Cognitive Artifacts in Complex Work - Ambient Intelligence for Scientific Discovery - page 156

Individuals develop and use cognitive artifacts so that it is possible to perform
otherwise impossible tasks, such as the process of care coordination for acute care
patients. As the patient length of stay and the number of procedures increase,
the need for more powerful cognitive artifacts also grows in order to support
increased demands for patient care coordination.
Artifacts can be used to distribute cognition in a variety of ways. They can be
used by an individual to hold information related to plan and status, which are
distributed across time. For example, an anesthesia coordinator who develops a
plan for the day's activities embeds intentions, speculations and anticipations in
it to mold what is to come. Later in the day, the same coordinator can use the
artifact that has been annotated and adjusted throughout the day to perform
trade-off decisions and re-plan to balance staff resources against changing care
demands. Artifacts can also distribute cognition socially by holding both the
patient care procedure plans and status to be distributed among staff members.
Earlier in the day, team members can use the artifact to anticipate their role in
the events that are expected. The artifact serves as a means to develop consensus
about, and embody, future needs. Later in the day, staff members use the artifact
as a platform to track progress and reconcile conflicts as they evaluate demands
for care that remain.
Computer systems make it possible to develop digital versions of cognitive
artifacts. In many instances, computer-based artifacts have been designed as
mimics of physical artifacts. In such cases, the traits of simple physical items
that made the artifacts so useful have been replaced by electronic analogs that
may not be as easy to use in complex work. Digital artifacts that are developed
with insucient research into people's work practice can make work more dif-
ficult instead of easier. Problems include creating lags in information updates,
truncating information by forcing it to fit into limited display real estate, and
requiring users to drill down through levels of hierarchical menus. The result
increases, rather than decreases, the amount of work an individual performs.
Operators who are confronted with such circumstances can reject such digital
artifacts and return to physical artifacts. This is because physical artifacts em-
bed well-understood but tacit cognitive tasks and have already been proven to
successfully support the shared practices of individuals.

2.3 New Information System Development

New approaches to computing systems are often couched in terms of the promise
of technology. Human participants are cast as the beneficiaries of advantages
that will accrue from new systems. Rather than considering abstractions of what
might be possible, it is more productive to portray real applications that new sys-
tems could benefit. Scientific research and acute healthcare have genuine needs
for improved information system performance that make this more practical
discussion possible. Both domains require constant access to time-sensitive in-
formation for all participants. Both differ in the way information is used through
time. As an operational system, acute care requires current information on pa-
tient and system status, as well as the ability to review, update, and anticipate