Xiaomu Zhou

I just don't know why it's gone : maintaining informal information use in inpatient care

We conducted a field-based study examining informal nursing information. We examined the use of this information before and after the adoption of a CPOE (Computerized Provider Order Entry) system in an inpatient unit of a large teaching hospital. Before CPOE adoption, nurses used paper working documents to detail psycho-social information about patients; after the CPOE adoption, they did not use paper or digital notes as was planned. The paper describes this process and analyses how several interlocked reasons contributed to the loss of this information in written form. We found that a change in physical location, sufficient convenience, visibility of the information, and permanency of information account for some, but not all, of the outcome. As well, we found that computerization of the nursing data led to a shift in the politics of the information itself - the nurses no longer had a cohesive agreement about the kinds of data to enter into the system. The findings address the requirements of healthcare computerization to support both formal and informal work practices, respecting the nature of nursing work and the politics of information inherent in complex medical work.

Quality management and manufacturing strategies in China

Quality has been identified as a key competitive weapon in the global market. Chinese firms are making considerable effort in implementing quality management in order to gain global competitiveness. The purpose of this study is to compare and contrast manufacturing strategies and business practices between TQM and traditional (or non‐TQM) firms in the Chinese manufacturing industry. This study explores the differences that may exist between TQM and traditional non‐TQM firms in manufacturing strategies and business practices by analyzing survey results of 243 Chinese manufacturing firms. Differences between TQM and traditional non‐TQM firms are investigated in several respects.

Cooperative documentation: the patient problem list as a nexus in electronic health records

The patient Problem List (PL) is a mandated documentation component of electronic health records supporting the longitudinal summarization of patient information in addition to facilitating the coordination of care by multidisciplinary medical teams. In this paper, we report an ethnographic study that examined the institutionalization of the PL. Specifically, we explored: (1) how different groups (primary care providers, inpatient hospitalists, specialists, and emergency doctors) perceived the purposes of the PL differently; (2) how these deviated perceptions might affect their use of the PL; and (3) how the technical design of the PL facilitated or hindered the clinical practices of these groups. We found significant ambiguity regarding the definition, benefits, and use of the PL across different groups. We also found that certain groups (e.g. primary care providers) had developed effective cooperative strategies regarding the use of the PL; however, suboptimal usage was common among other user types, which could have a profound impact on quality of care and safety. Based on these findings, we provide suggestions to improve the design of the PL, particularly on strengthening its support on longitudinal and cooperative clinical practices.

Interactive systems for patient-centered care to enhance patient engagement

In today’s society, most people are both consumers of information technology and of health care. Virtually every person has consumed health care and will consume more as one ages. Moreover, 84% of US households own a computer,1 and 64% of adults own a smartphone.2 We carry pocket-sized devices that connect us to people around the world and vast stores of information. With these technologies, we manage our lives from mundane activities like reading, checking the weather, making to-do lists, and buying books and clothes, to more complex tasks such as learning, managing finances, shopping for houses, and maintaining ties with friends and family around the world. With such diverse and powerful technologies at our fingertips and myriad societal-level health care challenges in cost, quality, and outcome, it is tantalizing to imagine all of the ways that health information technologies (health IT) can be used to enhance people’s health and societies’ health care delivery. Patient-centered care respects and responds to individual differences in patient preferences, needs, and values.3 To respond to such differences and achieve patient-centered care, patients and health care professionals must engage in constant communication. In recent years, researchers have examined a number of ostensibly patient-oriented technologies that could enhance such communication, including patient portals, personal health records (PHRs), and mobile health (mHealth) applications. Furthermore, it is not difficult to conceptualize pathways through which such information systems might improve communication between patients and clinicians, create more patient-centered care, and help achieve the triple aim of better experiences of care, better population health, and lower health care costs.3 Yet, practically, these enticing tools and outcomes are far from reality. There is scant evidence that patients frequently or effectively access and use information systems that engage them and improve patient-centered care delivery. For example, patients generally have …

Messaging to your doctors: understanding patient-provider communications via a portal system

The patient portal is a relatively new healthcare information technology that enables patients more convenient access to their healthcare information and allows them to send messages to their doctors. Our study examines the themes discussed in these messages and the different ways in which patients communicate with their providers via a portal employed in a large medical center. We also explore the differences between the patient portal and more traditional communication media, and investigated the advantages and potential problems of the portal system. Our findings show a wide variety of topics discussed in the communication messages (such as medication, appointments, laboratory tests, etc.) and how patients provide information, consult with their providers, and express psychosocial and emotional needs. We argue that the patient portal improves the accuracy of communication and could facilitate illness management for patients, especially over a longer term. However, messaging through the patient portal is not popular among patients and the simultaneous use of multiple communication media may create information gaps. More research is needed to better elucidate barriers to the use of patient portals and the optimal methods of communication and information integration given different contexts.

Computerization and information assembling process: nursing work and CPOE adoption

This paper presents an ethnographic study investigating how nurses assemble information to start their shifts work. We examined this process before and after the adoption of a Computerized Prescriber Order Entry (CPOE) system in an inpatient unit of a large teaching hospital. Before the CPOE adoption, nurses used several collaboratively-created group working documents to assist in this information assembling process; after the CPOE adoption, they mainly used the CPOE itself for their information needs. We found while computerization facilitated medical data assembling process and improved order handling practice, it also resulted in some information gaps in understanding patients in their larger care context. We analyzed what it means when the computerization of medical information turns local knowledge into more readily available and public information objects, as well as what that means for patients and patient care.

Beyond formality: informal communication in health practices

Despite an increasing use of formal healthcare systems such as the Electronic Medical Record (EMR) and communication devices, informal communication continues to play an important role in the highly collaborative, dynamic, and information-rich medical work. Formal systems often fail to support the spontaneous and opportunistic needs of healthcare providers to communicate patient information. Yet it is not clear what constitutes informal communication in healthcare practices, what roles does it play in the patient care process, what types of technologies can be designed to support informal communication, and how to design them. This workshop aims to gather interested researchers to better understand informal communication in healthcare, to discuss their implications for CSCW healthcare research, and to brainstorm technological innovations that can support the informal aspects of health communication.

Health practices of immigrant women: Indigenous knowledge in an urban environment: Health Practices of Immigrant Women: Indigenous Knowledge in an Urban Environment

This qualitative study of folk health practices of an indigenous Mexican immigrant community in New Brunswick, New Jersey investigates the barriers this community faces, and their effects on its members’ everyday practice of health in a new urban environment. Facilitated by local community organizations, two focus group interviews were conducted with women from this community, along with a questionnaire and multiple field visits. Analysis revealed several themes related to health practices, including the role of food, and how indigenous knowledge influences the communitys beliefs about, and practices of, health. Additionally, several environmental, communication, and systemic barriers also appeared to affect the communitys health practices. This research indicates that providing healthcare access to immigrant communities is a complex issue extending beyond the availability of services and resources. A better understanding of immigrant communities’ socio‐cultural health practices may be a key to improving the communitys healthy living and overall quality of life.