A framework for practice-centred awareness and decision support in pervasive e-health

Studies have shown that clinical work in the real world involves considerable elements of local improvisations, use of tacit knowledge and experiences as well as patient-dependent and workplace-specific traditions of actions that are not easily captured by formal models of clinical workflows. We argue in this paper that decision support tools for emerging pervasive e-health need to take a more holistic view of clinical problem solving by considering the wide range of contextual, socio-cultural, dynamically situated factors that influence real world clinical practices. We discuss a set of design implications emerging from a user-centred study of clinical practices aimed to highlight the subtle differences in the ways clinicians often contextualise procedures and improvise practices in order to accommodate for peculiar workplace circumstances and patient-centred needs. Based on the result of the study, we propose a framework for cross-boundary awareness and practice-centred decision support in pervasive e-health.