Clinical Groupware: A Definition (Version 2.0?)

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A while ago I proposed the following definition of clinical groupware:

“Intentional care team processes and procedures pertaining to the observation and treatment of patients plus the tools designed to support and facilitate a care team’s work.” (emphasis not in original)

I received a surprising number of suggestions (but: Post! Post!). All food for thought.

I do have a list of what I like and a list of what I think is possibly problematic about the definition. “plus the” and “tools” are on my second (possibly problematic) list.

I’m tempted to replace “plus the” with “using,” or reverse the order of the primary clauses and use “applied to.” However I’d like to pay respect to the Johnson-Lenzs’ pioneering definition of groupware. I definitely *want* someone from the larger groupware industry and academic community to *recognize” this relatively well know construction. Nonetheless, I did replace “+” with “plus” because, well, “+” is just not a word.

“Tools” was on the second list too, not so much because “tools” is vague (and even if it was vague, that’s not necessarily bad); it’s that it is too general (too high up the knowledge representation abstraction hierarchy, using artificial intelligence-speak, therefore violating the third requirement for a good definition). It might admit “examples” of clinical groupware that we don’t want to be counted as examples. A rock can be used to compel coordination. But it’s not nice.

“Communication technology” is very close to what I had in mind. It implies information processing too, I think. However, successful communication does not ensure successful coordination to achieve common goals. Diplomatic instances of this give rise to the euphemism “a frank and constructive exchange of views.”

I considered all the possible combinations of “information,” “processing,” “communication, “digital,” and “technology” but wasn’t happy with any of them. So I decided to leave it “tools” until I came up with better. I’d rather gradually tighten the definition to exclude false positive examples of clinical groupware than untighten to include false negative examples of clinical groupware.

I’m also looking for a level of abstraction slightly higher than computer code-based clinical groupware. Examples of codeless coordination technology include the electrical lights and signal systems used in medical offices to represent who is where–with what priority–in real-time. EncounterPRO’s Office View is a digital example of this kind of radar view, albeit with much more task status information and driven automatically by the workflow engine.

Some computers don’t rely on electrons at all (at least directly). They are physical machines that operate deterministically according to the laws of Newtonian physics (not the laws of a computer language). A problem to be computed is mapped to their physical state, the machines move to equilibrium or quiescence, and the solution is mapped back out. I used to build gadgets out of tinker toys and punch cards that would play Tic-Tac-Toe. It blows my mind to think of how different today’s world might be if Babbage had succeeded to build a computer based on gears and powered by steam.

Physical machines can also be used to communicate (and I’m not talking  tin cans and string here). I recall that Leonardo De Vinci designed a mechanical means to convey a pixel-image from one location to another. Black and white squares in a grid are flipped, drive cords running over pulleys, which flip corresponding squares in another room. I don’t know if he built it and I can’t find it on the Web (keep coming up with television shows about his inventions instead of his invention of the television–or maybe I have the wrong inventor).

If all this seems a bit far afield from clinical groupware, I’d stress that this definition needs to be “extensible.” It needs to be compatible with innovative approaches to coordinating patient care we haven’t even imagined yet.

Technology is about more than digital computers. Finding the right representation for a coordination problem can be most of the battle. Annotating that representation, or moving physical tokens around on it, can be a groupware solution. Many board games are based on this idea. I’d like the definition of clinical groupware to be compatible with any such fiendishly clever annotatable or mutable physical representation (such as the common grease board). Codeless clinical groupware prototypes may be part of a developmental process in which some step will be to digital format.

So far, the best phrase I’ve come up with to specialize “tools” and tighten up the definition is “coordination technology.” It captures what I think needs to be captured, and resonates nicely with current discussions about “care coordination.” 

So here is another candidate for a definition for clinical groupware (version 2.0):

“Intentional care team processes and procedures pertaining to the observation and treatment of patients plus the coordination technology designed to support and facilitate a care team’s work.”

Just one problem though, it violates the fourth requirement for a good definition: Avoid obscurity. Coordination technology is not a commonplace and widely understood phrase. The interesting thing is that if I define coordination technology to be “tools designed to support and facilitate a (care) team’s work,” I end where I started.

So, for now at least, I think I’ll stick with my original definition for clinical groupware:

“Intentional care team processes and procedures pertaining to the observation and treatment of patients plus the tools designed to support and facilitate a care team’s work.”

P.S. Follow me on Twitter at @chuckwebster.

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