HEALTH INFORMATICS A SOCIO-TECHNICAL PERSPECTIVE SUE WHETTON OXFORD UNIVERSITY PRESS;2/ t '!_- ~) .~ ! 4 c; j .r { ,.-- OXFORD UNIVERSITY PRESS 253 Normanby Road, South Melbourne, Victoria 3205, Australia Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam OXFORD is a trade mark of Oxford University Press in the UK and in certain other countries Copyright © Sue Whetton 2005 First published 2005 This book is copyright. 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Whetton, Sue. 610.285 Typeset by Linda Hamley Printed in Hong Kong by Sheck Wah Tong Printing Press Ltd3 8 Foundations of Health Informatics • organisation development and change theories • learning theories. Drawing on a range of disciplines for theoretical input helps ensure the relevance of health informatics to the many different environments and professions in health care. At the same time, this has resulted in health informatics not yet having its own underlying theory to set it apart as a distinct discipline. This is a concern for some: 'We need to define our paradigm and to demonstrate how our research collectively builds on a common theory. Of course, articulating that theory remains a major academic challenge for us' (Musen & van Bemmel 2002, p. 195). Health informatics research The scientific method was originally a tool of the physical sciences, which deal with inanimate objects in the physical world. The social sciences, including health informatics, explore human attributes such as attitudes, opinions, and emotions, and abstract concepts such as power and authority. These phenomena cannot be adequately studied using only the approaches and methods applied to inanimate objects. Therefore health informatics, as with other social sciences, draws upon several methods for its scientific research (Neuman 2000, pp. 63-S 1). These are: • Positivist research: Also known as positivism, this approach most closely follows that of the physical sciences. • Interpretive research: This method emphasises the need to understand the social world from the perspective of the participants. • Critical research: This approach focuses on questioning the established social structures and relationships. Research involves the collection and analysis of data according to clearly defined rules, procedures, and techniques (methods). Data may be either quantitative (expressed numerically), or qualitative (expressed as words, images, or objects). Positivist research has traditionally emphasised quantitative data, interpretive research has emphasised qualitative methods, and critical research uses both. While both quantitative and qualitative methods are accepted in the social sciences, supporters of each method are often critical of the other (Neuman 2000, p. 16). Yet, as Table 2.2 demonstrates, the different approaches need not be mutually exclusive or in competition with each other. They can be complementary. The approach and related method depends on the context, subject matter, and purpose of the research. Today, a combination of methods is frequently adopted. Software usability, for example, is assessed in terms of how quickly and accurately tasks can be completed (positivist), and of how much users like using the software (interpretive). It has been suggested, however, that research in health informatics has tended to be predominantly qualitative, rather than quantitative, and this is viewed as a weakness of the discipline (Bowns eta!. 1999, Coiera 2003).What is Health Informatics? 39 Table 2.2 Research questions and methods Clinical Empirical research Quantitative Interpretive Qualitative field question research research research method for question method that question for that question Lung Do the vitamin Randomised What is the Individual (semicancer supplements alpha- controlled impact of specialist structured) tocopherol and trial palliative care on interviews beta-carotene the quality of life Focus groups prevent lung and for patients sufferCross-validation other cancers in ing lung cancer? between different male smokers in Finland? interviewers Cystic What is the effect Double- What is the Individual (semifibrosis of different doses of blind experience of structured) tauroursodeoxy- crossover mothers caring interviews cholic acid on randomised for a child with Respondent children suffering control cystic fibrosis? validation cystic fibrosis? study Chronic What is the efficacy Randomised How does Individual (semifatigue of an educational control trial educational structured) syndrome intervention intervention impact interviews explaining on the way patients Focus group symptoms to with chronic discussions encourage graded fatigue syndrome Respondent exercise in patients participate and validation with chronic experience graded fatigue syndrome? exercise? Health informatics is information management !Information management is! assuring that the right information is available to the right people, within and without an organisation, at the right time and place and for the right price (Wright 2002). Musen and van Bemmel state that 'our research community is dedicated to the study of information' (2003, p. 21 0). Consequently, information management is at the very heart of health informatics. Health professionals, whether caring for an individual patient, making decisions at an organisational level, or seeking information about a .