Developing information systems technology within NHS wound clinics: an evaluation
The diffusion of information and communication technology (ICT) into healthcare has been generally low. This varies with application and setting, but at the point of care clinical level it has been particularly slow. The ICT niche in clinics has been recognised in numerous publications, where it potential benefits are proclaimed. A reoccurring factor identified with criticism of design i information systems research (ISR) is the difficulty in integrating the different human and technical elements. Activity Theory (AT) has been proposed as a means of overcoming this by providing single theoretical framework able to represent relevant factors across all levels of operational abstraction. In this work the (practical) operational functionality of AT is employed (tested) as a basis for design and evaluation of ICT, applied to integration at the clinical level of the National Health Service (NHS) healthcare organisation. Chronic wound healing is a complex activity, with a long history and strong dependence on data, as observed and recorded by clinicians, to treat and heal patients. Wound clinics that are part of the NHS, which is currently actively pursuing a strategy for information technology (IT) integration in healthcare, afford the opportunity to develop specific ICT for wound data and consider issues of diffusion at different levels of the organisation. An Action Research paradigm, using methods borrowed from soft systems methodology (SSM), is applied to the problem of producing ICT to manage wound data in participating NHS clinics. Data are collected via naturalistic (participant) observation, 'in-depth' interviews and focus groups, and are recorded using ethnographic field notes, a research logbook and diary, and digital and analogue voice recordings. Activity models are generated, to interpret the research process and represent the activity at the action level of the clinic, situating the analysis, both within the network of supporting activities, and the influence and constraints of the administrative and the organisational levels. Practical findings highlight the potential of ICT in participating clinics, showing how this can be expanded to the chronic wound healing activity in general, and reporting the implications that this has for the NHS IT strategy at the level of the clinics involved with regards to integration of ICT. Theoretical findings support the suitability of the Action Research strategy and the relevance of AT both as a descriptive framework for information systems development (!SD), and as an evaluative framework for ISR.
Information storage and retrieval systems, Medicine, Medical informatics
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