TU Wien, Austria
Computer-support and the automation of hospital work – a historical perspective
Based on more than 30 years of fieldwork in hospital settings, this talk will address old and new issues surrounding computers in hospital work. The early studies focusing on the medical record (and its digitization), medical decision-support systems, the digitization of services such as radiology, as well as nursing information systems looked at those applications as systems of accountability that made the work of doctors and nurses more amenable to managerial criteria. Among the critically discussed issues were the nature of ‘data’ (their completeness, their de-contextualisation for secondary uses), the effects of standardization, as well as changing skill requirements and the division of labour. From a CSCW perspective, fieldwork in hospitals was used to develop systems that support the daily work of doctors and nurses. Although these debates continued, advances of technology and in particular the resurgence of AI bring additional issues into focus. Robotics (in particular care robots) on the one hand, automated decision-support systems based on machine learning on the other hand have intensified the debate on what are genuinely human skills and qualities – what is the nature of care work, what the nature of medical judgment and reasoning and which of their aspects can and should be transferred to machines. The talk will raise some of the issues that are of paramount ethical concern in relation to automation, among them control versus (relative) autonomy, the allocation of responsibility, equality and distributive justice. It will argue that the ‘ironies of automation’ that had already been identified with respect to the early hospital systems, re-emerge and take new forms that touch upon the complexity of the lives of patients, their illness trajectories and of the task to understand illnesses/sensibilities and to appropriately respond to them.
Ina Wagner is a leading European academic in the field of work and technology. Her research in the area of CSCW (Computer Supported Cooperative Work) and PD (Participatory Design) focuses on the study of work practices and the design of supporting technologies. She engaged early on in analyzing ethical and political aspects of ICT, with a focus on medical technologies. She has edited and written numerous books and authored over 160 papers on a variety of technology-related issues, amongst them computer-support of hospital work and of architectural design and planning, participatory design, and a feminist perspective in science and technology. Until September 2011 she was Head of the Institute for Technology Assessment and Design, Vienna University of Technology where she has built up a unique interdisciplinary research group. She was awarded the Woman's Prize of the City of Vienna (2011) and the 'Gabriele Possanner Staatspreis' (2011). Since 2001 she is a member of the Austrian Bioethics Committee. She currently holds a visiting position at the University of Siegen.
University of California, USA
Infrastructures for Enabling Smarter Interface Technology
Interface technology broadly refers to technological systems that mediate the communication and coordination between providers and patients. Interface technology plays a crucial role in extending the reach of professional care to patient homes. It also allows patients to actively contribute to care that takes place in clinical settings. This talk will describe some recent effort undertaken in the medical informatics community to develop infrastructures to enable consumer-facing applications to seamlessly interface with clinical information systems, electronic health records (EHR) in particular, using a new generation of health information exchange protocols such as Fast Healthcare Interoperability Resources (FHIR). Use cases include Sync for Science, via which patients can request their medical records to be denoted to research institutions such as the US National Institutes of Health; Apple’s Health Records within the HealthKit that can download clinical data from most commercial EHR systems; and many EHR-embedded apps that have been created to facilitate the collection of patient-reported outcomes and integration of such data into routine clinical practice.
Kai Zheng, PhD, FACMI, is Associate Professor of Informatics and Associate Adjunct Professor of Emergency Medicine at the University of California, Irvine. He also directs the Center for Biomedical Informatics at the UC Irvine Institute for Clinical and Translational Science. Prior to joining UC Irvine, he was Associate Professor of Health Management and Policy in the School of Public Health and Associate Professor of Information in the School of Information at the University of Michigan. He was Director of University of Michigan’s Health Informatics Program preparing students for careers that will harness the power of information to enhance health and transform individual health and healthcare. Zheng’s research draws upon techniques from the fields of information systems and human–computer interaction to study the use of information, communication, and decision technologies in patient care delivery and management. His recent work has focused on topics such as interaction design, workflow and sociotechnical integration, and diffusion and evaluation of health IT. His recent work also includes use of computational methods to augment the value of unstructured free-text data such as clinician notes and patient-generated content online. Zheng received his PhD degree in Information Systems from Carnegie Mellon University. He was the recipient of the 2011 American Medical Informatics Association (AMIA) New Investigator Award that recognizes early informatics contributions and significant scholarly achievements. He is an elected Fellow of the American College of Medical Informatics, and currently serves as Chair of AMIA’s Clinical Information Systems Working Group.