A participatory assessment of IS integration needs in maternity clinics using activity theory.

The design and development of information systems should focus on a wider context than merely one user group or organization. This is particularly the case with systems integration. A tentative description of the activity network, information needs, and user requirements should be acquired before any major changes are planned. Relatively rapid yet participatory methods are needed at this preliminary stage. In this article, we claim that activity theory offers a suitable framework for this. Subsequently, we present a qualitative study in which this approach was used, with focus on the practices of the information management within a maternity care activity network. The first aim was to elicit the most important integration needs in the existing information systems of Finnish maternity clinics. Secondly, we wanted to introduce a participatory approach to be utilized by the service-providing organizations themselves, rather than software companies or quality consultants. Data were collected in multi-professional group interviews. The results include information needs and communication problems as well as outlines for solutions in the systems integration of maternity clinics. Various tools of information management do not meet the concrete needs of health care work. Integration is needed on many levels, and it has to be adapted to the needs of numerous stakeholders. The applied activity-theoretical framework proved useful in describing such a multi-faceted system of information and its users. More research is needed on its wider applicability, particularly in situations where researchers are not active participants.

Integration models in health information systems: experiences from the PlugIT project.

Different approaches are available for the integration of existing health information systems (HIS) in integration projects. Within the PlugIT project in Finland, we have found it necessary to design and implement integration in a collaborative, multidisciplinary and open way. In this paper, we use some generic integration models and relate them to the methods, solutions and experiences of the project. We summarize the results from nine integration teams, methods development and supporting surveys and studies, and discuss these experiences to provide some guidelines for the HIS integration projects in general.

Gathering, structuring and describing information needs in home care: a method for requirements exploration in a "gray area".

The aim of our research is to develop a method for "requirements exploration"--gathering, structuring and describing requirements for information systems in previously weakly understood areas. In health care, information systems are usually developed for a single organization, or for information flow from one organization to another. In our case domain, multi-professional and multi-organizational home care, this approach is not very helpful. Moreover, home care takes place in "no-man's-land"; outside the organizations' infrastructure, in the customer's home, and technology is used scarcely. In this paper, we describe how information requirements were explored in this scantly understood domain by using an activity-theoretical approach. We also explain how this approach served our purposes. The method proved useful in grasping the network of activities and the information needs. The holistic nature of the method was particularly important, since technology is not the only solution to the needs we discovered.