Assessment of a computerized medical record system: disclosing scripts of use

In the last two decades, empirical studies adopting a critical sociological approach to technology have shown how innovations are socially shaped, and how their introduction into human practices is often problematic. This paper describes how the Actor–Network Theory (ANT) can contribute to the evaluation of information technology. Results of the evaluation of a computerized medical record system implemented in four Quebec (Canada) hospitals are presented. The distribution of skills and tasks among nurses, physicians and managers (as implied by the design), and the use of the computerized medical record system proved highly problematic since they radically modified clinical practices. Theoretical and practical implications of using ANT as an evaluation framework are discussed.     

Information, information systems, information society: interpretations and implications

The term “information” has become a universal and omnipresent keyword in almost all areas of our modern world—be it in science or society in general. This is not only obvious from the naming of whole scientific branches like Information Theory, Information Science or Informatics but even more from common speaking—characterising our present time and society as information age viz. information society. However, what “information” might mean, is by no means clear and there is a wide range of interpretations covering, among others, its technical, communicational, educational, mental, and scientific aspects. But is the use of the same term justified when adopted in Biology, Physics, Archaeology, Law, Communication Technology, and Informatics (to list just a few of the involved scientific branches) or do its different uses at least have some common characteristics—some sort of common denominator? Is information natural, e.g. manifesting itself as a material phenomenon residing in organisms, stars, atoms, or genes, or is it just a cultural product of human communication, thinking, and interpretation? In this article, we try to clarify some of the most important interpretations, discuss and contrast them with the Informatics point of view. Interpretations range from taking information as material, transferable signals (following Shannon’s Information Theory or the genetic approaches), treating it as a sign (following a semiotic approach), as a commercial product (now common in Web-based Information Business) to considering it a pure mental phenomenon bound to humans or human-like individuals or even to groups and societies. Based on these interpretations, we shall throw a critical glance on current trends in human science and society—focusing on the now popular concept of “information society”—and then derive some theses and guidelines for further research escorting the growth and dispersal of information technology. As it will turn out, an information society which defines itself through the number of computers, internet connections and network links is based on a very narrow, techno-centric concept of information. However, a reflection on the educational and cultural aspects of information might lead to a better-qualified society consisting of responsible and critical citizens.     

The information systems professional as a hermit

In this article, the contributions that Michael Thompson has made to the development of cultural theory are laid out. This is done by highlighting the ways in which Thompson has built upon the grid–group analysis of Mary Douglas. Thereafter, it is shown how cultural theory is compatible with, and can be strengthened by, the complexity theories that have been formulated within the natural sciences. The resulting theoretical framework is then applied to explain the persistent cultural gap between the business planning and the information systems (IS) departments within companies. It will be argued and demonstrated that the IS professional can usefully be understood as following the views and practices characteristic of the hermit, as defined in cultural theory.     

A computerized system to monitor resilience indicators in organizations

The concepts developed by resilience engineering allow the understanding and monitoring the functioning of organizations and, particularly, to map the role of human activities, in success or in failure, enabling a better comprehension about how people make decisions in unexpected situations. The capture of information about human activities in the various organization levels gives managers a deeper real-time understanding of what is influencing the people performance, providing awareness of the factors that influence positively or negatively the organizational goals initially projected. The monitoring is important because the correct functioning of complex systems depends on the knowledge that people have to perform their activities and how the system environment provides tools that actually support the human performance. Therefore, organizations should look forward through precursors in operating signals to identify possible problems or solutions in the structure of tasks and activities, safety, quality, schedule, rework, and maintenance. We apply the concepts of resilience engineering to understand the organization by the analysis of cognitive tasks and activities. The aim is the development of a computerized system to monitor human activities to produce indicators to access system resilience. The validation of the approach was made in a real organization and the results show the successful applicability of the system. Based on findings obtained after the experiment of the system in a real organization, and managers and workers opinions, it was possible to show that the use of system provided an anticipated (real-time) perception about how activities are effectively being performed, allowing managers and workers to make decisions more consistent with daily problems, and also to anticipate solutions to cope with unexpected situations.     

