Federico Cabitza

When once is not enough: the role of redundancy in a hospital ward setting

The paper discusses the role of redundancy in hospital ward work on the basis of a field study that focuses on the use of paper artifacts supporting healthcare and its coordination. On the basis of literature and direct observations, we identified different kinds of redundancy, i.e. redundancy of effort, functions and data. Hence, we analyzed how these different forms of redundancy may affect each other and the coordination inside hospital wards. Redundancy plays a positive or negative role depending on various circumstances. This twofold nature defines different requirements for a technology to support healthcare and ward work by preserving practices linked to paper-based artifacts and by unobtrusively augmenting them with computational capabilities.

Infectious and thromboembolic complications of arthroscopic shoulder surgery

HYPOTHESIS This study investigates the rate of infectious and thromboembolic complications in shoulder arthroscopy and their association with pharmacologic prophylaxis. MATERIALS AND METHODS On behalf of the Italian Society for Knee Surgery, Arthroscopy, Sport Traumatology, Cartilage and Orthopaedic Technologies (SIGASCOT), we asked the members to complete an on-line Web survey about their experiences and strategies of prophylaxis in shoulder arthroscopy. RESULTS In the period 2005-2006, 9385 surgeries were performed. We report 15 infections and 6 DVTs. The overall rate of infections was 0.0016 (1.6/1000) and the rate of DVTs was 0.0006 (0.6/1000) CONCLUSION The association between infection and antibiotic prophylaxis was significant (P=0.01); however, the risk of DVTs was not decreased with heparin prophylaxis. LEVEL OF EVIDENCE Level 3.

Unintended Consequences of Machine Learning in Medicine.

Over the past decade, machine learning techniques have made substantial advances in many domains. In health care, global interest in the potential of machine learning has increased; for example, a deep learning algorithm has shown high accuracy in detecting diabetic retinopathy.1 There have been suggestions that machine learning will drive changes in health care within a few years, specifically in medical disciplines that require more accurate prognostic models (eg, oncology) and those based on pattern recognition (eg, radiology and pathology). However, comparative studies on the effectiveness of machine learning–based decision support systems (ML-DSS) in medicine are lacking, especially regarding the effects on health outcomes. Moreover, the introduction of new technologies in health care has not always been straightforward or without unintended and adverse effects.2 In this Viewpoint we consider the potential unintended consequences that may result from the application of ML-DSS in clinical practice.

Leveraging underspecification in knowledge artifacts to foster collaborative activities in professional communities

Collaborative problem solving often involves actors with heterogeneous competences or that see a common problem from different perspectives: this can make mutual understanding difficult. The paper presents case studies in different domains where collaboration leverages shared representations, and discusses the main reasons why these representations succeeded in fostering mutual understanding. We observed how the technologies proposed to manage those representations were successful only to the extent they were made able to adapt to the dynamic and open conventions that actors adopted during their activities. The point of the paper is that locality, openness and underspecification are key factors in this process, for their capability to promote tacit knowledge and to let competent actors reach a sufficient level of mutual understanding towards some common goal. The paper proposes a conceptual framework to characterize the notion of knowledge artifact interpreted as a semiotic system where actors can make sense of shared and underspecified representations, and derives from this notion implications for the design of a supportive technology.

Leveraging Coordinative Conventions to Promote Collaboration Awareness

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.

Computational Coordination Mechanisms: A tale of a struggle for flexibility

Coordination mechanisms (CMs) can be defined as any kind of computable construct whose aim is to organize activities performed by a group of actors that are called to collaborate for some purpose or reason. As such, CMs can be observed, conceived for and applied in a vast number of coordinative practices in almost every work setting. The advent of information and communication technologies has raised the issue of how these technologies could be used to help cooperating actors governing the increasing complexity of collaboration in modern organizations. This issue has been at the core of CSCW from its foundation until today: the field studies therein conducted have highlighted the flexibility by which human beings master this complexity. The requirement of flexibility has become one of the necessary conditions to guarantee the effectiveness of any computer support of coordination. The paper presents the main paradigms and approaches that have been proposed to fulfil this challenging requirement. The story shows that this effort has really been a sort of a struggle for either conceptual and technological solutions that are still to be fully realized and generally adopted in the field of work.

Affording Mechanisms: An Integrated View of Coordination and Knowledge Management

In this paper we question the separation between technologies that support information and handle the ordered flow of work and technologies that support knowledge management. On the basis of observational studies and initiatives of participatory prototype design that we performed in the hospital domain and other cooperative work settings, the paper proposes a unified view of these high-level functionalities through the notion of Affording Mechanism. In order to clarify the implications for design, the paper discusses the relationships between knowledge and representations; the role of artifacts that are used in activities where knowledge is allegedly “produced, shared and consumed”; and finally the notion of affordance and its dynamics. In very general terms, an AM consists of an artifact and of dynamic relationships between the context of use and the artifact’s affordances, expressed in terms of simple if-then constructs. The affordances conveyed through and by the artifact are modulated in order to evoke a “positive” reaction in the actors who use these augmented artifacts and to support knowledgeable behaviors apt to the situation. Moreover, the paper illustrates a prototypical technology through examples derived from the studies mentioned above, and discusses the kind of support this application provides in the light of an unusual interpretation of what it might mean to “manage” knowledge through computer-based technology.

Providing awareness through situated process maps: the hospital care case

Clinical Pathways (CPs) are artifacts that clinicians are increasingly introducing in their practices in order to deal with health problems in the most effective, efficient and agreed way. As a result of an observational study at a Neonatology Intensive Care Unit, we found that most CPs are still paper-based. Although perceived useful even on paper, the physicians advocated a system integrating CPs with the clinical record. Based on their requirements, we present a proposal on how to conceive a computational system that can promote awareness in order to achieve better coordination and committed inclusion of pathways in daily clinical practice.

DJess - a context-sharing middleware to deploy distributed inference systems in pervasive computing domains

In this paper DJess is presented, a Java package that provides programmers with a lightweight middleware by which inference systems implemented in Jess and running on different nodes of a pervasive computing ensemble can transparently share both contextual knowledge (facts) and reactive behaviors (rules). Communication and coordination among inference systems (agents) is achieved through the ability of each agent to reason asynchronously on facts, i.e., propositional expressions representing the context, that might even be asserted by other agents on the basis of inference code (rules), which can be either local or transmitted by any node to any other node. Pervasive computing is the main reference domain that guided the design of the DJess architecture and still drives the API development.

ProDoc: an Electronic Patient Record to Foster Process-Oriented Practices

The paper presents ProDoc, an Electronic Document System that allows users to navigate documental artifacts according to predefined process maps. In fact in ProDoc, process models are to be considered as maps that users willingly take as guide for their decisions and actions, rather than scripts prescribed from above. The main tenet of this research is that, by integrating documents and processes, documental practices and related work practices could better align to intended models of action. The underlying concept is the result of a long empirical research in the healthcare domain, where we have deployed ProDoc as an innovative and process-oriented Electronic Patient Record. The user participation in the phase of document definition and clinical processes modeling is central in our approach and it is illustrated in three scenarios of the software informal validation that we present in this paper.