American Pharmaceutical Association, Washington.
Coiera, E. (2000): When Conversation is Better Than Computation. Journal of American Medical Informatics Association (JAMIA), vol. 7, pp. 277–286.
Coiera, E. and V. Tombs (1998): Communication Behaviours in a Hospital Setting -an Observational Study. British Medical Journal, vol. 316, pp. 673–677.
Dourish, P. (2001): Process Description as Organisational Accounting Devices: The Dual Use of Workflow Technologies. In GROUP01: Proceedings of the 2001 International ACM SIGGROUP Conference on Supporting Group Work, pp. 52–60. New York: ACM.
Eslami, S., N.F. de Keizer and A. Abu-Hanna (2008): The Impact of Computerized Physician Medication Order Entry in Hospitalized Patients: A Systematic Review. International Journal of Medical Informatics, (77), pp. 365–376.
Fitzpatrick, G. (2000): Understanding the Paper Health Record in Practice: Implications for EHRs. In HIC’2000: Proceedings of the 2000 Health Informatics Conference, Adelaide.
Fitzpatrick, G. (2004): Integrated Care and the Working Record. Health Informatics Journal, vol. 10(4), pp. 291–302.
Florijn, G. (1994): Workflow Management—A Limited View on Office Processes. Position Paper. In Proceedings of the CSCW’94 Workshop on Workflow and Office Information Systems.
Gorman, P. and J. Ash (2000): Bundles in the Wild: Managing Information to Solve Problems and Maintain Situation Awareness. Library Trends.
Gutwin, C. and S. Greenberg (1997): Workspace Awareness, Position Paper. In S.E. McDaniel and T. Brinck (eds): Proceedings of the ACM CHI’97 Workshop on Awareness in Collaborative Systems. Atlanta: USA.
Haas, C. (1996): Writing Technology: Studies on the Materiality of Literacy. Lawrence Erlbaum.
Hardstone, G., M. Hartswood, R. Procter, R. Slack, A. Voss and G. Rees (2004): Supporting Informality: Team Working and Integrated Care Records. In CSCW’04: Proceedings of the 2004 International ACM Conference on Computer Supported Cooperative Work, pp. 142–151. USA: New York, NY.
Hartswood, M., R. Procter, M. Rouncefield and R. Slack (2003): Making A Case in Medical Work: Implications for the Electronic Medical Record. Computer Supported Cooperative Work, The Journal of Collaborative Computing, vol. 12, pp. 241–266.
Heath, C. and P. Luff (1996). Documents and Professional Practice: ‘bad’ Organisational Reasons for ‘good’ Clinical Records. In CSCW’96: Proceedings of the 1996 International ACM Conference on Computer Supported Cooperative Work, pp. 354–363, Cambridge MA.
Heath, C.C., P. Luff, H. Kuzuoka and K. Yamazaki (2001): Creating Coherent Environments for Collaboration. In ECSCW’01: Proceedings of the Seventh European Conference on Computer Supported Cooperative Work. Germany: Bonn.
Hughes, J., V. King, T. Rodden and H. Andersen (1995): The Role of Ethnography in Interactive Systems Design. Interactions, vol. 2(2), pp. 56–65.
Jang, C.Y., C. Steinfield and B. Pfaff (2000): Supporting Awareness Aong Virtual Teams in a Web-based Collaborative System: The TeamSCOPE System. SIG- GROUP Bulletin, vol. 21(3), pp. 28–34.
Knight, A., S. Kravet, G. Harper and B. Leff (2005): The Effect of Computerized Provider Order Entry on Medical Student Clerkship Experiences. Journal of the American Medical Informatics Association, vol. 12(5), pp. 554–560.
Lewis, D.K. (1969): Convention: A Philosophical Study. Harward University Press.
Mark, G. (2002): Conventions and Commitments in Distributed CSCW Groups. omputer Supported Cooperative Work, The Journal of Collaborative Computing, vol. 11(3-4), pp. 349–387.
