SCHOOL OF COMMUNICATION
CMNS 855-5
Spring, 2006
Dr. Ellen Balka
Office: K 9674.
Tel. 604-725-2756 (Mon., Thurs., Friday)
604-291-3764 (Tues. & Wed.)
E-mail: ellenb@sfu.ca
Class: Tuesdays, 2:30-5:30
Office Hours:
Tuesdays, 12.45-2.30 and until 5:45
Or by appointment (on Tuesday and
Wednesday only).
COMMUNICATION, COMPUTERS AND HEALTH
INFORMATION:
PERSPECTIVES ON THEORY, PRACTICE & POLICY
Overview:
This course will focus on the complex interplay between communicative practices,
computerization of the health sector, and the production and use of health information. Students
will work with diverse theoretical perspectives from areas of inquiry such as technology and
society, computer supported cooperative work, population and public health and public policy
analysis to explore the complex interplay between communicative practices, computerization of
the health sector and the production of health information, in relation to regional, national and
international policy goals.
These issues will be addressed through a series of case studies each of which will explore
1 the historical context of the development of each technology,
2 the public policy context surrounding the introduction of each technology into the health
sector,
3 the communicative problem or challenge addressed by the introduction of computerized
technologies;
4 the interplay between communicative practices and computerized technologies;
5 the nature of health information each technology introduces, and challenges associated with
the use of such new forms of health information;
6 the intended benefits of each of the technologies to a population and public health agenda;
7 organizational and work practice issues related to the introduction and use of computerized
health information.
Case studies will include:
1 The electronic medical record/ health record/ patient record;
2 Automated drug dispensing systems and computerized physician order entry systems;
3 Computerized decision support systems in health care;
4
5
6
7
The use of computers and the internet for health promotion;
Digital imaging technologies and advanced diagnostics;
The use of computers to support communication between health care providers in varied
clinical contexts;
The role of existing computer systems in the production of health indicators.
Audience:
This course will be of interest to graduate students interested in the following areas:
1
2
3
4
5
6
7
8
9
10
Science, technology and society
Social aspects of communication technologies
Health communication and health promotion
Medical sociology and medical anthropology
Computer supported cooperative work
Bio-medical technology and design of information systems
Population and public health
Health administration
Health technology assessment
Public policy
Pre-requisites:
Enrollment in a graduate program and extensive knowledge of at least one of the areas outlined
above, and permission of the instructor. Please contact the course instructor for further
information.
Required texts:
Readings will be drawn from a variety of sources. See attached preliminary reading list.
Published materials will be supplemented by written case study vignettes drawn from current
research projects, developed for a teaching context.
Assignments:
Seminar presentation and accompanying written work
(it is anticipated that each student will present in class twice during the term).
Final paper
Class participation:
40%
40%
20%
Doctoral students will be required to write a more extensive final paper, and will be
expected to read more extensively than master’s level students.
Seminar presentation and accompanying written work:

Twice during the semester, each student will be required to present assigned readings to
the class, and submit a short written critique of the assigned readings.
In addition, written material accompanying a seminar presentation should address how the
theoretical perspective is relevant to the student's area of interest, as well as the implications for
policy or technology practice. Seminar presentations will be scheduled at the beginning of the
semester, and accompanying work is due the day a student presents his or her material in class.
Final paper:
In the final paper, students will be required to address the material presented in class in relation
to the technology they have focused on throughout the semester. The final paper should begin
with an introduction that includes a synopsis of the technology or technological problem of
interest to the student. The paper should include a discussion of the perspectives discussed in
class, and how they are relevant or not relevant to the student's area of interest. This section
should include a discussion of how our understanding of technology varies with the theoretical
approaches we adapt in thinking about technology (e.g., what problems are made central by each
approach? What issues are relegated to the realm of marginal concerns for each approach?). Each
paper should also include a discussion of policy and practice issues related to a variety of
theoretical perspectives.
Class Participation:
Students will be expected to come to class prepared to discuss the readings in relation to their
area of interest, and will be expected to aid students from disciplinary backgrounds that differ
from theirs in gaining a more in depth understanding of their home discipline.
In addition, students will be asked from time to time to comment on the relevance of various
perspectives to their classmates' areas of interest.
