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Learning from Users’ Adaptation Experience: Outlining the Design Space for Health IT Systems


No IT system is perfect at the time of its deployment. Users gradually adapt to the technology through everyday use. This is especially true for IT systems that are situated in complex environments, such as the healthcare domain. In a typical medical environment, information is constantly changing, and patient care tasks often require close collaboration among multiple providers and care teams. These challenges escalate the difficulties of designing effective health IT systems. They also makes users’ technological adaptation behaviors a particularly important research area as adaptation behaviors directly inform the (re)design of such systems. This dissertation investigates users’ adaptation behaviors and the subsequent redesign practice in an in-depth ethnographic study of an implementation of a hospital-wide Electronic Health Records (EHR) system.

I conducted two case studies in an Emergency Department (ED) affiliated with a large teaching hospital. The first study evaluates ways in which healthcare providers engaged in the adaptation process after a large-scale health IT system deployment; the second study examines the ways in which patients engaged in adaptive behaviors in this sociotechnical environment to leverage information breakdowns and ensure their quality of care. Qualitative and ethnographic formative research methods were used to examine both the providers and the patients’ information practices. The results of these studies indicate detailed adaptation processes. They shed light on how a newly deployed health IT system alters clinical work practices; how individual clinicians and a healthcare organization respond to a new system through technological and organizational adaptations; and how patients engage in various adaptive behaviors to achieve quality of care when information and technologies are not available and/or do not meet their needs.

Based on the study’s findings, I argue that the adaptation practices from these two different stakeholders are active end-user driven design practices, with significantly common characteristics. My study further reveals that these adaptation practices comprise two types of adaptive goals – one addressing immediate breakdowns and the other addressing healthcare specific needs – both of which are undervalued, yet crucial parts of healthcare organizations. This study provides broader design implications for evaluating and designing a sociotechnical information system in highly-regulated, complex, and information-critical contexts, focusing on the role of HCI researchers and designers.

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