Page - 79 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Halverson [19] makes the point that distributed cognition does not explicitly name its concepts and constructs, which makes it harder to apply. DiCoT and DiCoT-CL advance the field by making explicit the concepts that support reasoning about a system in terms of distributed cognition, which are called ‘principles’ in DiCoT (e.g. see application of a sample of distributed cognition principles in Table 1). These principles are organised under the five DiCoT models that act as constructs for distributed cognition. DiCoT-CL adds constructs in the different layers of the sociotechnical system, and the proposition is that these layers are part of and nested within another. Naming these principles encourages deeper insight because they refer to more abstract sociotechnical issues, configurations and patterns in the data. The principles go beyond mere description and improve the rhetorical power of distributed cognition because the theory can help frame arguments about what is influencing the performance of the system, e.g. decisions in one layer might have an impact on performance in another layer. Hollan et al. [2] offer a framework describing how integrated research activities using distributed cognition theory might be carried out. The framework links distributed cognition theory to ethnography, experimentation and testing, work materials, and workplaces. The order of these elements in the framework can be adapted for different studies; for example, observational work to identify key determinants for system performance might be conducted to inform the design of experimentation and testing; or it might be that results of tests or design processes away from the workplace can then be trialled to see how they perform in the messiness of practice. 2. Use of distributed cognition in health informatics In this section we give a brief overview of how distributed cognition theory has been used in health informatics before presenting two use cases to demonstrate how DiCoT and DiCoT-CL can be used in both formative and summative stages of a project life cycle. 2.1. Overview of how distributed cognition theory has been used in health informatics The case for distributed cognition’s relevance for health informatics has been argued previously [20]. It lends itself well to exploring how people interact with technology in the workplace, issues to do with communication and coordination, how people’s thinking extends into the environment and sociotechnical system architecture and performance more broadly. Published studies using distributed cognition in health informatics journals and related areas include: • Hazlehurst et al. [21], who used distributed cognition to help identify six types of communication exchange that help situation awareness arise from coordinated work and achieve successful performance between surgeons and perfusionists in cardiac surgery. They investigated activities, artefacts, resources, constraints and information flows. • Cohen et al. [22], who used distributed cognition to analyse morning rounds and handovers in a psychiatric emergency department to explore how error commission, detection and recovery are an integral part of cognitive work. They identified instances of perceived violations and miscommunication. D.Furniss etal. /DistributedCognition:UnderstandingComplexSociotechnical Informatics 79