Building systems to enable knowledge sharing and decision support among clinicians
across organizational and geographical boundaries is a complex but important task that
lies at the core of the idea of telehealth. Practice-centered awareness has the potential to
enhance the usability of cross-boundary clinical decision support systems by providing a
shared context of work for decision support across organizational and geographical bound-
aries based on awareness of a clinician’s work contexts and practice-related work activities,
including local workarounds, non-explicit rules, improvisation strategies, institutional
agenda and patients’ needs. We present a multi-method evaluation of the practice-
centered awareness features of CaDHealth. CaDHealth is a clinical decision support system
that enables clinicians to construct awareness of one another’s work activities and contexts
across geographical and organizational boundaries based on three categories of work
practice – ontological, stereotyped and situated work practices. Evaluation results indicate
that incorporating practice-centered awareness features in telehealth systems results in
better work coordination across organizational and geographical boundaries, leads to more
effective cross-boundary clinical decision support, and enhances the perceived usefulness
and adoption of telehealth and e-health applications.