An “Awareness” Environment for Clinical Decision Support in e-Health

The notion of cross-boundary decision support has the potential to transform the design of future work environments for e-health through a connected system that allows for harnessing of healthcare information and expert knowledge across geographical boundaries for more effective decision-making. The trouble, however, is that the use of healthcare information in decision-making usually occurs within the context of a complex structure of clinical work practices that is often shaped by a wide range of factors, including organisational culture, local work contexts, socially constructed traditions of actions, experiences and patients’ circumstances. They vary across geographical and organisational boundaries, and have remained to date largely unaccounted for in the design of e-health systems. As a result, achieving the e-health vision of ‘open’ clinical decision support requires a rethinking of key clinical and organisational processes in a manner that accommodates clinical work practice as a fundamental part of how clinicians work and make decisions in real-world settings. Drawing on the theories of human activity system and situation awareness as well as the belief-desire-intention architecture in AI, this paper presents the design of an awareness environment for cross-boundary clinical decision support in e-health that takes account of the concept of work practice as a design requirement. The proposed system shows that incorporating practice information into the design of e-health systems enhances their usefulness for ‘open’ clinical decision support.