TY - JOUR AU - Greenhalgh, Trisha AU - Wherton, Joseph AU - Shaw, Sara AU - Papoutsi, Chrysanthi AU - Vijayaraghavan, Shanti AU - Stones, Rob PY - 2019 DA - 2019/12/19 TI -基础设施重访:卫生信息基础设施如何塑造和制约技术创新的民族志案例研究J - Med Internet Res SP - e16093 VL - 21 IS - 12 KW -信息基础设施KW -结构理论KW -视频咨询KW -新制度理论KW -组织民族志KW -隐藏工作KW -行动者网络理论AB -背景:Star将基础设施定义为“运行”的其他东西;它主要由“无聊的东西”组成。在她1999年的经典论文的基础上，考虑到技术、服务和系统的当代发展，我们开发了一种新的卫生信息基础设施理论，具有五个定义特征:(1)材料脚手架，在工作时作为背景，在故障时作为前景;(2)嵌入式、关系型和突发性;(3)集体学习、了解和实践(通过技术支持的合作工作和组织惯例);(4)拼凑(增量建造和固定)和路径依赖(受技术和社会文化遗产的影响);(5)制度上的支持和持续(例如，体现由监管机构和专业机构协商和监督的标准)。目的:我们的理论目标是，在卫生保健背景下，探索信息基础设施是什么，以及它如何塑造、支持和限制技术创新。我们的实证目标是研究实施和扩大视频咨询服务的挑战。 Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to “boring things”: the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate incrementally, taking account of technological and socio-cultural legacies; (5) consider standards but also where these standards come from and what priorities and interests they represent; and (6) seek to create leeway for these standards to be adapted to different local conditions. SN - 1438-8871 UR - //www.mybigtv.com/2019/12/e16093/ UR - https://doi.org/10.2196/16093 UR - http://www.ncbi.nlm.nih.gov/pubmed/31855184 DO - 10.2196/16093 ID - info:doi/10.2196/16093 ER -