Page - 76 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

sociotechnical informatics. Sociotechnical informatics includes the propagation and transformation of information across natural and engineered computational systems at a sociotechnical level. For distributed cognition, the argument is that individuals form a tightly coupled system with their environment in such a way that they employ and exploit external structures in cognitive tasks, so the task of cognition is actually distributed [2]. For example, ambulance dispatch coordinators have cards (representing incidents) and a tray of slots (each slot representing an ambulance) so they can easily see what ambulances are assigned to what incidents and how many ambulances they have free without relying solely on their internal memory [3]. Furthermore, we can configure sociotechnical systems and design external structures to influence how information is transformed and propagated in teams of individuals. For example, in the London ambulance control room dispatch teams are organised by region so if they have an incident between two regions one team can more easily communicate with the team beside them about resource allocation [3]. Modern healthcare informatics faces increasing challenges in how information processing systems should be designed and organised, especially as systems become more distributed, interconnected and complex. Distributed cognition can help to understand complex sociotechnical informatics. 1.1. Distributed cognition: The basics Distributed cognition was pioneered by Edwin Hutchins and colleagues in the early nineties. His book, Cognition in the Wild, is the seminal text in the area [1]. Distributed cognition distinguishes itself from other approaches by taking the information processing metaphor of the mind and suggesting that this should not be limited to the brain, broadening what can be considered part of the cognitive system [2]. Its unit of analysis is not the individual mind but a complex cognitive system, which is essentially sociotechnical in nature [4]. It is complex because it involves different artefacts and people, over time and physical space; it is cognitive because it is focused on information processing; and it is a system because it involves elements that interact to perform a task or achieve a goal. These defining features resonate well with complex sociotechnical informatics. One of the earliest and best-known applications of the theory involved considering a cockpit as a complex cognitive system comprising the pilots, instruments, controls and reference materials [5]. Hutchins [5] examined the intricacies of how this system worked as the design of the tools and instruments, the way the pilots sat, and the way they communicated could influence performance. He showed that distributed cognition is not simply about offloading memory into the environment, whereby operators have extra reference material to aid recall, but that their tasks can fundamentally change depending on how cognition is distributed. For example, Hutchins described how speed bugs are adjusted on a speed dial to indicate safe parameters for landing speeds depending on an aircraft’s weight. These do not act solely as an additional reference point in case the pilot cannot recall the figures that define the parameters for safe landing speeds: they actually provide a spatial range that the speed dial indicator should remain within, which is a very different form of interaction. Hutchins [5] includes these interactions to account for the cockpit system’s memory. Distributed cognition has also been shown in carefully constructed laboratory experiments. For example, Maglio and Kirsh [6] showed that experts sometimes make epistemic actions in the environment to simplify a problem space rather than trying to solve the problem in their head before acting. Also, Zhang and Norman [7] showed that D.Furniss etal. /DistributedCognition:UnderstandingComplexSociotechnical Informatics76