Nicolas Nova, M.S.P.D. (2008): Reconsidering Clark’s Theory in CSCW. In COOP ’08: Proceedings of the 8th International Conference on the Design of Cooperative Systems.
Parker, J. and E. Coiera (2000): Improving Clinical Communication: A View From Psychology. Journal of the American Medical Informatics Associationvol. 7(5), pp. 453–461.
Patel, V.L., K.N. Cytryn, E.H. Shortliffe and C. Safran (2000): The Collaborative Health Care Team: The Role of Individual and Group Expertise. Teaching and Learning in Medicine, vol. 12(3), pp. 117–132.
Reddy, M., P. Dourish and W. Pratt (2001): Coordinating Heterogeneous Work: Information and Representation in Medical Care. In ECSCW’01: Proceedings of the European Conference on Computer Supported Cooperative Work, pp 239–258. Germany: Bonn.
Rosenbloom, S., A. Geissbuhler and W. Dupont (2005): Effect of CPOE User Interface Design on User-initiated Access to Educational and Patient Information During Clinical Care. Journal of the American Medical Informatics Association, vol. 2(4), pp. 458–473.
Schmidt, K. (1997): Of maps and scripts: the status of formal constructs in cooperative work. In GROUP’97: Proceedings of the 1997 international ACM SIGGROUP Conference on Supporting Group Work, pp. 138–147, Phoenix Arizona USA.
Schmidt, K. (2002): The problem with ‘Awareness’: Introductory remarks on ‘Awareness in CSCW’. Computer Supported Cooperative Work, The Journal of Collaborative Computing, vol. 11(3), pp. 285–298.
Schmidt, K. and C. Simone (2000): Mind the gap! Towards a unified view of CSCW. In COOP2000: Proceedings of the 4th International Conference on the Design of Cooperative Systems, Sophia-Antipolis (Fr).
Schmidt, K. and I. Wagner (2002). Coordinative artifacts in architectural practise. In COOP’02: Proceedings of the 5th International Conference on the Design of Cooperative Systems, pp. 257–274.
Schmidt, K., C. Heath and T. Rodden (2002): Special Issue on Awareness in CSCW. Computer Supported Cooperative Work, The Journal of Collaborative Computing, vol. 11(3–4).
Schulmeister, L. (2006): Look-alike, sound-alike oncology medications. Clinical Journal of Oncology Nursing, vol. 10(1), pp. 35–41.
Schutz, A. (1970): On Phenomenology and Social Relations. The University of Chicago Press.
Strong, D.M., Y.W. Lee and R.Y. Wang (1997): Data quality in context. Communications of ACM, vol. 40(5), pp. 103–110.
Suchman, L. (1993): Technology in Working Order. Studies of Work, Interaction, and Technology, chapter Technologies of Accountability: On Lizards and Airplanes. London, UK: : Routledge, pp. 113–126.
Vincent, C. (2006): Patient Safety. Oxford, UK: Elsevier Limited.
Winograd, T. and F. Flores (1986): Understanding Computers and Cognition: a new foundation for design. Reading MA: Addison Wesley.
The work presented in this paper has been partially supported by the Italian fund F.A.R. 2007. The authors would like to thank the management and the Internal Medicine and Neonatal Intensive Care Unit personnel of the “Alessandro Manzoni” Hospital in Lecco (Italy) for their kind collaboration. In particular, we would like to acknowledge the invaluable help and courtesy of Dr Roberto Bellù, Mrs Daniela Colombo and Mrs Rossana Pezzotta.
About this article
Cite this article
Cabitza, F., Simone, C. & Sarini, M. Leveraging Coordinative Conventions to Promote Collaboration Awareness. Comput Supported Coop Work 18, 301–330 (2009). https://doi.org/10.1007/s10606-009-9093-z
- hospital work
- clinical record
- coordinative conventions
- collaboration awareness
- awareness promoting information
- electronic patient record