Course Overview
Week
1-2
2-3
4
5
6
7
8
9
Topics
Background and Overview of Course
Overview of Technology Case studies
Policy Context
Health policy: population health, social determinants of health & evidence based medicine
The emergence of the Canadian information highway and the Canadian health information
infrastructure
Health and information technology policy within an international context
Theoretical Frameworks
Studies in technology and society (social constructivist and political economic perspectives)
The constructivist turn in computing (computer supported cooperative work; contributions of
workplace ethnography to system design)
Perspectives on health: individual, population and public health
Health policy: the role of the state; non-state actors and the policy process
Application Case Studies
Overview of themes and issues arising from recent theoretical developments
Computer-mediated health promotion: health information web sites, on-line support groups and health
promotion programs
The electronic health record/ electronic medical record/ electronic patient record
Automated drug dispensing systems and computerized physician order entry
Decision support systems
Digital imaging and advanced diagnostics
10
11
12-13
Supporting clinical communications: wireless call systems, remote monitoring systems
Administrative computer systems, health outcomes and indicators
Effecting Change
Overview of health technology acquisition processes: challenges and opportunities
Health technology evaluation and health technology assessment
Course Overview
Week
Date(s)
1-2
January 10
January 17
Topics
Background and Overview of Course
Overview of Technology Case studies
Policy Context
Health policy: population health, social determinants of health &
evidence based medicine
The emergence of the Canadian information highway and the
Canadian health information infrastructure
Health and information technology policy within an international
context
Readings for Jan. 17:
Elston, M. A. (1997). Introduction. The sociology of medical science and
technology (pp. 1-27). Malden, MA : Blackwell Publishers.
Blaxter, M. (2004). How health is constructed. Health. (pp. 26-44). Cambridge,
UK: Polity.
Gabe, J., Bury M. & Elston, M A. (2004). Medical Technologies. Key concepts
in medical sociology (pp. 145-150). London: Sage Publications.
Berg, M., Aarts, J. & van der Lei (2003). ICT in Health Care: Sociotechnical
Approaches (Editorial). Methods of Information in Medicine, 42, p. 297301.
Berg, M. (2003). Introduction & Chapter 1. Health Information Management:
Integrating Information in Health Care Work. (pp. 1-44). New York:
Routledge.
Wyatt, J. C. & Sullivan F. (10 September, 2005). ABC of health informatics:
What is health information? BMJ, 331, p. 566-568.
2-3
January 17
January 24
Theoretical Frameworks
Studies in technology and society (social constructivist and political
economic perspectives)
The constructivist turn in computing (computer supported cooperative
work; contributions of workplace ethnography to system design)
Perspectives on health: individual, population and public health
Health policy: the role of the state; non-state actors and the policy process
Readings for Jan. 24
Timmermans, S. & Berg, M. (2003). The practice of medical technology.
Sociology of Health and Illness, 25 (3), p. 97-114.
Engstrom, Y. (1999). Expansive Visibiization of Work: An Activity-Theoretical
Perspective. Computer Supported Cooperative Work, 8, p. 63-93.
Taylor, J.R., Groleau, C., Heaton, L. and van Every, E. (2001). Chapters 1-3.
The computerizatrion of work: A communication perspective (pp. 1-78).
London: Sage Publications.
Guest speaker: (pending finalization): James E. Taylor, Professor Emertus,
University of Montreal. Co-author of The Computerization of Work: A
Communication Perspective.
4
Jan. 31
Application Case Studies
Overview of themes and issues arising from recent theoretical developments
The politics of standardization
Readings for Jan. 31
Bowker, G. and Star, S.L. (2000). Introduction and Chapter 1. Sorting things
out: Classification and its consequences (pp. 1-50). Cambridge, MA.:
MIT Press.
Timmermans, S. & Berg, M. (2003). Introduction and Chapter 1. The Gold
Standard: A Sociological Exploration of Evidence-Based Medicine and
Standardization in Health Care (pp. 1-54). Philadelphia, PA: Temple
University Press.
5
Feb. 7
Computer-mediated health promotion: health information web sites, online support groups and health promotion programs
6
Feb 14
The electronic health record/ electronic medical record/ electronic patient
record
Hartswood, M., et.al. (2003). Making a Case in Medical Work. Comput
Supported Coop
Work, 12, 241-266.
Hanseth, O., Thoresen, K. & Winner, L. (1994). The politics of Networking in
Health Care.
Computer Supported Cooperative Network, 2, 109-130.
Hellesco, R. & Lorensen, M. (2005). Inter-organizational continuity of care and
the electronic
patient record: A concept development. International Journal of Nursing
Studies, 42,
807-822.
Balka, E. (2003). Getting the big picture: The macro-politics of information
system
development (and failure) in a Canadian hospital. Methods of Information
in
Medicine, 42(4), 324 – 330.
7
Feb. 21
8
Feb. 28
(MAY RESCHEDULE CLASS TO ACCOMODATE ALPIS SIMINAR OR
GUEST SPEAKER)
No class- mid-term break
Automated drug dispensing systems and computerized physician order
entry
Balka et.al.