Substitute-care information systems under public law 96-272

This paper reports on the results of a survey of state responses to the requirements of Public Law 96-272, including the use of permanency planning and periodic review techniques in substitutecare services, and, in particular, the nature and scope of information systems developed to monitor these services. Officials from 44 states and the District of Columbia completed the survey.All respondents reported having implemented statewide policies requiring permanency planning for and periodic review of all substitute-care cases. Those surveyed also indicated strongly favorable attitudes toward these policies among both administrators and direct-service personnel.A large majority (85%) of responding states had developed automated information systems for substitute care, most in the form of a central, statewide data base. Only four states reported depending solely on manual record keeping. The computer systems were most frequently used for administrative applications such as generating aggregate reports, monitoring case reviews, and coordinating caseloads. Applications least commonly reported included reducing narrative recording, determining placement availability, and linking clients to resources, activities more common to direct services. Finally, results of a set of attitudinal questions indicated support for the use of automated data management and the belief that it is a necessary technology, but many respondents also noted that automation has engendered complaints and opposition from staff members in field settings.     

职业适应:从有业到乐业——全面开发大学生就业能力探析

近几年,我国大学生就业难问题突出。有关统计数据显示,2010年全国高校毕业生规模将达到630万,较2009年的611万的毕业生规模再创新高,加上往年累积下来未就业的人数,2010年的毕业生就业形势严峻。本文分析了目前大学生就业指导服务工作存在的问题,并依据USEM就业能力模型,提出建立以全面开发就业能力为目的的大学生就业指导服务体系,包括确立"有业且乐业"的理念、建立"大学生就业能力模型"和"全面开发"基本框架三方面内容。     

Providing medical information to college health center personnel: a circuit Librarian Service at the University of Illinois

College health center personnel are no different from other health practitioners in their need for medical information. To help meet this need, the McKinley Health Center, University of Illinois Urbana-Champaign, developed a partnership in 1997 with the Library of the Health Sciences-Urbana, a regional site library of the University of Illinois at Chicago campus. This partnership led to the adoption of circuit librarianship, a dynamic outreach model, to enhance access to health information for McKinley Health Center personnel. A circuit librarian consults with health center personnel during regularly scheduled on-site visits to the center and its satellite office. Upon returning to the resource library, the circuit librarian conducts research for clinical information on behalf of the center's personnel, then sees that articles, books, and relevant Web sites are identified and delivered to assist in answering questions regarding disease management, drug therapy, wellness, and health administration.     

Some implications of the emergence and diffusion of medical expert systems

This paper has two sections. The first introduces the area of medical decision making and the use of artificial intelligence techniques for developing medical expert systems. It also briefly discusses how a physician and an expert system interact, using the INTERNIST-I system as an example. An elaboration of several technical problems which expert systems must overcome for them to be accepted and used by physicians ends this discussion. The second section considers the implications medical expert systems for physicians and patient care. It suggests that medical expert systems regulate and routinize physicians' work. Moreover, the encoding of expert knowledge in a computer program will likely demystify the practice of medicine, nullifying much of the art of medicine. Alternatively, medical expert systems may improve the physician's decision making, extend the practitioner's capabilities, and hence increase the physician's prestige. Moreover, computer aided decision making could speed diagnosis, especially for difficult cases, thus providing the doctor with time for other pursuits. However, medical expert systems will be a mixed blessing for patient care. On the one hand, they could provide expert advice in medically underserved areas, decrease the number of referrals patients and physicians must contend with, while offering expert advice to a greater number of patients. On the other hand, expert systems could further alienate patients from practitioners and from the health system in general. Even more than other medical technologies, computers in the doctor's office could increase the separation between the doctor and patient, while lowering the physician's confidence in her or his own decision making. The conclusion discusses the importance of control over work in determining the use of technology and the influence of the changing medical power structure on the use of expert systems.I thank J. Zvi Namenwirth for his careful review and thoughtful comments on this and previous drafts of this paper. I also appreciate the useful suggestions offered by anonymous reviewers of an earlier draft.     

