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.

Stakeholder engagement in early stage product-service system development for healthcare informatics

This paper presents the findings from four case studies on stakeholder engagement in new health information and communication technology (ICT) product-service system (PSS) development. The degree of connectivity between the new health ICT PSS and its intended operating environment has emerged to be an important contextual factor that may impact the decision of stakeholder engagement in the early stage development process. Along with the proposition of a four-level framework to guide stakeholder identification for new PSS development, three stakeholder engagement propositions that are based on the degree of connectivity are developed. Analysis has shown that there can be two types of connectivity: data and process. Moreover, each connectivity type can be characterized by how much the new PSS is connected with its environment: independent if there is no linkage, linked if it interfaces with, or incorporated if it is embedded into. Furthermore, depending upon whether and to what extent the PSS has data and process connectivity with its intended operating environment, the stakeholder engagement needs in early stage development vary. The propositions presented in this paper provide important directions for future work exploring PSS characterization and stakeholder engagement decision in early stage new PSS development in the healthcare industry. © 2013 PICMET.