Page - 81 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Table 1. Examples based on the PHIMed project showing how DiCoT principles can generate thoughts and questions before a project has started. The models show the area of Figure 1 that these principles are related to, however they are interdependent models so in practice there is a lot of overlap between models. Principle (and associated model) Description of principle Application to PHIMed project Information hubs (Information flow model) Information hubs are a central focus where different information channels meet and different information sources are processed together, e.g. where decisions are made on various sources of information. Patients may consider their general practitioner or healthcare record as a hub. However, others may see their care as fragmented so they are the hub, or they may perceive their PHIMed to act as a hub where there medications are concerned. Behavioural trigger factors (Information flow model) In teams it is possible for individuals to operate without an overall plan as each member only needs to know what to do in response to certain localfactors. Individuals may also base their behaviour on their perception of local circumstances. These initiating factors can be dubbed ‘trigger factors’ because of their property to trigger behaviour. What was the reason for starting to use PHImed? What triggers someone to show PHIMed to a particular healthcare practitioner or to take it to a particular consultation? What triggers someone to update their PHIMed? Situation Awareness (Physical layout model) One of the key things in shared tasks is to keep people informed of what is going on, what has happened and what is planned. This can be influenced by how accessible the work of the team is. For example, in large control rooms the fact that an operator is in one area may lead to the correct inference of what they are doing, as that area pertains to certain activities. This seems really important because different healthcare practitioners may lack situation awareness and PHIMed can help improve situation awareness in fragmented pockets of care. Horizon of observation (Physical layout model) The horizon of observation is what can be seen or heard by a person. This will differ for each person in an environment depending on their physical location, the activities they are close to, what they can see and hear, and the manner in which activities take place. The horizon of observation of a person refers to the scope of information input, whereas situation awareness is about the inferences that are made from this information. Different healthcare practitioners will have very different horizons of observation, as will the patient and carer. Different technologies and PHIMed may influence the healthcare practitioner’s horizon of observation. Socially distributed properties of cognition (social model) “The performance of cognitive tasks that exceed individual abilities is always shaped by a social organisation of distributed cognition. Doing without a social organisation of distributed cognition is not an option. The social organisation that is actually used may be appropriate to the task or not. It may produce desirable properties or pathologies. It may be well defined and stable or may change moment by moment; but there will be one wherever cognitive labour is distributed, and whatever one there is will play a role in determining the cognitive properties of the system that performs the task” [1, pp 262]. The cognitive tasks involved in looking after a patient, which could include treating different conditions, appear to be distributed between different specialists and individuals. How are these individuals distributed and coordinated? What impact does this have on patient care and decisions about medication optimisation? D.Furniss etal. /DistributedCognition:UnderstandingComplexSociotechnical Informatics 81