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Retha de la Harpe
1. Retha de la Harpe
Cape Town
South Africa
September 2009 Finland 1
2. AGENDA
Data Stakeholders interacting with data
– Interaction in social and technical worlds
• Information Technology
• Structures
• Inscriptions
• Design and use of records as data objects
• Patient records in practice
– Healthcare case
– Conclusion
September 2009 Finland 2
3. Community Empowerment
Project
The collaborative creation of innovative ICT solutions to facilitate the
improvement of the wellbeing of a community in tension
•Problem:
Complex socio-economic factors threaten the wellbeing of
communities and often ad-hoc ICT solutions are proposed
without addressing specific aspects that will influence their
successful adoption.
The following aspects are often not sufficiently considered:
– the complex nature of the problems and environment
– the need for the solution to be sustainable
– the factors specific to the local context
– the educational needs of training ICT practitioners and
citizens as the users of the ICT solutions; etc.
September 2009 Finland 3
4. Community in Tension
(CiT)
• Many communities suffer from problems that threaten the wellbeing of their
citizens resulting in a community with tension.
• These problems are complex social problems often associated with poverty, e.g.,
crime; health, e.g. HIV/AIDS; substance abuse, etc.
• These problems interfere with, impede, or even outright prevent the development
and empowerment of the communities and their citizens.
• Contributing factors are:
– the lack of economic development (unemployment, inflation, etc.)
– social inequality (insufficient social services, social issues such as drug abuse)
– insufficient education
– lack of appropriateness and use of technology.
• One of the consequences is that citizens become antagonists, victims or
citizens at risk contributing towards the tension between citizens; within families;
within the community, etc.
September 2009 Finland 4
5. Community Citizens
A citizen can be:
• neutral (is neither affected by the problems that cause the tension or contributing to the
problems)
• antagonist – the citizen causing the tension, e.g., gangster, drug-addict, etc.
• victim – the citizen that is caused harm as a result of the problems contributing to the
tension, e.g., hurt by gangster activities, etc.
• citizen at risk – the citizen that suffers from an illness (patient) or as a result of the
tension, e.g., a family member of the victim or the antagonist
• Supporter – the citizen who provides immediate support to the citizen at risk, e.g., family
member
• reconstructed/reformed citizen – the citizen who used to be an antagonist, i.e., who
has caused harm to others and has reformed
• facilitator – the citizen or “thing” (ICT can also be regarded as a facilitator) that acts as
a change agent to bring about change
• community leader – a citizen formally or informally accepted as a leader who act as a
spokesperson for a group of citizens within the community, e.g., pastor, etc.
• Care giver / volunteer / community developer – a citizen (within or outside the
community) who offers time and expertise to assist with the care, education,
dissemination of information, etc. whose involvement contributes towards addressing the
problems contributing to the tension
September 2009 Finland 5
6. Proposed solution
• Universities can play an important and leading role in
addressing problems that negatively impact the
wellbeing of communities
• Often ICT solutions are developed based on perceived
anticipated needs without sufficiently considering the
continuing actual-use-in-practice – Is the solution
usable and useful for the user? Is it sustainable?
• This can be best achieved if a collaborative approach
is used involving reseachers, students, citizens and
other stakeholders from the onset where citizens
become co-developers of the ICT solution.
September 2009 Finland 6
7. Approach to address
problems
• All aspects, namely:
– Research
– Education
– The process of creating and deploying
innovative ICT solutions
• The reason for the project:
to address the needs of a community by
bridging the gap between universities and
communities.
September 2009 Finland 7
8. Focus of the Project
ICT Solution to facilitate the:
– care of citizens
• (home-based care for health-related reasons, e.g., HIV/AIDS
or
• counseling, e.g. against drug-abuse, gangsterism, etc.;
– dissemination of information, e.g., to inform citizens about
the problems, their consequences and preventative
mechanisms;
– education of citizens, e.g., train citizens specific skills, how
to deal with a problem, etc.
Care Inform Educate
Social innovation
September 2009 Finland 8
9. Counseling Modes
1. Face to face
2. Telephonically
Person in need
3. ICT facilitated
IBM Compatible
Person in need
September 2009 Finland 9
12. Counseling, Technology &
Community support spaces
Some stats – (without any funding):
20 week period – 4 hours per week
• 4 000+ contacts
• 8 122 conversations
• 31 066 messages
Supported by:
8 – 10 advisors managing
300 – 400 conversations
in a 2 hour session
September 2009
(10 at the same time) Finland 12
13. Sample
Conversation
4:17 PM @mxit.co.za: i need support
me: how can i help
4:19 PM @mxit.co.za: im using tik and desperately need help coz I have a
9 month old baby.
4:20 PM me: well we are here to help
4:21 PM @mxit.co.za: r u there
me: yes
how long hav u been using?
4:22 PM @mxit.co.za: 6 years nd im only 18 nw
me: well are you willing to come and see someone in person?
4:23 PM @mxit.co.za: yes i am. where
me: we are based in Bridgetown 66 Tarentaal Rd
4:26 PM u free during the day?
@mxit.co.za:yes i did nd thanx i'll come in next week.
September 2009 Finland 13
14. Technology Facilitated
Interaction Space
Components
• Humans:
– Counselors
– Community developers
– Professional counselors
– Moderator
– “Runner”
– Facility manager
– Developers
• Space:
– Caring/ counseling space
• A space that supports caring / counseling, etc.
