Artifacts and collaborative work in healthcare: methodological, theoretical, and technological implications of the tangible.

Although modeled as knowledge work with emphasis on data flow and decision making, healthcare is delivered in the context of a highly structured physical environment, with much effort and emphasis placed on physical and spatial arrangement and re-arrangement of workers, patients, and materials. The tangible aspects of highly collaborative healthcare work have profound implications for research and development of information and communication technology (ICT) despite the tendency to model work as flow of abstract data items. This article reviews field studies in healthcare and other domains on the role of artifacts in collaborative work and draws implications in three areas: methodological, theoretical, and technological. In regard to methodologies, assessment of new ICT and development of user requirements should take into account how artifacts are used and exploited to facilitate collaborative work. In regard to theories, the framework of distributed cognition provides a starting point for modeling the contribution and exploitation of physical artifacts in supporting collaborative work. In regard to technology, design and deployment of new technology should support the functions provided by physical artifacts replaced or disrupted by new technology, and profitable ways for new technology to support collaborative work by embedding ICT into existing infrastructure of physical artifacts.