A Model for Context-Sensitive Digital Integrators.

The realization of benefits from health information technology (HIT) implementation takes place in the long tail of implementation that must integrate technology, work practices and contextual factors. While formal health informatics education programs exist, they tend to be focused at the strategic management or specialized implementation level. HIT support at the local level often falls to clinical care staff that have little or no formal training in HIT implementation. This paper will expand on the term context-sensitive digital integrators (CSDI) as a role that could support local implementation. We discuss the CSDI role, including terminology, competencies and the role context sensitivity plays in implementation, and how CSDIs could be better supported and trained in different contexts.

Data work and practices in healthcare: A scoping review.

CONTEXT: In healthcare, digitization has been widespread and profound, entailing a deluge of data. This has spurred ambitions for healthcare to become data-driven to improve efficiency and quality, and within medicine itself to improve diagnosing and treating diseases. The generation and processing of data requires human intervention and work, though this is often not acknowledged. PURPOSE: The paper investigates who, where, by which means, and for which purposes data work is conducted which is crucial for healthcare managers and policy makers if ambitions to become data-driven are to succeed. To guide further research, it also provides an overview of existing research on data work and practices. METHODS: We conducted a scoping review based on a search for papers including the terms healthcare or health care combined with at least one of the following terms: data work, data worker*, data practice*, data practitioner* in Scopus and Web of Science. 74 papers on data work or practices in healthcare were included. ANALYSIS: The 74 papers were coded and analyzed regarding the following themes: the kind of data workers and practitioners, organizational settings, involved technologies, purposes, data work tasks, theories and concepts, and definitions of data work and practice. RESULTS: Data work is pervasive in healthcare and conducted by various professions and people and in various contexts. The field researching data work and practices is emerging, with publications spread across multiple venues. and there is a need for more precise definitions of data work. Further, data work and practices are useful concepts that have enabled the exploration of those efforts and tasks in detail. CONCLUSION: The research on data work and practices in healthcare is emerging and promising. We call for more research to consolidate the field and to better understand and support the work needed for healthcare to become data-driven.

Equity in digital healthcare - the case of Denmark.

As digital healthcare services are expanding in use and purpose in a Danish context so are the functionalities embedded in these, constituting citizens' access to healthcare services and personal health data. In Denmark, the impact of inequalities in digital healthcare remains largely unexplored, making it crucial to pay close attention to this aspect as the digital transformation of the sector progresses. According to the Danish Health Act (2019), the Danish healthcare system is required to ensure easy and equal access to healthcare, high-quality treatment, coherent patient pathways, freedom of choice, easy access to information, transparency, and short waiting times for every citizen. These are focal law-based requirements influenced by the digitalisation of healthcare. Hence, based on insights from a highly digitalised country, in this case, Denmark, this paper aims to initiate a discussion on inequities in digital healthcare, address current challenges, and consider future directions by elaborating on conceptual, ethical, evidence-informed, and methodological issues linked to inequities in digital healthcare. Specifically, this paper discusses why inequities in digital healthcare in a Danish context need increased attention, how health equity is embedded in Danish legislation and how it can be approached from an ethical perspective. The central focus revolves around the essential principles of empowerment, emancipation, and equity, which are being highlighted to emphasise that the digitalisation of healthcare should actively work towards preventing and avoiding the perpetuation of healthcare inequalities. The paper concludes by discussing future directions for ensuring a more sustainable, robust, and equitable digital healthcare system.

Medical Secretaries' Registration Work in the Data-Driven Healthcare Era.

Through a qualitative study in six hospital departments in the Northern Region of Denmark, this article aims to shed light on how a non-clinical group, medical secretaries, supports clinical-administrative documentation as they translate between the clinical and administrative domains. This article shows how this demands context-sensitive knowledge and skills acquired through deep engagement with the full scope of clinical-administrative work at the department level. We argue that, given the increasing ambitions for secondary uses of healthcare data, specific clinical-administrative competencies beyond those of clinicians are increasingly necessary in the skillmix in hospitals.

The Last Mile Problem and Beyond in HIT - The Role of Context-Sensitive Digital Integrators.

Issues of non-use of available health information technology (HIT) have been referred to as the 'last mile problem' impeding harnessing the full potential of HIT. We reflect upon which competencies are needed to address the last mile problem by ensuring a context-sensitive implementation. We argue that there is a need for context-sensitive digital integrators, who can navigate the realm where technological systems meet practice. This entails a situated, socio-technical, context-sensitive approach and competencies which are not easily addressed through formal training but require lifelong situated learning, as the field evolves continuously. Our ambition is to highlight the complexities of implementation and integration into local practice. This paper emphasizes the role of digital integrators in the hope of fostering further discussions on how to acknowledge and nourish these competencies in order to address and go beyond the last mile problem.

Data Work in Health Care: The Case of Medical Secretaries.

This paper investigates the often neglected area of data work by medical secretaries, specifically in the context of hospitals in Denmark. Since the 1930s medical secretaries have played a steadily more central role in meeting the growing need for health data. With electronic health records (EHRs) and promises of data automation, the profession has been put at risk of redundancy. While there is a considerable base of research on the datafication of health care, the data work emerging from datafication remains undescribed. Hence, we are conducting a socio-technical study of clinical-administrative data work in contemporary Danish public hospitals. In this paper we present early insights of this research, indicating the vital role of medical secretaries' data work in securing clinical information at the point of care.

Changing Health Behavior with Social Technology? A Pilot Test of a Mobile App Designed for Social Support of Physical Activity.

Mobile applications targeting people engaged in physical activity have increased. However, while research has identified social support as a key factor for people's engagement in physical activity, most mobile health (mHealth) applications are designed for individual use. In this paper, we report on a research study exploring opportunities for designing mHealth to facilitate social support around physical activity. A mHealth application was designed, and pilot tested for eight weeks with healthcare professionals (n = 3) and two groups of citizens (n = 20) who were motivated but challenged physically due to various health conditions. Data was collected via online monitoring of the use of the mHealth application during the pilot test and via qualitative interviews with the participants before and after. The results support the idea that designing for social health support is important but so is identifying key challenges related to (i) the facilitation of technology-mediated social health support, especially to a target group that is living with health challenges, and (ii) finding a balance between social and health agendas that bring social support to the foreground for the participants.