Kari Dyb

GETTING THE WHOLE PICTURE?: New information and communication technologies in healthcare work and organization

Considerable effort has been invested in telemedicine and e-health, but relatively few applications have endured beyond the research and development phase. Research within different academic disciplines points to the significance of established working and organizational relations within healthcare in shaping the outcome of particular projects, whether successful or otherwise. Even so, the findings appear as disparate and discrete observations which make it difficult for those involved in the field to get an overview of ICT in healthcare work and organization or to interpret the implications of the studies. The aim of our article is to demonstrate the importance and value of situating ICT initiatives within a sociological framework of healthcare work and organization and to show how this enables us to carry out systematic analysis across a range of ICT initiatives in different clinical settings.

Placing Globalizing Technologies: Telemedicine and the Making of Difference

The development and proliferation of new information and communication technologies has generated some profound claims about the erasure of place. Whilst these claims have continued political and policy resonance, they are increasingly challenged in sociological debate, which emphasizes the persistence of the local. Following this lead, our article explores relations between technology and place. We develop our understanding through engagement with Science and Technology Studies, Actor Network Theory and geographical conceptualizations of place. Our argument is worked through a new empirical study of telemedicine, where new technologies are applied precisely to overcome place. Our analysis is that, on the contrary, empirical outcomes are legible only through the lens of place. This has important policy implications and broader implications for thinking about technology in contemporary debates about globalization.

DIFFERENCES AND INEQUALITIES IN HEALTH

The potential for information technologies (ITs) to contribute to a struggle against social inequalities in health is discussed in contemporary policy and research. Expectations are on IT to facilitate access to health expertise and knowledge, and hence result in improved health practices and outcomes for individuals. In this article, the authors argue that this currently dominant understanding of the relation between IT and social inequalities in health is constraining as well as insufficient to explain the persistence of health inequalities in digitalized western societies. Human action is reduced to be about rational choice, and technology is expected to be a passive tool to be employed by implementers and policy-makers. Drawing on case studies from two telemedicine projects in Norway, this analysis combines perspectives from sociology concerned with structural inequalities on the one hand, with science technology studies on the other. It reveals how the practice and performance of IT is tied to the practice and performance of local differences, and this might be important to a discussion of the social distribution of health. Combining these two perspectives allows for an alternative understanding of how IT and social inequalities in health interact.

Un/doing gender with ICT?

What might new information and communication technologies (ICTs) at work do for gender? This question is explored here through an empirical study that traces the introduction of one ICT application—an electronic patient record (EPR)—into nursing and medical work in a University hospital in Norway. Health care work is well documented as a highly gendered field, where normalizing gender practices have dominated. The aim of this article is to explore emergent configurations of gender, ICT, and health care work following the introduction of the EPR. Drawing on Judith Butlers conceptualization of performativity, where gender is produced only as it is cited in everyday practice, we pay attention to both the normative and the disruptive moments of these configurations. In order to understand gender in modern health care we suggest an analysis of the performative co-constitution of gender, technology, and work as it is done on a daily basis at the hospital. We explore the gender effects of this co-constitution, also as gender norms are challenged and new ways of performing professional identities in health care are moved beyond the familiar categories of the past.

Digitized patient - provider interaction: How does it matter? A qualitative meta-synthesis

Sociological interest in the digitization of health has predominantly been studied using qualitative approaches. Research in this field has grown steadily since the late 1990s but to date, no synthesis has been conducted to integrate this now rather comprehensive corpus of data. In this paper we present a meta-ethnography of 15 papers reporting qualitative studies of digitally mediated patient - professional interactions. By dissecting the detailed descriptions of digitized practices in this most basic relationship in health care, we explore how these studies can illuminate important aspects of social relations in contemporary society. Our interpretative synthesis enables us to reassert a sociological view that places changes in social structures and interaction at the core of questions about the digitization of health care. Our synthesis of this literature identifies four key concepts that point at structural processes of change. We argue that when patient-professional interactions are digitized, relations are respatialized, and there are reconnections of relational components. These lead to empirically specific reactions, which can be characterized as reconstitutions and renegotiations of social practices which in turn are related to the reconfiguration of basic social institutions. We propose a new direction for exploring the digitalization of health care to illuminate how digital health is related to contemporary social change.

The Norwegian National Summary Care Record: a qualitative analysis of doctors’ use of and trust in shared patient information

BackgroundThis paper explores Norwegian doctors’ use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals’ use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors’ direct SCR experiences.MethodsWe conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach.ResultsThe SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool’s six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data.ConclusionTherefore, we can assume that the popularity of the pharmaceutical summary among doctors is based on their preference to place their trust in – and therefore more often utilise – automatically updated information. In addition, the doctors’ lack of trust in manually updated information might have severe implications for the future success of the SCR and for similar digital tools for sharing patient information.