Crisis Readiness: Revisiting the Distance Framework During the COVID-19 Pandemic.

While CSCW researchers have studied collaboration across distance for more than two decades, the scale and context of geographically distributed work during the pandemic is unprecedented. Working from home as the default setting during the COVID-19 pandemic provides a unique opportunity for CSCW research to explore and develop new understandings of what it entails to engage in distributed collaborative work during a global crisis. In this paper, we revisit the distance framework, originally developed by Olson and Olson in 2000, through empirical data collected during the critical moments where COVID-19 was declared a pandemic and the world shut down: namely March 2020. We use the data to interrogate the distance framework and to extend it with a new dimension - Crisis Readiness. Crisis Readiness stipulates that for organizations to successfully respond to crises, four factors are required: 1) the ability to respond fast with dramatic measures; 2) the ability to supply adequate infrastructure to their employees; 3) the ability to adapt work practice responding to new work and life conditions; and 4) the ability to handle multiple and diverse interruptions both at the individual and organizational levels. Our contribution to CSCW research is a revised distance framework, which demonstrates that for geographically distributed work to be successful during a global crisis, cooperating actors need to achieve Common Ground, engage in different types of coupled work, be ready for collaboration and collaboration technology - and lastly, work in an organization which demonstrates Crisis Readiness.

Infrastructures for healthcare: From synergy to reverse synergy.

The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classifications, on the entire Danish population. However, in the Autumn of 2014, the system was temporarily shut down due to a lawsuit filed by two general practitioners. In this article, we ask why and identify a political struggle concerning authority, control, and autonomy related to a transformation of the fundamental ontology of the information infrastructure. We explore how the transformed ontology created cracks in the inertia of the information infrastructure damaging the long-term sustainability. We propose the concept of reverse synergy as the awareness of negative impacts occurring when uncritically adding new actors or purposes to a system without due consideration to the nature of the infrastructure. We argue that while long-term information infrastructures are dynamic by nature and constantly impacted by actors joining or leaving the project, each activity of adding new actors must take reverse synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare.

Designing for collaborative interpretation in telemonitoring: re-introducing patients as diagnostic agents.

PURPOSE: We investigate why clinicians experience problems interpreting implantable cardioverter-defibrillator (ICD) data when the patient is absent, and we explore how to re-introduce patients into the socio-technical setup of telemonitored interpretation practices. METHOD: An action research study with a design interventionist perspective was conducted to investigate the telemonitoring arrangement for chronic heart patients with ICDs and to identify the nature of the collaborative practices involved in ICD data interpretation. We diagnose the main challenges involved in collaborative interpretation practices. These insights were used to re-design the socio-technical setup of the telemonitoring practices by designing and building a web-based, patient-centric, collaborative application, myRecord, to re-introduce the patients as active participants into the telemonitoring setup. Finally, we introduce myRecord at Copenhagen University Hospital and evaluate the new practices and the collaborative technology related to the transformed role of the patients. RESULTS: The interpretation of ICD data is a collaborative practice engaging clinicians and patients and involving three separate collaborative processes: interpretation of numbers; interpretation of general condition; and patient's interpretation of own condition and ICD data. In a collocated setup, these three interpretation processes are entangled and seamlessly interrelated. However, in the current telemonitoring setup, only the interpretation of numbers process is fully supported, neglecting the two other processes, and, in particular, the role of the patient. By re-introducing patients into the socio-technical setup of telemonitoring through myRecord, our design acknowledges the collaborative nature of the interpretation process. However, re-introducing patients transforms their role, and leads to new transformed telemonitoring practices, different from both the current telemonitoring setup as well as from the collocated setup. CONCLUSION: Telemonitoring practices of patients with ICDs involve three entangled collaborative processes, whereas the existing socio-technical setup only mediate one. myRecord is designed as an add-on collaborative technology to mediate the two remaining collaborative processes. We argue that myRecord solves some of the problems with ICD data interpretation inherent in telemonitoring practices by providing a collaborative, asynchronous space for healthcare practitioners and patients to mediate the two processes that are otherwise lost. Our new socio-technical design also transforms the role of patients considerably, thus new studies should take these insights into consideration.

A cross-case analysis of technology-in-use practices: EPR-adaptation in Canada and Norway.

PURPOSE: To identify and characterize enabling factors that support a continuous adaptation of technology and work practices in the health care sector. METHODS: Cross-case analysis of two longitudinal ethnographic studies of managing the gradual adaptation of electronic patient records, one in Canada and one Norway. RESULTS: The cross-case analysis revealed that technology-in-use practices developed more rapidly in one of the cases, and one of the major driving forces was the establishment of a special committee and the associated project meetings. Based on the literature and grounded in the empirical observations, we complement and expand the notion of project meetings as composed of continuous reflection-on-practice activities to construct technology-in-use practices. CONCLUSION: We characterize reflection-on-practice activities as frequent encounters of negotiations of work practices and technology use, providing internal actors a space for systematic evaluation of suggested changes. Further we argue that representatives of the affected professions should not only participate, but also have a mandate to make and evaluate decisions of the technology-in-use practices of the particular group.

Constructing technology-in-use practices: EPR-adaptation in Canada and Norway.

Investigating two longitudinal ethnographic studies of managing gradual adaptation of electronic patient records in Canada and Norway, we conduct a cross-case analysis of the enabling factors that support a continuous transformation of technology and health care practices. In line with previous research, our study shows that large-scale information systems adaptation in health care should be managed by a project-group including not only IT-developers, but also representatives of future users and management. While we also argue for the importance of these meetings, we complement and expand the notion of project meetings by providing a conceptualization of the essential aspects of these meetings. Our conceptualization is composed of continuous reflection-on-practice activities to construct technology-in-use practices. Reflection-on-action activities are internally initiated, and comprise critical reflections by the participants, who continuously evaluate and question work practices in relation to technology.