Background: ‘The Body Multiple: Ontology in Medical Practice’ is the title of an influential ethnographic study of health care practices (1). As the title conveys, disease is not just one thing, but have different meanings related to the various medical practices involved, and thus the ontology of the body becomes multiple! As in the case of patients with multi-morbidities and chronic diseases (MCD), the multiplicity of their bodily illnesses turn them into complex patients, involving many health care practices. Providing care to frail elderly with MCD is a ‘wicket’ problem because of the clinical complexity, the social complexity and the system complexity (2;3) that follow from the many care needs. The collaboration between the providers, patient and relatives are pushed to its edges. Expanded coordination of the care paths of frail elderly is called for to make transitions safer, alongside with the acknowledgement of patient involvement in ‘circular care’ arrangements, where the sectors collaborate on the MCD patients’ ongoing needs (4). Method: Participatory design with third space learning (5) between the sectors via the use of Video for Cross-sectorial Virtual Conferencing, (VCVC). The participants represented four different knowledge-practices of care, i.e. the family home, the municipality, general practice and the hospital. The VCVC was conducted from the hospital who included 20 elderly patients with MCD. Eleven video-meetings were video-recorded and transcribed verbatim. The hybrid dialogues between patient and health care professionals at the hospital (HPH), the municipality (HPM), the family doctor (GP) and relatives was framed in a collective mail-invitation with a 30 minuts timeslot, video-link and instructions. In total 64 participants: 11 patients, 16 relatives, 14 HPH, 13 HPM and 10 GPs. Results: The use of video for cross-sectorial collaboration on complex patients' care needs becomes a third-space-of-learning, and of expanding relational coordination. Analysis of the video-recordings show patterns of interaction at different levels, that in total created unique, patient-tailored care plans. One pattern comes from the need of moderation to secure inclusion, turn taking, and closure in the virtual setting of communication. The other pattern arose from the interaction between the four knowledge-perspectives on the patient’s situation, i.e. the perspective of the hospital, of the GP, of the municipality and of the family home into a new totality of understanding. Discussion: The hospital nurse plays a leading part in including the patient’s voice and wishes. S(h)e also ensures that all contextual perspectives are included, to sum up agreements and documentation. The circular discourse of knowledge exchange between the participants take-off from the patient’s wish, e.g. “come back home”. The hospital doctor follows with a clinical opinion on a specific medical problem. This speech act resemblances “doctors’ rounds”, but is cut short from the virtual others’ perspectives on the patient’s situation. Especially from the GP' questions about other medical conditions. This question open up to a new, circular form of discourse were GP, municipality and relatives complement each other’s perspectives with new information that in sum add to the whole understanding of the patient’s situation, and circular care needs. References (1) A.M. Mol (2002). The Body Multiple: Ontology in Medical Practice. Duke University Press. (2) P. Kuipers; E. Kendall; C. Ehrlich; M. McIntyre; L. Barber; D. Amsters; M. Kendall; K. Kuipers; S. Brownie (2013). Complexity in healthcare : implications for clinical education. Focus on Health Professional Education; v.15 n.2 p.4-16; October 2013, 15(2), 4–16. https://search.informit.org/doi/10.3316/aeipt.201585 (3) J. Amblàs-Novellas; J. Espaulella; L. Rexach; B. Fontecha; M. Inzitari; C. Blay; X. Gómez-Batiste (2015). Frailty, severity, progression and shared decision-making: A pragmatic framework for the challenge of clinical complexity at the end of life. Palliative medicine and care. European Geriatric Medicine. Volume 6, Issue 2, April 2015, Pages 189-194 (4) D. Høgsgaard et al. (Submitted for peer-review) Development of the Circular Care Model to improve cross-sectoral and interprofessional collaboration for patients with multimorbidity. An action research study. Journal of Interprofessional Care. (5) M. J. Muller; A. Druin (2002) Participatory design with third space learning. https://www.researchgate.net/publication/228398475_Participatory_Design_The_Third_Space_in_HCI

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Health care is in dramatic transformation due to the rapid development and massive implementation of (high- and low-tech) technologies. But not all transformations are as intended. Research in health transformation has disclosed new sources of risk and unpredictability, which require more research and organizational adjustment, i.e. learning. However, unintended consequences and effects occur at different levels of interaction and collaboration, requiring corresponding adjustment and learning strategies. - On the background of an ethnographic study of support-work in surgery in different Danish hospitals, this paper analyses cognitive-socio-technical health care practices as learning ecologies, giving special attention to the intentional and unintentional roles of technologies herein and their context dependency. The paper argues for an increased awareness of support at different contextual levels of use, presenting three examples from the study as learning cases. The three cases exemplify instances of disruption of the workflow and the collaboration among clinicians. They display how these instances are taken as challenges requiring learning at different levels in order to live up to the overall purpose, which is to reestablish safety - in the team and for the patient.

