Coordination Challenges in Collaborative Practices in the Prevention of Mother to Child Transmission of HIV in Tanzania
Background and Purpose: This paper describes some of the complexities that face health service provision in developing countries, with the motivation to inform design of appropriate information systems. In particular, we are interested in a better understanding of the challenges to coordination and collaboration between health staff that are located in different facilities and employed to work in different health programs.
Methods: The study reported and analyzed in this paper was conducted in two districts in Tanzania. Using ethnographic data collection methods, we studied health workers’ practices of coordination and collaboration in Prevention of Mother to Child Transmission (PMTCT) services in Tanzania.
Results: In our study we describe the collaboration required when managing patient trajectories of PMTCT patients across facilities and programs, and how contingencies may change the course of a patient trajectory. We provide a rich empirical description of coordination work in a resource constrained setting and we propose improvements to the design of both computer and paper-based information systems.
Conclusions: The rich empirical description of coordination work in a resource constrained setting and our analysis of coordination challenges contribute to a better understanding that can strengthen collaboration and thus also improve health care provision.
Keywords: Patient-Care Information Systems, Collaborative Practices, Coordination Mechanisms, Coordination Artefacts
Bagayoko, C., Anne, A., Geissbuhler, A., & Fieschi, M. (2008). Can ICTs Contribute to the Efficiency and provide Equitable Access to the Health Care System in Sub-Saharan Africa? Thromb Haemost, 99(6), 1112-1115.
Bardram, J. (1998). Designing for the dynamics of cooperative work activities. Paper presented at the Proceedings of the 1998 ACM conference on Computer supported cooperative work.
Bath, G. (2006). Telemedicine in Africa. Journal of the South African Veterinary Association, 77(3), p. 107-p. 107.
Berg, M. (1999a). Accumulating and coordinating: occasions for information technologies in medical work. Computer Supported Cooperative Work (CSCW), 8(4), 373-401.
Berg, M. (1999b). Patient care information systems and health care work: a sociotechnical approach. International journal of medical informatics, 55(2), 87-101.
Bjørn, P., & Hertzum, M. (2011). Artefactual multiplicity: A study of emergency-department whiteboards. Computer Supported Cooperative Work (CSCW), 20(1-2), 93-121.
Blomberg, J., & Karasti, H. (2013). Reflections on 25 years of ethnography in CSCW. Computer Supported Cooperative Work (CSCW), 22(4-6), 373-423.
Braa, J., Monteiro, E., & Sahay, S. (2004). Networks of action: sustainable health information systems across developing countries. Mis Quarterly, 337-362.
Bryman, A. (2012). Social research methods: Oxford university press.
Cabitza, F., Sarini, M., Simone, C., & Telaro, M. (2006). Torres, a conceptual framework for articulation work across boundaries. Frontiers in Artificial Intelligence and Applications, 137, 102.
Cheng, K. G., Ernesto, F., & Truong, K. N. (2008). Participant and interviewer attitudes toward handheld computers in the context of HIV/AIDS programs in sub-Saharan Africa. Paper presented at the Proceedings of the SIGCHI Conference on Human Factors in Computing Systems.
DeRenzi, B., Lesh, N., Parikh, T., Sims, C., Maokla, W., Chemba, M., . . . Borriello, G. (2008). E-IMCI: Improving pediatric health care in low-income countries. Paper presented at the Proceedings of the SIGCHI conference on human factors in computing systems.
Engestrom, Y., Engestrom, R., & Saarelma, O. (1988). Computerized medical records, production pressure and compartmentalization in the work activity of health center physicians. Paper presented at the Proceedings of the 1988 ACM conference on Computer-supported cooperative work.
Fagerhaugh, S. Y., & Strauss, A. L. (1997). Social organization of medical work: Transaction Publishers.
Fitzpatrick, G. (2004). Integrated care and the working record. Health Informatics Journal, 10(4), 291-302.
Fitzpatrick, G., & Ellingsen, G. (2013). A review of 25 years of CSCW research in healthcare: contributions, challenges and future agendas. Computer Supported Cooperative Work (CSCW), 22(4-6), 609-665.
Fraser, H. S., Allen, C., Bailey, C., Douglas, G., Shin, S., & Blaya, J. (2007). Information systems for patient follow-up and chronic management of HIV and tuberculosis: a life-saving technology in resource-poor areas. Journal of medical Internet research, 9(4).
Garfinkel, H., & Bittner, E. (1967). Good organizational reasons for “bad” clinic records. Englewood Cliffs.
Gasser, L. (1986). The integration of computing and routine work. ACM Transactions on Information Systems (TOIS), 4(3), 205-225.
Geissbuhler, A., Ly, O., Lovis, C., & L’Haire, J.-F. (2003). Telemedicine in Western Africa: lessons learned from a pilot project in Mali, perspectives and recommendations. Paper presented at the AMIA Annual Symposium Proceedings.
Gizaw, A., Mukherjee, A., Lewis, J., & Sahay, S. (2012). Understanding design-use interaction: the case of name based health information system in India. Paper presented at the Proceedings of IADIS International Conference on Information Systems.
Gulube, S., & Wynchank, S. (2001). Telemedicine in South Africa: success or failure? Journal of telemedicine and telecare, 7(suppl 2), 47-49.
