From Artefacts to Infrastructure

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From Artefacts to Infrastructure
Eric Monteiro Norwegian Univ. of Science
Technology and Univ. of Oslo www.idi.ntnu.no/
ericm
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Bias towards local solutions

• Artefacts in use
• workplace studies
• ethnographies
• contingencies, glitches, situated action
• small commuties of practice

• Artefacts in context
• prototyping
• users, participation

Pelle Ehn Scandinavia
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From Artefacts to Infrastructure
How similar ? - granularity Standardisation !
Dependencies with Others ? -
scope Integration !
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Analytic themes
Robustness, resilliance, dependability
Ecology/ genealogy
Integration ... as in tight integration ...
as in integrated with use/ work ... as in
integrated service
Heterogenity
Interventions/ sustainability
Standardisation
Dependecies (aka complexity)
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Perceptions of mess

• A jungle of information systems in hospitals

You dont get the test results or x-rays Ive
got 3 different systems with 3 different login
that I have to engage with (Physician,
Rheumatology)
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Self-defeating effects

• Increased complexity as replacement was too
  risky keep the old alive, in addition
• additional work lab sample DIPS gateway
  old PAS emergency number

Emergency numbers
Gateway machine
The Dips portfolio
The old PAS
Other clinical IS
RIS
Laboratory systems
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Redundancy multiplicity
Three bottles with blood culture received
All analyses performed at the Microbiology
laboratory to identify the bacteria
When it comes to the medical side, we need
several components available in the work sheet
information that has come to the laboratory,
what is ordered, clinical findings etc.,
information generated inside the laboratory
what have we done, what have we found and
things like that and finally, our response where
we can see that we have provided a sensible
result. The Dips vendor has no understanding of
this (Chief physician, Microbiology).
Process description how are the analyses
performed, internal findings and instructions of
what to do further This process continues over
several days
Bacteria findings on the sample based on
interpretation of resistance patterns
Physician on the laboratory phones the Department
of Paediatric and presents preliminary result of
the test
Clinician in the Department of Paediatric
provides additional clinical information in this
process
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Standardisation Example
but for us it is not helpful . Just consider
that you have to scroll the listbox the list of
analyses codes. This also means that there are
too many available options for the physician
ordering a test. Mixing everything together in
a big chunk on the working lists has caused a
problem for several departments because they
want Microbiology results separated from the
mass produced blood results
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Global certification
Figure 1. The chronological order of major events
related to the development, implementation and
use of various versions of the GSIS system in MCC.
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Metamorphosis II
Figure 3. Metamorphosis II Second phase of
implementation the GSIS involving the integration
and standardization of local work practices and
legacy systems.
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We had problems with data quality that had
increased since the first version. This was, to
a large extent, caused by the migration from
the Software Component to GSIS- which we
never managed to control, and that we always
underestimated the seriousness of. We managed to
correct some errors but while doing that, we
also introduced new errors. (Business
manager, HQ (emphasis added))
What happen is that they new patches very much
fall from the sky and then it doesnt work we
get lots of new patches and it is still not
working. And we think did they not test this
thing before they sent it out? Anyway, you find
that things dont work and you get another
patch and they say it has all been fixed, and
all you have to do is to click that box twice,
stand on your left leg and drink a cup of tea.
(Auditor, UK)
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Nursing (I)
The figure illustrates how open categories are
broken down and specialised. Double hyphen - -
is used to separate free text information (nurses
elaboration) from standard text (NIC
interventions).
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Nursing (II)
The plan for a patient suffering from numerous
conditions. Notice how the intervention
Reducing Anxiety is moved to the top of the
list to indicate its increased importance.
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Change to remain the same
DHIS

• data standards
• reporting
• indicators

GIS
ART/HIV
Morbidity Mortality
Scheduler/FMHIS
(www.hispindia.org)
Adm/budgetting
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Oil

• Sharepoint
• collaborative infrastructure
• tagging/ meta data, everyday categorisation
• ecology
• Production optimalisation
• uniformation of underground
• third party key (Schlumberger)

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The preoccupation with the hygenic

• sorting out the mess inscribed into
• methods (refinement, modelling, dev. phases)
• notions/constructs (modularisation, architecture)
• ideology
• taps into deep sentiments (Purity and danger)
• outcomes ??
• cost-effective ?
• dysfunctional ?
• risk mega-projects (B Flyvbjerg)
• Embracing heterogenity
• inherent mess
• multiplicity (A Mol, J Law, )

vs.
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Perfectionism would be dangerous

• Totalizing change efforts
• fall short of achieving their goals (of course)
• produce in themselves disorder (self-defeating)
• C Perrow, J Law, M Berg, S Timmermans immant
  dialectics of formalisation

It's an argument about imperfection.That there
are always many imperfections. And to make
perfection in one place (assuming such a thing
was possible) would be to risk much greater
imperfection in other locations The argument is
that entropy is chronic. Some parts of the
system will dissolve For a manager accepting
imperfection is not a failing. It is an
advantage. Indeed a necessity. Perfectionism
would be dangerous. J. Law (Ladbrok grove,
2003)
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From Artefacts to Infrastructures
Standardisation

• Architecture vs Urban planning
• houses vs neigherhood
• blend in ... ?
• Heterogenous integration
• oppose idealisations/abstractions
• curb totalizing inclination/ambitions
• Complexify concepts in response to complex
  phenomena (Tsoukas)

Integration
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Recent stuff on this
G. Ellingsen, E. Monteiro. Seamless integration
standardisation across multiple settings.
Computer supported coopertive work the
journal, vol 15, no 6 (In press) Knut H. Rolland
and Eric Monteiro. The dynamics of integrated
information systems the multiplication of
unintended consequences. (Subm. in
Risk-book, C Ciborra/ O Hanseth) G. Ellingsen, E
Monteiro and G Munkvold Standardisation of work
co-constructive practice, (TIS ?) K
Rolland, V Hepsø and E Monteiro, Heterogeneity
Proc CSCW 06 G Ellingsen and E Monteiro. Slight
surprise of integration, Proc IFIP 8.2 06