Unity in diversity: electronic patient record use in multidisciplinary practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

The effects of non-unity lewis numbers on turbulent premixed flame interactions in a twin V-flame configuration

The influence of Lewis number on turbulent premixed flame interactions is investigated using automatic feature extraction (AFE) applied to high-resolution flame simulation data. Premixed turbulent twin V-flames under identical turbulence conditions are simulated at global Lewis numbers of 0.4, 0.8, 1.0, and 1.2. Information on the position, frequency, and magnitude of the interactions is compared, and the sensitivity of the results to sample interval is discussed. It is found that both the frequency and magnitude of normal type interactions increases with decreasing Lewis number. Counternormal type interactions become more likely as the Lewis number increases. The variation in both the frequency and the magnitude of the interactions is found to be caused by large-scale changes in flame wrinkling resulting from differences in the thermo-diffusive stability of the flames. During flame interactions, thermo-diffusive effects are found to be insignificant due to the separation of time scales. © 2013 Copyright Taylor and Francis Group, LLC.