Occupational Claims to Professionalism: The Case of Paralegals

This article, based on fifty‐one in‐depth interviews with paralegals working in private law firms, bridges the gap between sociologists' understanding of professions and professionalization and workers' subjective meaning of professional and professionalism. For paralegals to be professional, they must be both competent and capable of maintaining the proper demeanor, which includes their thoughts, behaviors, appearances, and emotions. Ironically, paralegals claim the title professional, or make claims to professionalism, to make themselves feel better about the unprofessional manner in which they are treated by attorneys; however, their assumptions about the meaning of professionalism undercut the likelihood that they will ever make collective demands for the professional treatment they seek.     

Occupational licensing and the transition from welfare to work

Occupational licensing laws erect barriers to entry into various labor markets, impeding the upward mobility of welfare recipients seeking to transition into employment. This paper, recognizing that labor market interventions have often been used precisely because of this effect, proceeds to examine various restrictions which directly affect low-skilled workers in the U.S. economy who now have stronger incentives to participate in labor markets in response to recent welfare policy reforms. Three distinct types of labor market restrictions are identified: (1) the licensing of professional, high-skilled occupations tends to crowd workers into lower-skilled occupations, lowering such wages and thus weakening work incentives among the welfare population; (2) quantity license restrictions (permits which set quotas limiting the overall number of suppliers in a market) suppress demand for low-skilled workers, and may substantially reduce work opportunities and, thus, incentives. Taxi license restrictions alone, for instance, may result in several hundreds of thousands of lost employment opportunities throughout the United States; and (3) quality license restrictions, where entrants face higher entry costs (typically through educational requirements above the requirements of the market), may paradoxically provide welfare recipients with enhanced opportunities for employment, particularly when coupled with job-training subsidies typically extended to welfare recipients. This we call a “de facto liberalization” of occupational licensure. While incumbent workers are certain to resist enhanced entry by welfare recipients into licensed occupations, vocational schools should aggressively support such entry, affording a possible realpolitik to the migration path envisioned. More interestingly, once entry has accelerated under de facto liberalization, occupational license rents will predictably decline, thus increasing the likelihood of explicit liberalization, and further opening labor markets to competitive entry.     

The Contribution of White Collars to Occupational Prestige*

Regression analysis of the 1947 and 1963 NORC occupational prestige scores for 45 occupations indicates that being white-collar may have contributed modestly to the prestige of the 24 nonmanual occupations in 1947, net of economic rewards and educational selectivity, but that any such effect had largely disappeared by 1963. The findings tend to support the view that the white-collar-blue collar distinction has become less important in American society.     

A method for work modeling at complex systems: towards applying information systems in family health care units

Work in organizations requires a minimum level of consensus on the understanding of the practices performed. To adopt technological devices to support the activities in environments where work is complex, characterized by the interdependence among a large number of variables, understanding about how work is done not only takes an even greater importance, but also becomes a more difficult task. Therefore, this study aims to present a method for modeling of work in complex systems, which allows improving the knowledge about the way activities are performed where these activities do not simply happen by performing procedures. Uniting techniques of Cognitive Task Analysis with the concept of Work Process, this work seeks to provide a method capable of providing a detailed and accurate vision of how people perform their tasks, in order to apply information systems for supporting work in organizations.     

Modernizing information systems: A comparison of scientific and technological research perspectives

As part of a series which compares different methodological paradigms, this article highlights technological and scientific themes in an information systems research study. While scientific endeavor is primarily oriented toward overcoming difficulties that stand in the way of seeking truth, technological efforts are devoted to finding practical solutions to real-world problems. The implications of this difference are applied to a telephone survey of high ranking information system executives in a variety of organizations. Topics in the survey included: coordination of information resources; improving data quality; evaluation of information system change; software productivity; information technology's role in pursuing strategic goals; information technology's impact on white collar work; and information resource management. Although both scientific and technological objectives are attained, a variety of factors led to a much heavier technological emphasis.