Page - 173 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

How is what is being implemented different from what already happens? (Differentiation) Differentiation refers to the work that people do to understand how a new ensemble of practices is different from what came before. For example: a group of clinicians implementing a video conferencing system to interact with patients will likely want to understand how this new practice and its objects (i.e. video consultation equipment) operate differently from in-person consultation (both in terms of clinician patient interaction, and how new objects interact with other existing tools, protocols, and diagnostic implements) [3]. What does the intervention mean for team working? (Communal Specification) Healthcare is commonly delivered by teams, many of which involve clinicians and other professionals with different skill sets and contributions to overall patient pathways. This activity involves team working, including both immediate collaboration within the same physical setting, and remote working between individuals and teams based at different locations. Introducing new technologies and ways of working therefore has the potential to change working relationships. Making sense of interventions therefore also involves questions such as, ‘what needs to be done, by who, and when?’ [3]. For example, the rationale for changes to information recording systems may be to reduce workloads and/or improve accuracy and responsiveness. However, this also implies changes to the tasks and divisions of labour associated with record keeping. If we imagine the hypothetical case of a new electronic health record (EHR) being implemented into a General Practice (GP) clinic, questions around Communal Specification might include: how will the new system change who records and/or retrieves patient information? Are these changes the same for all information pathways within the service (e.g. does it affect the pathway of care for patients managing asthma in the same way as for patients managing a mental health condition)? What does the intervention mean for specific people? (Individual Specification) Making sense of interventions also has an individual component; that is, how interventions will affect the tasks and responsibilities of specific people. For example, staff recruiting patients to a clinical trial need a strong understanding of the work required to secure informed consent from patients (i.e. how the conditions of a new trial will affect their specific tasks and responsibilities in recruitment) [3]. How do participants see the value of the intervention? (Internalization) While understanding the practical aspects of the intervention (i.e. what is new, what it means for team working as well as individual responsibilities) is vital, it is also important that participants see the value of what is being implemented. Returning to the example of a video conferencing system for remote consultations, we might ask how clinicians involved in its implementation come to see its worth (or not) [3]. M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems 173