Plug-in healthcare: Development, ruination, and repair in health information exchange
Notice bibliographique
Résumé
This dissertation explores the work done by people and things in emerging infrastructures for health information exchange. It shows how this work relates to processes of development, production, and growth, as well as to abandonment, ruination, and loss. It argues for a revaluation of repair work: a form of articulation work that attends to gaps and disruptions in the margins of technological development. Often ignored by engineers, policy makers, and researchers, repair sensitizes us to different ways of caring for people and things that do not fit, fall in between categories, and resist social norms and conventions. It reminds us that infrastructures emerge in messy and unevenly distributed sociotechnical configurations, and that technological solutions cannot be simply ‘plugged in’ at will, but require all kinds of work. With that, repair emphasizes the need for more democratic, critical, and reflexive engagements with (and interventions in) health information exchange. Empirically, this study aims to understand how ‘integration’ in health information exchange is done in practice, and to develop concepts and insights that may help us to rethink technological development accordingly. It starts from the premise that the introduction of IT in healthcare is all too often regarded as a neutral process, and as a rational implementation challenge. These widespread views among professionals, managers, and policy makers need to be addressed, as they have very real – and mostly undesirable – consequences. Spanning a period of more than ten years, this study traces the birth and demise of an online regional health portal in the Netherlands (2009-2019). Combining ethnographic research with an experimental form of archive work, it describes sociotechnical networks that expanded, collapsed, and reconfigured around a variety of problems – from access to information and data ownership to business cases, financial sustainability, and regional care. It puts a spotlight on the integration of standards, infrastructures, and users in the portal project, and on elements of collapsing networks that quietly resurfaced elsewhere. The reconstruction of these processes foregrounds different instances of repair work in the portal’s development and subsequent abandonment, repurposing, and erasure. Conceptually, this study contributes to academic debates in health information exchange, including the politics of technology, practices of participatory design, and the role of language in emerging information infrastructures. It latches on to ethnographic studies on information systems and infrastructural work, and brings together insights from actor-network theory, science and technology studies, and figurational sociology to rethink and extend current (reflexive and critical) understandings of technological development. It raises three questions: What work is done in the development and demise of an online health portal? How are relations between people and things shaped in that process? And how can insights from this study help us to understand changing sociotechnical figurations in health information exchange? The final analysis includes five key concepts: the act of building network extensions, the method of tracing phantom networks, the notion of sociotechnical figurations, the logic of plug-in healthcare, and repair as a heuristic device.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,027 | 0,036 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,008 | 0,061 |
| Communication savante | 0,020 | 0,037 |
| Science ouverte | 0,002 | 0,020 |
| Intégrité de la recherche | 0,005 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».