Mary Darking

Object lessons and invisible technologies

In this paper, we explore some of Claudio Ciborras ideas about the technological object. We do this in contrast to recent analysis by Law and Singleton (L&S) that advocates a methodological radicalism that moves beyond epistemological uncertainties about the technological object to ontological concerns. L&S present a series of stages in this analysis that include fluid objects that change relatively gently and fire objects that have more radical discontinuities. This approach is applied to empirical work studying the engagement practices of a large, sophisticated information infrastructure research project, the Digital Business Ecosystem (DBE). At the start of the DBE engagement process, the DBE was an invisible technology that did not exist and this made the process of engagement with it particularly challenging. Drawing on the analysis presented by, however, the DBE appears to have the ontological characteristics of both the fluid and the fire object. In order to address this dilemma, we draw upon Ciborras thinking, particularly around the information infrastructure and Gestell as a means that allows us to consider technologies like the DBE as being both fluid and fire objects. The paper ends with a discussion of the implications of this work on Claudio Ciborras legacy for the study of information and communications technologies.

Governing diversity in the digital ecosystem

The concept of ecosystem is about to be brought into the digital age where, instead of plants and animals, the digital species who roam the landscape include software components, applications, services, business models, contractual frameworks and laws. Along with understanding the nature of habitat and the significance of localisation, diversity is one of the key characteristics of a healthy ecosystem. However, encouraging diversity in the context of technology production brings with it significant challenges, and designing a framework for governance that can balance interests, address technology lock-in and enable the co-existence of diverse software production methods quickly becomes a priority, as participants in the Digital Business Ecosystem project have found.

Practice-centred evaluation and the privileging of care in health information technology evaluation

Our contribution, drawn from our experience of the case study provided, is a protocol for practice-centred, participative evaluation of technology in the clinical setting that privileges care. In this context ‘practice-centred’ evaluation acts as a scalable, coordinating framework for evaluation that recognises health information technology supported care as an achievement that is contingent and ongoing. We argue that if complex programmes of technology-enabled service innovation are understood in terms of their contribution to patient care and supported by participative, capability-building evaluation methodologies, conditions are created for practitioners and patients to realise the potential of technologies and make substantive contributions to the evidence base underpinning health innovation programmes.BackgroundElectronic Patient Records (EPRs) and telemedicine are positioned by policymakers as health information technologies that are integral to achieving improved clinical outcomes and efficiency savings. However, evaluating the extent to which these aims are met poses distinct evaluation challenges, particularly where clinical and cost outcomes form the sole focus of evaluation design. We propose that a practice-centred approach to evaluation - in which those whose day-to-day care practice is altered (or not) by the introduction of new technologies are placed at the centre of evaluation efforts – can complement and in some instances offer advantages over, outcome-centric evaluation models.MethodsWe carried out a regional programme of innovation in renal services where a participative approach was taken to the introduction of new technologies, including: a regional EPR system and a system to support video clinics. An ‘action learning’ approach was taken to procurement, pre-implementation planning, implementation, ongoing development and evaluation. Participants included clinicians, technology specialists, patients and external academic researchers. Whilst undergoing these activities we asked: how can a practice-centred approach be embedded into evaluation of health information technologies?DiscussionOrganising EPR and telemedicine evaluation around predetermined outcome measures alone can be impractical given the complex and contingent nature of such projects. It also limits the extent to which unforeseen outcomes and new capabilities are recognised. Such evaluations often fail to improve understanding of ‘when’ and ‘under what conditions’ technology-enabled service improvements are realised, and crucially, how such innovation improves care.Summary

Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews

Background Despite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. Objective The goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. Methods Between January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. Results Findings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. Conclusions Our approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process.