Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments
Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments
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DOI：
10.1016/j.socscimed.2012.09.013
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发表时间：
2012-12-01
影响因子：
5.4
通讯作者：
Gonzales, Ralph
中科院分区：
文献类型：
--
作者：
Ackerman, Sara L.;Tebb, Kathleen;Gonzales, Ralph
对新技术的高期望与信息技术 (IT) 项目在临床环境中的实际采用和影响的巨大变化并存，并且经常未能将原本“成功”的项目纳入常规实践。本文利用行动者网络理论对这样一个项目进行了深入的社会技术分析——一个旨在诊断和加速成年女性尿路感染 (UTI) 治疗的计算机亭。一家医院紧急护理诊所的研究证明了该信息亭计划在诊断尿路感染和减少患者等待时间方面的有效性，该信息亭随后被该诊所用于常规患者护理。然而，一项促进急诊科 (ED) 采用该设备的研究的特点是，工作人员持续抵制，并且患者获得自助服务终端辅助护理的资格低于预期。该设备最终被废弃，除了一个新站点外。 2011 年 4 月至 7 月期间，我们对加利福尼亚州的四个 ED 进行了观察和采访，并与 ED 工作人员和设计/研究团队进行了访谈，结果表明对该设备有用性的证据和（不）采用该设备的原因存在相互矛盾的理解。信息亭程序的设计者试图通过在信息亭的软件中嵌入分诊实践的正式表示来“合理化”医疗工作。然而，由于遇到了不同的患者群体、机构政治以及每个站点急诊工作的复杂、务实方面，该信息亭的“网络”未能稳定下来。这项评估的结果挑战了一个长期存在的神话，即无论背景如何，技术都具有先验的品质和意义。在复杂的医疗环境中设计和部署新的 IT 项目将受益于对人类技术关系的偶然特性的经验性理解和响应。 (C) 2012 Elsevier Ltd. 保留所有权利。
High expectations for new technologies coexist with wide variability in the actual adoption and impact of information technology (IT) projects in clinical settings, and the frequent failure to incorporate otherwise "successful" projects into routine practice. This paper draws on actor-network theory to present an in-depth, sociotechnical analysis of one such project - a computer kiosk designed to diagnose and expedite treatment of urinary tract infections (UTI) in adult women. Research at a hospital urgent care clinic demonstrated the kiosk program's effectiveness at diagnosing UTI and reducing patient wait times, and the kiosk was subsequently adopted by the clinic for routine patient care. However, a study promoting the adoption of the device at emergency departments (ED) was characterized by persistent staff resistance and lower-than-expected patient eligibility for kiosk-assisted care. The device was ultimately abandoned at all but one of the new sites. Observations and interviews with ED staff and the design/research team were conducted at four California EDs between April and July 2011 and point to conflicting understandings of evidence for the device's usefulness and reasons for its (non)adoption. The kiosk program's designers had attempted to "rationalize" medical work by embedding a formal representation of triage practices in the kiosk's software. However, the kiosk's "network" failed to stabilize as it encountered different patient populations, institutional politics, and the complex, pragmatic aspects of ED work at each site. The results of this evaluation challenge the persistent myth that a priori qualities and meanings inhere in technology regardless of context. The design and deployment of new IT projects in complex medical settings would benefit from empirically informed understandings of, and responses to, the contingent properties of human technology relations. (C) 2012 Elsevier Ltd. All rights reserved.