Journal Article

Communication spaces

Enrico Coiera

in Journal of the American Medical Informatics Association

Published on behalf of American Medical Informatics Association

Volume 21, issue 3, pages 414-422
Published in print May 2014 | ISSN: 1067-5027
Published online September 2013 | e-ISSN: 1527-974X | DOI:

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  • Medical Statistics and Methodology
  • Bioinformatics and Computational Biology
  • Biomathematics and Statistics


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Background and objective Annotations to physical workspaces such as signs and notes are ubiquitous. When densely annotated, work areas become communication spaces. This study aims to characterize the types and purpose of such annotations.

Methods A qualitative observational study was undertaken in two wards and the radiology department of a 440-bed metropolitan teaching hospital. Images were purposefully sampled; 39 were analyzed after excluding inferior images.

Results Annotation functions included signaling identity, location, capability, status, availability, and operation. They encoded data, rules or procedural descriptions. Most aggregated into groups that either created a workflow by referencing each other, supported a common workflow without reference to each other, or were heterogeneous, referring to many workflows. Higher-level assemblies of such groupings were also observed.

Discussion Annotations make visible the gap between work done and the capability of a space to support work. Annotations are repairs of an environment, improving fitness for purpose, fixing inadequacy in design, or meeting emergent needs. Annotations thus record the missing information needed to undertake tasks, typically added post-implemented. Measuring annotation levels post-implementation could help assess the fit of technology to task. Physical and digital spaces could meet broader user needs by formally supporting user customization, ‘programming through annotation’. Augmented reality systems could also directly support annotation, addressing existing information gaps, and enhancing work with context sensitive annotation.

Conclusions Communication spaces offer a model of how work unfolds. Annotations make visible local adaptation that makes technology fit for purpose post-implementation and suggest an important role for annotatable information systems and digital augmentation of the physical environment.

Keywords: annotation; situated cognition; human-computer interaction; task-technology fit; clinical information system; augmented reality

Journal Article.  6431 words.  Illustrated.

Subjects: Medical Statistics and Methodology ; Bioinformatics and Computational Biology ; Biomathematics and Statistics

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