Koppell et.al. (2005). Role of Computrized Physician Order Entry Systems in
Facilitating
Medication Errors. Journal of the American Medical Association, 293
(10), 11971203.
9
March 7
10
March 14
Decision support systems
Garg et.al. (2005). Effects of Computerized Clinical Decision Support Systems
on Practitioner
Performance and Patient Outcomes. Journal of the American Medical
Association,
293 (10), 1223-1238.
Digital imaging and advanced diagnostics
Barley S. R. (1990). The alignment of technology and structure through Roles
and Networks. Administrative Science Quarterly, 35, 61-103.
Telliogou, H.& Wagner, I. (2001). Work Practices Surrounding PACS: The
Politics of Space
in Hospitals. Computer Supported Cooperative Network, 10, 163-188.
11
March 21
12-13
March 28
Supporting clinical communications: wireless call systems, remote
monitoring systems
Bardam, J & Bossen, C. (2005). Mobility Work: The Spatial Dimension of
Collaboration at a
Hospital. Comput Supported Coop Work, 14, 131-160.
Balka, E., Wagner, I. & Jensen, C. (2005). Reconfiguring Critical Computing in
an Era of
Configurability. Proceedings, Critical Computing Conference: Between
Sense and
Sensibility. Aarhus, Denmark 20-24 August.
Administrative computer systems, health outcomes and indicators
The Elusive Quest
12-13
April 3
NOTE DAY
CHANGE
Effecting Change
12-13
April 4
Effecting Change
Overview of health technology acquisition processes: challenges and
opportunities
Health technology evaluation and health technology assessment
Students are free to attend ACTION for Health Day of Dialogue that brings
together decision makers to have a dialogue about ethical and legal issues
arising with computerization of health care.
CLASS MUST BE RESCHEDULED IN ORDER TO ACCOMODATE
ACTION for Health team MEETING
PRELIMINARY READING LIST
Note: Once course is approved in principle bibliographic citations will be tidied up and readings assigned to weekly
schedule.
Readings on theory
Barley SR. (1990). The alignment of technology and structure through Roles and Networks. Administrative Science
Quarterly 1990;35:61-103.
Bowker, G. and Star, S.L. (2000). Sorting things out: Classification and its consequences. Cambridge MA.: MIT
Press.
Gartner J, Wagner I. (1996). Mapping actors and agendas: Political frameworks of systems design and participation.
Human-Computer Interaction 1996;11:187-214.
Knorr-Cetina K, Cicourel AV, eds. (1981). Advances in Social Theory and Methodology : Toward an Integration of
Micro- and Macro-sociologies. Boston: Routledge & Kegan Paul., 1981.
Monterio E, Hanseth O. (1995). Social Shaping of Information Infrastructure: On Being Specific about the
Technology. In: Orlikowski W, Walsham WJ, Jones MR, DeGross JI, eds. Information Technology and
Changes in Organizational Work. New York: Chapman & Hall, 1995:325-43.
Mosco, V. (1996). The political economy of communication. Newbury Park, CA 1996.
Taylor JR, Groleau C, Heaton L, Van Every E. (2001). The Computerization of Work: A Communication
Perspective. Thousand Oaks, Ca.: Sage, 2001.
Application cases
Anderson JG, Aydin CE. (1998). Evaluating Medical Information Systems: Social Contexts and Ethical Challanges.
In: Goodman KW, ed. Ethics, Computing and Medicine: Informatics and the Transformation of Health
Care. Cambridge, U.K.: Cambridge University Press, 1998:57-74.
Balka, E. (2003). Getting the big picture: The macro-politics of information system development (and failure) in a
Canadian hospital. Methods of Information in Medicine, 42(4), 324 – 330.
Balka, E. (2004). Fragmented Views from the Field: Reflections on Field Observations of Computerized Health
Sector Work. Proceedings, Work Practice Research and Information Technology Development in Hospital
and Community Health Care Settings. Workshop held in conjunction with Computer Supported
Cooperative Work Conference 2004, (pp. 7-12). Chicago, IL. Nov. 7.
Balka, E. (In press). Designing healthy technology? The Canadian health information highway and women’s health.
In S. Kretchmer and R. Carveth (Eds.), Navigating the Network Society: The Challenges and Opportunities
of the Digital Age. Thousand Oaks, CA: Sage.
Balka, E. and Kahnamoui, N. (2004). Technology trouble? Talk to us! Findings from an ethnographic field study.
Proceedings of the eighth conference on Participatory design: Artful integration: interweaving media,
materials and practices – Volume 1. Toronto, ON, July 27 – 31, (pp. 224 – 234). New York, NY: ACM
Press.
