Bente Christensen1, Gunnar Ellingsen2. 1. Telemedicine and E-health Research group, Department of Clinical Medicine, Arctic University of Norway, UIT, Tromsø, Norway; University Hospital of North Norway, Tromsø, Norway. Electronic address: bente.christensen@telemed.no. 2. Telemedicine and E-health Research group, Department of Clinical Medicine, Arctic University of Norway, UIT, Tromsø, Norway.
Abstract
PURPOSE: In healthcare, the openEHR standard is a promising Model-Driven Development (MDD) approach for electronic healthcare records. This paper aims to identify key socio-technical challenges when the openEHR approach is put to use in Norwegian hospitals. More specifically, key fundamental assumptions are investigated empirically. These assumptions promise a clear separation of technical and domain concerns, users being in control of the modelling process, and widespread user commitment. Finally, these assumptions promise an easy way to model and map complex organizations. METHODS: This longitudinal case study is based on an interpretive approach, whereby data were gathered through 440h of participant observation, 22 semi-structured interviews and extensive document studies over 4 years. RESULTS: The separation of clinical and technical concerns seemed to be aspirational, because both designing the technical system and modelling the domain required technical and clinical competence. Hence developers and clinicians found themselves working together in both arenas. User control and user commitment seemed not to apply in large-scale projects, as modelling the domain turned out to be too complicated and hence to appeal only to especially interested users worldwide, not the local end-users. Modelling proved to be a complex standardization process that shaped both the actual modelling and healthcare practice itself. CONCLUSION: A broad assemblage of contributors seems to be needed for developing an archetype-based system, in which roles, responsibilities and contributions cannot be clearly defined and delimited. The way MDD occurs has implications for medical practice per se in the form of the need to standardize practices to ensure that medical concepts are uniform across practices.
PURPOSE: In healthcare, the openEHR standard is a promising Model-Driven Development (MDD) approach for electronic healthcare records. This paper aims to identify key socio-technical challenges when the openEHR approach is put to use in Norwegian hospitals. More specifically, key fundamental assumptions are investigated empirically. These assumptions promise a clear separation of technical and domain concerns, users being in control of the modelling process, and widespread user commitment. Finally, these assumptions promise an easy way to model and map complex organizations. METHODS: This longitudinal case study is based on an interpretive approach, whereby data were gathered through 440h of participant observation, 22 semi-structured interviews and extensive document studies over 4 years. RESULTS: The separation of clinical and technical concerns seemed to be aspirational, because both designing the technical system and modelling the domain required technical and clinical competence. Hence developers and clinicians found themselves working together in both arenas. User control and user commitment seemed not to apply in large-scale projects, as modelling the domain turned out to be too complicated and hence to appeal only to especially interested users worldwide, not the local end-users. Modelling proved to be a complex standardization process that shaped both the actual modelling and healthcare practice itself. CONCLUSION: A broad assemblage of contributors seems to be needed for developing an archetype-based system, in which roles, responsibilities and contributions cannot be clearly defined and delimited. The way MDD occurs has implications for medical practice per se in the form of the need to standardize practices to ensure that medical concepts are uniform across practices.
Authors: Videha Sharma; Iliada Eleftheriou; Sabine N van der Veer; Andrew Brass; Titus Augustine; John Ainsworth Journal: J Med Internet Res Date: 2022-04-21 Impact factor: 7.076
Authors: Cristina Soguero-Ruiz; Inmaculada Mora-Jiménez; Javier Ramos-López; Teresa Quintanilla Fernández; Antonio García-García; Daniel Díez-Mazuela; Arcadi García-Alberola; José Luis Rojo-Álvarez Journal: Int J Environ Res Public Health Date: 2018-03-01 Impact factor: 3.390