This afternoon's panel is on health care and information. Surprisingly, none of the panelists is from the US. There's two folks from Simon Fraser University in Vancouver, Canada, and a couple of obscure global locations.
Our first talk is by Zena Sherman, "'It kinda sucks, actually': information failure in a Canadian Hospital"
She saw a sign that said "never but never question the engineer's judgement" next to a human genome project sign and was amused to see the juxtaposition. And the interesting thing about this quotation is that it was actually said by a person in British Columbia's biggest trauma center.
The presenter here, despite being fast, is very interesting. She's using terms from my info sci background, such as "invisible work". And she's talking a lot about usability and how the Canadian health information infrastructure. She's a real great presenter. She put up a floorplan to show us what she's been talking about. She showed us two different floorplans to show us and talked about the plexiglass put in place to protect the workers. I guess some British Columbians got violent against the workers, and in many ways this is violence against woman because nurses and clerks are traditionally women. So she talks about the contstraints put in by the users. There's a hole cut in the bottom for passage of documents and two speak holes, one at a sitting height and one at a standing height. This is very bad, because people can't hear each other from either side. A user suggested design would be to just have an open hole down the center.
She compared this plastic barrier to the implementation of health care information systems in Canada. A combination of budget cuts and reliance on health information systems became a bit of a problem. Unfortunately, the system is constrained and was done with consulting the users. There are huge problems, like you can't cut and paste, you can't put in a long foreign address and it's generally a pain. Nobody really likes it.
Unfortuantely, in this case, it's easier to change the plexiglass than the information system, and so it continues with a system nobody's really happy about and that contains extra work and it reminds me of Lyman's comment about how users don't notice the technology until it's BROKE.
next up is Patrick Feng, also from SFU. His talk is about "Some COnceptual Issues in the Design of Health Info-structures"
He confesses that he's starting a new program and is just starting to put together his ideas. He was interested in the cultures of technology (As am I) and he took a couple maps and said, "What's the politics that lie under this infrastructures?" Much like the hospital information system that has a, well, culture is a bad word for this, but there's something underneath the forms and lines for blood type and things like that.
So what is infrastructure? Feng said that the projector and screen might be infrastructure for his speech, but his computer and Powerpoint are his tools, which differ with Becker's interpretation last night.
He thinks infrastructure is:
- support systems that enable and contain
- lie in the background
- taken for granted
- at least one level removed from the user.
Uh oh, word I don't know. Feng thinks infrastructure is a multivalent. He says that "Infrastructure has multiple, hetereogeneous groups of users, some of whom who might be at cross purposes: for example, cyclists and motorists sharing the road or cyclists and pedestrians sharing software or the whole Segway debate in San Francisco. He also says valence implies politics which I still don't quite get, but design changes politics.
Feng talks about transparancy of infrastructure. there are two possible meanings, in politics, it's clear to the user; in tech it's when it's invisible and hidden from the user. For example, Word. Feng then put up the "Hidden Settings" like the "crash every two hours" and "create extremely large files". It was a great joke and helped make his point.
Feng then said "Infrastructures -- like all technolgies -- support some tasks/action/modes of life better than others.
That quote yesterday was by Latour's scientists who lay the tracks.
Apperantly, Canadians are having a debate about health care (again!), and one of the things that might improve the Canadian Health Care system is information collected well and easily searchable. "Electronic health care is one of the keys to improving the Canadian health care system..." (from the Romanov(?) report)
Information systems are designed by techies. For techies, technology should be invisible, so this might just be a problem.
feng talks about translation and erasure. "Building an information infrastructure is a matter of standardizing, codifying, making durable..." He's going too fast though, for me to get down all his ideas.
What about empowerment of people? If they can pull up their health record at home, is that power? Is design a "superficial" or is it a "deep" critique of technology? Do we need to go beyond a humanist critique of infrastructures? If we accept that technology is inevitable, how can we go beyond "silly designers, they don't know what they're doing."
Next up is Caspar Jensen, from Denmark. Unfortunately I can't get his title.
He's talking about the electricalization and standardization of health care in Denmark. Again, sometimes, because of my ears, I can't quite make out what he's saying. His english seems to be very good, but he's not deviating from his paper. Oh dear.
In his paper, he wrote a lot about the different standards.it's starting to delve into jrenken's social science theme song. (And that's right what Cal typed just as I was thinking about it.)
*yawn*. Where's the solitare game?
I mean...I like hearing about this sort of stuff, but he's reading. There's a speed difference from somebody working directly from their head usually, and somebody who's reading, and this guy is most definitely reading.
This narrative is starting to remind me of the opening to "Nunavit" by Three Dead Trolls in a Baggie. But he's Danish, not Canadian. they had a commitee, which talked and sent their work to another committee, which added another committee. And after six years, they had a *gasp* PRE-standard.
To be honest, I'm not sure they have a final standard yet.
Yep, I was right, they're on their sixth pre-standard or so.
"national semantic standards" *eyes glaze over* Yay, he's only got THREE minutes left. ...and looking at what jrenken wrote about this in comparison to the California DMV, perhaps this is why Bush thinks Europe is irrevalent.
When you have three minutes left, don't *READ* quotes from the paper.
I went random a long time ago, Cal.
but I guess two good ones and a dud is decent. Better than this morning when the presenters went oh for fer and would have caused their baseball team to lose if this was a baseball game. Is the three minutes over *yet*? *PRACTICE* before you talk.
Brit Ross, again I couldn't get the title. She is really slurring her words. Look at jrenken's journal.
gah. this is really boring. She's reading even worse than the last guy.
Well, two for four.
She's getting slightly better, she's talking about why doctors wouldn't adopt this system, and some said that the out of contextness was a problem, and some felt they were being surveilled.
I think I have a different defintion than the rest of the people here over what "infrastructure" means.
She's saying it's *bad* for doctors to be autonomous? Because she's talking about prescribing and a system that flags patients if an allergy pops up or a contraindication...and she says it's bad that doctors can overrule the information system? I call that somewhat smart. For example, anti-depressants are counterindicated for bipolar disorder, but I'm on an antidepressant because I needed one in addition to my stabilizer. I am really disappointed in this talk.
three minutes left.
Commentary: We'll see if he sums this up well.
He's talking about his time in Argentina and the anti-psychiatry movement. So they decided an open door policy was a good idea. The result? The doctors started locking *their* doors and making sure there were good locks where they went.
His ancedotes are good, but I wish he'd get to the point.
hmmm, I'm not sure if I like this.
he asked a bunch of questions and now the panelists are trying to ask them. jrenken got them, so...I'm not totally worried about it, but it's still kinda a bit of trickiness. I don't seem to follow a question and answer format very well, especially with long complicated questions.
I'll let jrenken handle this, my memory and my typing are not up to the task.
and I suddenly understand some of what the third person was trying to say, but it was just a bad presentation, and that's why I didn't get the idea. He pointed out that Denmark really doesn't use the ECRs. That's those pre-standards.
*thunk* one of the conference co-coordinators just dropped a nasty question.