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.

Experimental demonstration of a record high 11.25Gb/s real-time optical OFDM transceiver supporting 25km SMF end-to-end transmission in simple IMDD systems.

The fastest ever 11.25Gb/s real-time FPGA-based optical orthogonal frequency division multiplexing (OOFDM) transceivers utilizing 64-QAM encoding/decoding and significantly improved variable power loading are experimentally demonstrated, for the first time, incorporating advanced functionalities of on-line performance monitoring, live system parameter optimization and channel estimation. Real-time end-to-end transmission of an 11.25Gb/s 64-QAM-encoded OOFDM signal with a high electrical spectral efficiency of 5.625bit/s/Hz over 25km of standard and MetroCor single-mode fibres is successfully achieved with respective power penalties of 0.3dB and -0.2dB at a BER of 1.0 x 10(-3) in a directly modulated DFB laser-based intensity modulation and direct detection system without in-line optical amplification and chromatic dispersion compensation. The impacts of variable power loading as well as electrical and optical components on the transmission performance of the demonstrated transceivers are experimentally explored in detail. In addition, numerical simulations also show that variable power loading is an extremely effective means of escalating system performance to its maximum potential.