This article presents the results of a qualitative, comparative study of three hospital-based telemedical solutions for patients with COPD. Based on an analysis of technological and patient perspectives the paper identifies three parameters that influence the role of the patient and the collaboration between patient and clinician. The article develops a stra-tegic TeleMatch-model that conceptualizes how the planning of patient care paths can be supported by various technologies matching the specific needs of the patient, supporting self-monitoring for those who are able and offering video consultations to vulnerable patients.

PURPOSE:New technologies enable new forms of patient participation in health care. The article discusses whether communication in online patient support groups is a source of individual as well as collective empowerment or to be understood within the tradition of compliance. The discussion is based on a qualitative analysis of patient communication in two online groups on the Danish portal sundhed.dk, one for lung patients and one for women with fertility problems.METHODS:The object of study is the total sum of postings during a specific period of time - a total of 4301 posts are included. The textmaterial was analyzed according to the textual paradigm of Paul Ricoeur, and the three steps of critical interpretation. Thus, the analysis moves from describing communicative characteristics of the site to a thorough semantic analysis of its narrative structure of construing meaning, interaction and collective identity, and finally as a source of collective action.RESULTS:The meta-narratives of the two groups confirm online patient support groups for individual empowerment, for collective group identity, but not for collective empowerment. The collective identities of patienthood on the two sites are created by the users (patients) through specific styles of communication and interaction, referred to as 'multi-logical narratives'.CONCLUSION:In spite of the potential of online communities of opening up health care to the critical voice of the public, the analysis points to a synthesis of the otherwise opposite positions of empowerment and compliance in patient care. On a collective level, the site is empowering the individual users to comply with 'doctor's recommendations' as a group.

Siden 2007 har undervisere og studerende på Humanistisk Informatiks første semester løbende eksperimenteret med implementering af digitale porteføljer, og hvad der kan betegnes som personlige læringsmiljøer. I denne artikel fremhæver vi de pædagogiske motiver for eksperimenterne samt analyserer og diskuterer de erfaringer, som især den seneste interventionhar tilvejebragt omkring pædagogiske, organisatoriske og systemmæssige udfordringer og problematikker.

New technologies enable a different organization of the public's admission to health care services. The article discusses whether online support groups in patient treatment are to be understood in the light of patient empowerment or within the tradition of compliance. The back-ground material of the discussion is complementary data from quantitative research on characteristics of patient support groups, and from two qualitative, in depth studies of the impact of patient networks for lung patients and for women with fertility problems. We conclude that in spite of the potential of online communities of opening up health care to the critical voice of the public, the quantitative and qualitative studies surprisingly point to a synthesis of the otherwise opposite positions of empowerment and compliance in patient care. Thereby the critical potential of online communities in health care services seems reverted into configuring ideal patients from diverse users.

INTRODUCTION:Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure.THEORY AND METHODS:Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices.RESULTS:This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT.CONCLUSION AND DISCUSSION:The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes.

A socio-technical approach was used to study the qualitative effects of deploying a medication computerized physician order entry system (CPOE with no decision support) at two internal medical wards in a hospital in Denmark. Our results show spatial and temporal transformations of core acts and relations in medication work, i.e. of the intended use of the system inscribed in hardware and software, in the relations of care between doctors and patients, of collaboration between doctors and nurses, and prospectively of the patients' trajectories when readmitted to hospital or another health care institution, reusing data from the system. This study throws light on problems of continuity of patient care paths, patient-related and IT-system-related error handling and time spent on core activities--when ubiquitous IT is used locally in a real physical setting with specific traditions of performing or 'doing medication'. The paper argues for the project organization to support the local collaboration and renegotiation of time and place of enacting medication with CPOE, as well as set up feedback for maturation of the software for future clinical use.

The paper develops a language for addressing transformations of communication and workflow in health care from implementing IT. Introducing categories for identifying distorted communication; different levels of ITinteractions are discerned into a framework for identifying IT initiated problems in health care. The categories evolved from synthesizing three studies of ITimplementation in healthcare arrangements, i.e. on ITimplementation for supporting communication across different health care institutions, across wards in a University Hospital and for internal communication at a medical ward and major empirical usability studies in health care. The studies are based on qualitative interviews and observation. The analysis of the studies is inspired from theoretical work on IT-infrastructure. The conceptual framework of identifying distorted communication and collaboration mediated by IT is discussed and additional strengthened in a metaanalysize with recent research on unintended adverse consequences from implementing CPOE, computer order entry systems in health care practices.