Balka, E., Kahnamou, N. and Nutland, K. (in press). Who’s in Charge of Patient Safety? Work Practice, Work
Processes and Utopian Views of Automatic Drug Dispensing Systems. International Journal of Medical
Informatics.
Balka, E., Messing, K. & Armstrong, P. (Under review). Indicators for all: Including occupational health in
indicators for a sustainable health care system. Submitted to Policy and Practice in Health and Safety.
Balka, E., Wagner, I. & Jensen, C. (2005). Reconfiguring Critical Computing in an Era of Configurability.
Proceedings, Critical Computing Conference: Between Sense and Sensibility. Aarhus, Denmark 20-24
August.
Barley SR. (1986). Technology as an occasion for structuring: Evidence from Observations of CT Scanners and the
Social Order of Radiology Departments. Administrative Science Quarterly 1986;31:78-108.
Berg M. (1997). Rationalizing Medical Work: Decision-Support Techniques and Medical Practices. Cambridge,
Ma.: MIT Press, 1997.
Berg M. (1998). Order(s) and Disorder(s): Of Protocols and Medical Practices. In: Berg M, Mol A, eds. Differences
in Medicine: Unraveling practices, Techniques and Bodies. Durham N.C.: Duke University Press,
1998:226-46.
Berg, M. (1997a) Problems and promises of the protocol, Social Science & Medicine, 44, 8, 1081-8.
Berg, M. (1997b) Rationalizing Medical Work: Decision Support Techniques and Medical Practices. Cambridge,
MA: MIT Press.
Berg, M. (2003). Health Information Management: Integrating Information in Health Care Work. New York:
Routledge.
Berg, M. and Mol, A-M. (eds.) Differences in Medicine, Durham, NC: Duke University Press.
Timmermans, S. & Berg, M. (2003). The Gold Standard: A Sociological Exploration of Evidence-Based Medicine
and Standardization in Health Care. with Marc Berg. (2003) Temple University Press: Philadelphia, PA.
Goodman KW, ed. (1998). Ethics, Computing and Medicine: Informatics and the Transformation of Health Care.
Cambridge U.K.: Cambridge University Press, 1998
Gregory J. (2000). Sorcerer's Apprentics: Creating the Electronic Health Record- Re-Inventing Medical Records and
Patient Care [Dissertation]. Department of Communication, University of California- San Diego., 2000.
Hanseth O, Thoresen K, Winner L. (1994). The politics of networking technology in health care. Computer
supported cooperative work 1994;2:109-30.
Mitchell, L.M. (2001). Baby's first picture: Ultrasound and the politics of fetal subjects. Toronto: University of
Toronto Press.
Timmermans, S., Bowker, G.C. and Star, S.L. (1998) 'The architecture of difference: visibility, controllability, and
comparability in building a Nursing Intervention Classification'. In Berg, M. and Mol, A-M. (eds.)
Differences in Medicine, Durham, NC: Duke University Press.
Treichler, P., Cartwright, L. & Penley, C. (Eds.). (1998). The visible woman. New York: New York University
Press.
Wagner I. (1995). Hard times: The politics of women's work in computerized work environments. The European
journal of women's studies 1995;2(3):295-314.
Wagner, I. (1993) 'Women's voice: the case of nursing information systems', AI and Society, 7, 295-310.
Waldby, C. (2000). The Visible Human Project: Informatic Bodies and Posthuman Medicine. London: Routledge
Policy Perspectives
Alexander CJ, Stafford AP. (1998). The cutting edge? Gender, legal and ethical implications of high-tech health
care. In: Pal L, Alexander CJ, eds. Digital Democracy: Policy And Politics In The Wired World. Toronto:
Oxford, 1998:194-218.
Balka, E. (2003). The role of technology in making gender count on the health information highway. Atlantis,
27(2), 49 – 56.
Balka, E. (2004). Redefining P3: Political economy, policy and privacy issues on the Canadian health information
highway. In L. Shade and M. Moll (Eds.), Communications In the Public Interest Vol. 2: Seeking
Convergence in Policy and Practice (pp. 201-219). Ottawa, ON: Canadian Centre for Policy Alternatives.
Balka, E. (In press). Building the road to Canada's field of dreams: Looking back on Canada's public access strategy .
New Media & Society, (Special Theme Section: Reassessing the 'Digital Divide' Concept For Research and
Policy).
Balka, E., Doyle-Waters, M., Lecznarowicz, D. and. FitzGerald, J.M. (In press). Technology, Governance and
Patient Safety: Systems Issues in Technology and Patient Safety. International Journal of Medical
Informatics.
Messing, K., Seifert, A.M., Vézina, N. Balka, E. & Chatigny, C. (In press). Qualitative research using numbers:
Analysis developed in France and used to transform work in North America. New Solutions.