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. 2000 May-Jun;7(3):277-86.
doi: 10.1136/jamia.2000.0070277.

When conversation is better than computation

E Coiera  1
Affiliations

When conversation is better than computation

E Coiera. J Am Med Inform Assoc. 2000 May-Jun.

Abstract

While largely ignored in informatics thinking, the clinical communication space accounts for the major part of the information flow in health care. Growing evidence indicates that errors in communication give rise to substantial clinical morbidity and mortality. This paper explores the implications of acknowledging the primacy of the communication space in informatics and explores some solutions to communication difficulties. It also examines whether understanding the dynamics of communication between human beings can also improve the way we design information systems in health care. Using the concept of common ground in conversation, proposals are suggested for modeling the common ground between a system and human users. Such models provide insights into when communication or computational systems are better suited to solving information problems.

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Figures

Figure 1
Figure 1
A voice-driven interface to an electronic medical record system can use a computational solution relying on speech technologies or a hybrid approach using communication and information technology. One design solution developed at the University Hospital in Geneva allowed clinical staff to interact with the medical record via a telephone pool of trained operators.
Figure 2
Figure 2
The cost of pre-emptive grounding increases with the amount of knowledge agents share: The more we share, the greater the cost of telling and maintaining.
Figure 3
Figure 3
The cost of “just-in-time” grounding decreases with the amount of prior knowledge agents already share about a task: The less we share, the more I have to share now.
Figure 4
Figure 4
For any given interaction, some of the grounding costs are borne at the time of the interaction and some have been borne earlier. This means that an information system designer has a spectrum of options for designing the interaction between computer and user.
Figure 5
Figure 5
A continuum of common ground between agents defines how much of the interaction can be modeled formally ahead of time and how much needs to be left informal until the time of the interaction. Computational systems work well when substantial modeling can occur ahead of time, while communication systems can be used when agents are unable to reliably model their interactions ahead of time.
See this image and copyright information in PMC

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