i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 389–390
journal homepage: www.intl.elsevierhealth.com/journals/ijmi
Editorial
Information technology in health care: Socio-technical
approaches
Early studies of health information system failures identi-
fied the central role of the human, social and organizational
contexts in which information systems operate. They set
the challenge for researchers to understand how to obtain
the best fit between the technical systems (e.g. the informa-
tion systems and associated work practices) and the social
and organizational systems (e.g. organizational culture, social
practices and behaviors, associated work practices and polit-
ical milieu), resulting in a socio-technical approach towards
health information systems. A quick search on Medline for
the period 2007–2009 showed 74 health informatics papers
that used the term ‘socio-technical.’ A similar search over the
period 2004–2006 yielded 34 publications. The search clearly
demonstrates an increase in scientific interest. In the edito-
rial to the first conference “Information Technology in Health
Care: Socio-technical Approaches,” Marc Berg, Jos Aarts and
Johan van der Lei stated that information systems require
interaction with people and that inherently understanding
them requires a focus on the interrelation between technology
and its social environment. It is the study of this interrela-
tion that has been labeled as the socio-technical approach
[1]. There are different strands in this approach. An impor-
tant contribution came from workplace studies that aimed to
enhance users’ skills, job satisfaction and good working rela-
tionships. There was a realization that designing processes
and policies that recognize and address the interdependency
between the social and technical subsystems of an organiza-
tion, also produced organizational performance benefits [2].
Another strand originated from a critical assessment of the
influence that technology had on people and its associated
determinism in shaping the technological future. These schol-
ars were mainly active in the domain of social studies of
science and technology and Actor-Network Theory is a major
exponent of this line of thinking. Computer scientists also
struggled with the fact that quite a few computer projects were
not particularly successful and sought explanations in orga-
nizational behavior [3]. Since then these strands have been
merging and the quality of the research papers has contin-
ued to improve, as have the theoretical sophistication and
empirical methodologies.
The Third International Conference “Information Technol-
ogy in Health Care: Socio-technical Approaches” was held in
Sydney, Australia, after successful conferences in Rotterdam
(2001) and Portland, Oregon (2004) [4]. Some thirty papers were
presented and they covered a wide range of topics, includ-
ing policy issues, user acceptance and usability, ethnographic
studies and qualitative methodologies. Seven papers have
been selected for publication in this special issue. Five papers
explore how work processes interact with information tech-
nology. One paper examines how professionals network with
each other and the other puts the consumer center stage.
Samantha Adams explored for what purposes blogging
is being used by consumers [5]. She introduced the notion
of “health goal-oriented” blogging. Nina Boulus and Pernille
Bjorn identified and characterized enabling factors that sup-
port continuous adaptation of technology and work practices
by comparing in a longitudinal ethnographic study the use and
adaptation of electronic patient records in two countries [6].
Juliana Brixey et al. studied how nurses and doctors initiated
and responded to interruptions in an emergency department
and concluded that strategies to reduce non-desired interrup-
tions should be managed from both sides [7]. Nerida Creswick
and Johanna Westbrook looked at behavior of health care
professionals and studied how professionals sought advice
from other professionals, the findings of which provided a
baseline to study the effect of interventions, such as an elec-
tronic medication system [8]. Maria Hägglund et al. moved
the study of ICT to the private home [9]. They developed
user-centered scenario’s to capture cooperative work routines,
information demands and other requirements in shared home
care to assist in the development of information systems.
Jesper Kjeldskov et al. studied whether the usability of an
electronic patient record system would improve when users
became more experienced over time [10]. They found that time
did not heal and usability problems remained. Finally, Inger
Dybdahl Sørby and Øystein Nytrø described an approach to
the analysis of observational data of clinicians’ information
and communication activities [11].
The special issue with selected papers from the Third Inter-
national Conference Informational Technology in Health Care:
390 i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 9 ( 2 0 1 0 ) 389–390
Socio-technical Approaches signals foremost the maturing of
the research field. It focuses on the interplay between people,
context and technology using a multi-method approach,
which recognizes the strengths of both qualitative and quan-
titative research methods. The body of studies illustrates how
interpretive theory is crucial for the understanding of the
complex phenomenon of health information technology in a
social and organizational context. It does not necessarily aim
at testing hypotheses, but enrich our sense making of a com-
plex world. It remains a challenge how critical socio-technical
thinking may contribute to the process of developing and
implementing new and more effective IT systems in health
care [12]. The fourth socio-technical conference, which will
be held in Aalborg, Denmark, in June 2010 and which will
have the theme “Designing and Implementing Health IT:
from Safe Systems to Patient Safety,” may point to some
answers.
references
[1] M. Berg, J. Aarts, J. Van Der Lei, ICT in health care:
sociotechnical approaches, Methods Inf. Med. 42 (4) (2003)
297–301.
[2] J.I. Westbrook, J. Braithwaite, A. Georgiou, A. Ampt, N.
Creswick, E. Coiera, et al., Multimethod evaluation of
information and communication technologies in health in
the context of wicked problems and sociotechnical theory, J.
Am. Med. Inform. Assoc. 14 (6) (2007) 746–755.
[3] H.C. Lucas Jr., Why Information Systems Fail, Columbia
University Press, New York, 1975.
[4] Information technology in health care 2007, in: J. Westbrook,
E. Coiera, J. Callen, J. Aarts (Eds.), Proceedings of the 3rd
International Conference on Information Technology in
Health Care: Socio-technical Approaches, IOS Press,
Amsterdam, 2007.
[5] S.A. Adams, Blog-based applications and health
information: two case studies that illustrate important
questions for Consumer Health Informatics (CHI) research,
Int. J. Med. Inform. 79 (6) (2010) e89–e96.
[6] N. Boulus, P. Bjorn, A cross-case analysis of
technology-in-use practices: EPR-adaptation in Canada and
Norway, Int. J. Med. Inform. 79 (6) (2010) e97–e108.
[7] J.J. Brixey, D.J. Robinson, J.P. Turley, J. Zhang, The roles of MDs
and RNs as initiators and recipients of interruptions in
workflow, Int. J. Med. Inform. 79 (6) (2010) e109–e115.
[8] N. Creswick, J.I. Westbrook, Social network analysis of
medication advice-seeking interactions among staff in an
Australian hospital, Int. J. Med. Inform. 79 (6) (2010)
e116–e125.
[9] M. Hagglund, I. Scandurra, S. Koch, Scenarios to capture
work processes in shared homecare—from analysis to
application, Int. J. Med. Inform. 79 (6) (2010) e126–e134.
[10] J. Kjeldskov, M.B. Skov, J. Stage, A longitudinal study of
usability in health care: does time heal? Int. J. Med. Inform.
79 (6) (2010) e135–e143.
[11] I.D. Sørby, O. Nytrø, Analysis of communicative behaviour:
profiling roles and activities, Int. J. Med. Inform. 79 (6) (2010)
e144–e151.
[12] E. Coiera, Putting the technical back into socio-technical
systems research, Int. J. Med. Inform. 76 (June (Suppl. 1))
(2007) 98–103.
Jos Aarts ∗
Institute of Health Policy and Management, Erasmus University
Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
Joanne Callen
The University of Sydney, Sydney, Australia
Enrico Coiera
University of New South Wales, Sydney, Australia
Johanna Westbrook
The University of Sydney, Sydney, Australia
∗ Corresponding author.
E-mail address: aarts@bmg.eur.nl
(J. Aarts)
1386-5056/$ – see front matter
© 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijmedinf.2010.03.006