Datafication: the Flavor and Scent of Data.

This paper deals with data handling in health care on three distinct and different levels. The three levels can be classified in the following way: ethical level based on principles, political level based on negotiations and relations, and phenomenological level based on relation in between the physical and digital world. The paper takes an outset in a recent report, published in October 2021, from the Lancet and Financial Times Commission on governing health futures 2030 (ethical level), and a recent publication (2020) and exhibition at the Biennale of Architecture in Venice (2021) on Data Publics (political level), and finally makes an attempt to frame our being with digital technology on a philosophical and phenomenological level. It is the assumption that all these levels are needed the moment we try to appropriate and incorporate data in different arenas and worlds, might they be global, national, institutional, or/and individual.

People Centeredness, Chronic Conditions and Diversity Sensitive eHealth: Exploring Emancipation of the 'Health Care System' and the 'Patient' in Health Informatics.

Health care systems struggle to consistently deliver integrated high-quality, safe, and patient-centered care to all in an economically sustainable manner. Inequity of access to health care services and variation in diagnostic and treatment outcomes are common. Further, as health care systems become ever more complex, iatrogenesis and counter productivity have emerged as real dangers. In exploring this paradox, this paper considers a subset of those in society living with chronic conditions. Their attributes and circumstances have led to them being marginalized or excluded from 'end-user' engagement and/or from their requirements being incorporated into technology supported chronic disease management initiatives. Significantly, these citizens are often the most vulnerable and socially disadvantaged and tend to achieve poorer results and cost more per capita than the 'average patient' in their interactions with the health care system. Critically, this paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. This paper suggests innovative ways of supporting interactions with these 'end-users' and highlights how reflection on these approaches can contribute to emancipating the health system to move towards more socially inclusive eHealth solutions.

How Can Health Information Technologies Contribute to Improve Health Care Services for High-Need Patients?

This paper discusses how health information technologies like tele-care, tele-health and tele-medicine can improve the condition for high-need patients, specifically in relation to access. The paper addresses specifically the values of timeliness and equity and how tele technological solutions can support and enhance these values. The paper introduces to the concept of scaffolding, which constitutes the framework for dynamic, appropriate, caring and embracing approaches for engaging and involving high-need patients that are vulnerable and exposed. A number of specific considerations for designing tele-technologies for high-need patients are derived, and the paper concludes that ethical and epistemological criterions for design are needed in order to meet the needs and requirements of the weak and exposed.

Nursing Telehealth, Caring from a Distance.

Tele-technology in the health care system is prognosed to be able to produce better health, better care at lower cost (Triple aim). This paper will discuss the validity of this prognosis, which in many ways is considered as some sort of diagnosis of the conditions concerning triple aim in relation to Tele-technology. Tele-technology in the health care system covers three different types of technological settings: telecare, telehealth and telemedicine. This paper will disclose the different meanings of telecare, telehealth and telemedicine and discusses how nursing informatics can accomplish and gain from this disclosure. Theoretically and methodologically the paper is based on post-phenomenological readings and reflections, where use, practice, users, participants, values and knowledge systems are addressed on an equal level in order to understand technology and how we act appropriately through and with technology.

Challenges in Improving Health Care by Use of Health Informatics Technology.

This chapter discusses the complementary role of Techno-Anthropological methodologies in relation to classical quantitative and qualitative methodologies. The chapter addresses the importance of evidencing the problems in health informatics and how these problems are framed in order to find appropriate solutions. It is the claim that problem based learning approaches (PBL) and inter-disciplinary teamwork is paramount in order to meet the current challenges of development and implementation of health informatics in the health care system. The triple aim of providing better health, better care at lower cost on a societal level is complemented by similar aims on an institutional and individual level in order to frame health informatics on a more holistic level. In order to achieve this goal we have to embrace concepts like co-creation and co-construction with users and actors. The aim of the chapter is condensed in methodological recommendations for Techno-Anthropological work in health informatics contexts.

The Question Concerning Narration of Self in Health Informatics.

Narration is central, even crucial, when it comes to embracing the whole individual, continuity of care, and responsible (ethical) handling of the technological construction of the self that takes place in health informatics. This paper will deal with the role of narratives in the construction of health informatics platforms and how different voices should have space for speech on these platforms. Theoretically the paper takes an outset in the actant model for narratives by the French-Lithuanian theorist of linguistics and literature A.-J. Greimas and post-phenomenological readings of human-technology interactions. The main assumption is that certain interactions and voices are absent from the construction of health informatics platforms, because regarded as outside the text of computational and medical practice and expertise. This has implications for what concerns meaning and understanding regarding both the actual users (physicians and medical staff) and excluded users (patients and citizens).

How standards will degrade the concepts of the art of medicine.

The paper is dealing with the problematic positioning of the whole health care system towards the concept of standard. There is a constant quest for standards, and a prediction of how everyday language gradually will disappear. It is the assumption and conjecture of this paper that as we outdo everyday language from our communication in the system we lose major part of meaning-construction concerning health and life of the patient/citizen. It is the normative and ethical aim of the discussion to frame how human factors are terminated as standards and bodies as machines replaces everyday language and bodies as carrier of health. Hans Georg Gadamer has led me on the way through inspiring essays on the Enigma of Health.

How to dwell in an EHR. The question concerning architecture EHR.

The article deals with architecture and EHRs on a conceptual and philosophical level. Architecture is seen as the essential human expression of being, exemplified through the thoughts and writings of the German architect Gottfried Semper, the American architect Philip Johnson and the German philosopher Martin Heidegger. It is the assumption of the article that the current versions of EHR architectures are the result of a technical and systemic perspective on architecture, as opposed to the thoughts of Semper, Johnson and Heidegger. The article has a value-based and phronetic approach to the topic field, and claims that construction of EHRs should be a matter of concern, and not, as it is for now, a matter of fact.

Methodology for analysis of work practice with video observation.

Prior to developing and implementing health informatics systems it is essential to acquire information about the work practice. Interviews are often used but they don't always capture important details. In this project we used video cameras to observe the work practice of two medical secretaries at Department of Urology at Arhus University Hospital, Skejby. The project was carried out with a clear user influence in all phases of the project. The observation and the analysis focused on interruptions of the work processes, of which we found numerous that we categorized in three different types. The use of video and audio proved to be powerful tools for analysis of work practice, although it is very labor intensive method.