– Technology space
• Sufficiently equipped space with appropriate infrastructure
• Technology:
– Servers (Application and Web)
– Network
– Applications
– Mobiles
– Connectivity
– Databases
– Telephones
September 2009 Finland 14
15. Interaction in Social and
Technical Worlds
• Data stakeholders & roles (data producer, consumer and custodian)
• Data object – a logical record that is constituted of one or more physical
parts.
• A data object is a data representation of real-world object
• Health record is an integral part of the practical “doing” of healthcare -
record “at work” – complex collection of related forms, papers, documents
and records embedded in the social, spatial context of a healthcare
enterprise (Fitzgerald, 2000)
• Humans and artefacts are both social products as well as social makers in
shaping and remaking each other (Widjaja & Balbo, 2006)
• Technology not used within a vacuum but always involves social actors
where technology and humans shape each other (Kallinikos, 2002)
September 2009 Finland 15
16. Information Technology
• Information technology is the product of human agency
and will reflect the structures of the social system that
designs and manages it as well as interpretations of its
anticipated versus actual use
• Information systems can be regarded as a social system
of information practice supported by information
technologies (a material resource) (Weber, 2004)
• An emphasis on technology use can lead to a
detachment of the IT artifact (Widjaja & Balbo, 2006)
• Focus more on the interplay between IT and
organisations by reaching a deeper understanding of this
interwoven relationship as to how IT shapes, enables
and constrains organisations (Monteiro & Hanseth,
1996)
September 2009 Finland 16
17. Real-world objects represented
as data objects
Designer
Real-world Object
Perceived
observation
Representation
Perceptions of Inscribing Representation states:
anticipated use perceived 1. Proper
anticipated 2. Incomplete
use 3. Ambiguous
(Wand & Wang, 1996)
Actual use
User Data Object
(Data Stakeholder)
September 2009 Finland 17
18. Patient records in
practice
• Patient records (a multiplicity
of things which forms a whole Data (previously captured,
new data added)
only sometimes or for some
purpose) are large and
complex networks (Berg &
Bowker, 1997; Fitzpatrick, Patient
2000; Hanseth & Monteiro,
1997; Jensen, 2004)
Observations,
• At a point of care a network is diagnosis,
formed between the healthcare treatment details,
professional(s), data object(s) etc.
and patient – this interaction
results in data exchange Patient Record
between the different
stakeholders
Representation
Healthcare
Professional
September 2009 Finland 18
19. Design and use of patient
records as data objects
September 2009 Finland 19
21. DOSD, DOH 2001. Integrated Home/Community Based Care model options
What is
Home and Community Based
Care
• Home care is defined as the provision of
comprehensive services, which include health and
social services by formal and informal caregivers in
the home in order to promote, restore and maintain a
person's maximal level of comfort, function and health
including care towards a dignified death.
• Home care services can be classified into
preventive, promotive, therapeutic, rehabilitative, long-
term maintenance and palliative care categories.
• Home/community based care and support is the
care/services that the consumer can access nearest to
home, which encourages participation by people,
respond to the needs of people, encourages
September 2009 community life and creates responsibilities.
traditional Finland 21
22. What is HCBC – 2
“HCBCs are providing a valuable service against many
obstacles.
There is a low percentage of HCBCs that have
computers, and that maintain financial records or even
lists of the individuals and families served.
They need equipment, finances, trained and paid full-
time, protocols for standards of care in order to
become an even more effective force in the provision
of home community-based care.
There needs to be closer links between the work they
do and policy-makers.”
September 2009 Finland 22
28. Needs within HCBC – 3
Bridgetown, Athlone
Day hospital
Residents
Community clinic
Community clinic
September 2009 Finland 28
29. Needs within HCBC – 6
Dept of Dept of Social
Health Development
Manage Manage
ment ment
Bridgetown, Athlone
Software Day hospital
organization
Systems
devl
Residents
Software
organization Community clinic
Community clinic
Systems
devl
Do they know Do they need Do they need
how to design better ICT better
September 2009 Finland
tools? services?
29
such tools?
34. 5-party collaboration vs.
triple helix in innovation chain
Government – national, provincial, municipal
Univers ity Software org Healthcare Community,
citizens
Researc h Education Systems Service
devl Services
Needs
Civil society is missing from the triple helix innovation chain!
→ 4-party collaboration for open innovation chain
In healthcare ICT, you need 5-party collaboration:
Civil society, care providers, industry, academia,
September 2009 Finland 34
government
35. What is
socio-technical IS development
• Start from analyzing the “landscape” – organizations,
political structures, broad level stakeholders
• Identify the activities and services, involve actual
ground level stakeholders – service providers and
consumers, management, key partners, key support
• Help stakeholders analyze their current situation,
needs and “future target state” – individually and
together, through collaborative analysis
• Draft social and technical solutions, create hands-on
protos/mock-ups, co-develop with stakeholders
• Continue co-designing with stakeholders during product
testing, organizational implementation and improvement
September 2009 Finland 35
36. The Socio-Tech SA project
funded by SAFIPA – 3
Expected outcomes
• (Portfolio of) software products for HCBC
• Improved service models of ICT-supported HCBC
• SMMEs distributing the products and making more
• Professionals in SMMEs who are skilled “socio-techies”
• Socio-tech IS development methodology tried in practice
• Undergrad teaching material on socio-tech ISD methods
• Dream: Undergrad textbook available in Global Text
• Dream: Socio-tech education for all undergrad software
and systems students in 3 South-African universities
September 2009 Finland 36