Hartswood, M., Procter, R., Rouncefield, M., & Slack, R. (2003). Making a case in medical work: implications for the electronic medical record. Computer Supported Cooperative Work (CSCW), 12(3), 241-266.
Heath, C., & Luff, P. (1996). Documents and professional practice:“bad” organisational reasons for “good” clinical records. Paper presented at the Proceedings of the 1996 ACM conference on Computer supported cooperative work.
Hinds, P., & McGrath, C. (2006). Structures that work: social structure, work structure and coordination ease in geographically distributed teams. Paper presented at the Proceedings of the 2006 20th anniversary conference on Computer supported cooperative work.
Jones, M. (2003). " Computers can land people on Mars, why can't they get them to work in a hospital?" Implementation of an Electronic Patient Record System in a UK Hospital. Methods of information in medicine, 42(4), 410-415.
Kamadjeu, R. M., Tapang, E. M., & Moluh, R. N. (2005). Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: a case study from Cameroon. Informatics in primary care, 13(3), 179-186.
Korpela, M., Mursu, A., & Soriyan, H. A. (2002). Information systems development as an activity. Computer Supported Cooperative Work (CSCW), 11(1-2), 111-128.
Luk, R., Ho, M., & Aoki, P. M. (2008). Asynchronous remote medical consultation for Ghana. Paper presented at the Proceedings of the SIGCHI conference on human factors in computing systems.
Madden, R. (2010). Being ethnographic: A guide to the theory and practice of ethnography: Sage Publications.
Marcus, G. E. (1995). Ethnography in/of the world system: the emergence of multi-sited ethnography. Annual review of anthropology, 95-117.
Mars, M. (2010). Health capacity development through telemedicine in Africa. Yearb Med Inform, 87, 93.
Martínez-Alcalá, C. I., Muñoz, M., & Monguet-Fierro, J. (2013). Design and customization of telemedicine systems. Computational and mathematical methods in medicine, 2013.
Mayo-Smith, M. F., & Agrawal, A. (2007). Factors associated with improved completion of computerized clinical reminders across a large healthcare system. International journal of medical informatics, 76(10), 710-716.
Mellini, B. (2013). The Materialization of Articulation Work and its Implications on Nursing Practices. Paper presented at the CHItaly (Doctoral Consortium).
Mønsted, T., Reddy, M. C., & Bansler, J. P. (2011). The use of narratives in medical work: A field study of physician-patient consultations. Paper presented at the ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24-28 September 2011, Aarhus Denmark.
Olson, G. M., & Olson, J. S. (2000). Distance matters. Human-computer interaction, 15(2), 139-178.
Oluoch, T., Santas, X., Kwaro, D., Were, M., Biondich, P., Bailey, C., . . . de Keizer, N. (2012). The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: A systematic review. International journal of medical informatics, 81(10), e83-e92.
Patterson, E. S., Doebbeling, B. N., Fung, C. H., Militello, L., Anders, S., & Asch, S. M. (2005). Identifying barriers to the effective use of clinical reminders: bootstrapping multiple methods. Journal of biomedical informatics, 38(3), 189-199.
Reddy, M., Bardram, J., & Gorman, P. (2010). CSCW research in healthcare: Past, present, and future. Paper presented at the Proceedings of the Conference on Computer Supported Cooperative Work. Retrieved from http://sites.google. com/site/cscwinhc.
Robertson, A., Cresswell, K., Takian, A., Petrakaki, D., Crowe, S., Cornford, T., . . . Jacklin, A. (2010). Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. BMJ, 341.
Rotich, J. K., Hannan, T. J., Smith, F. E., Bii, J., Odero, W. W., Vu, N., . . . Tierney, W. M. (2003). Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. Journal of the American Medical Informatics Association, 10(4), 295-303.
Safadi, H., & Faraj, S. (2010). The role of workarounds during an opensource electronic medical record system implementation.
Saugene, Z. (2013). Customization of Generic Open Source Software for Health Sector in Developing Countries. University of Oslo, Norway.
Saugene, Z., & Kaasbøll, J. (2013). Foregrounding invisible work practices: the customization of generic software systems.
Schmidt, K. (1991). Riding a tiger, or computer supported cooperative work. Paper presented at the Proceedings of the Second European Conference on Computer-Supported Cooperative Work ECSCW’91.
Schmidt, K., & Bannon, L. (1992). Taking CSCW seriously. Computer Supported Cooperative Work (CSCW), 1(1-2), 7-40.
Schmidt, K., & Simonee, C. (1996). Coordination mechanisms: Towards a conceptual foundation of CSCW systems design. Computer Supported Cooperative Work (CSCW), 5(2-3), 155-200.
Schmidt, K., Wagner, I., & Tolar, M. (2007). Permutations of cooperative work practices: a study of two oncology clinics. Paper presented at the Proceedings of the 2007 international ACM conference on Supporting group work.
Simone, C., & Schmidt, K. (1998). Taking the distributed nature of cooperative work seriously. Paper presented at the 16th Euromicro Conference on Parallel, Distributed and Network-Based Processing (PDP 2008).
Vikkelsø, S. (2005). Subtle redistribution of work, attention and risks: Electronic patient records and organisational consequences. Scandinavian Journal of Information Systems, 17(1), 10.
Walsham, G. (1995). Interpretive case studies in IS research: nature and method. European Journal of information systems, 4(2), 74-81.