Evaluation of practice-centered awareness (PCA) as a requirement for decision support systems for new pervasive digital
infrastructures where clinicians increasingly engage in informal encounters and share knowledge to support one another’s
decisions across geographical and workplace boundaries in a way that adapts to patients’ needs and clinical work contexts is
presented. PCA potentially enhances awareness of other people’s work activities across organizational and geographical
boundaries by providing a structure for people working on disparate tasks to gain understanding of what each other does
at three levels – ontological, stereotyped and situated awareness.
The study shows that incorporating PCA enhances the usefulness, acceptance, and user adoption of e-health systems for
cross-boundary clinical decision support. As noted by Househ et al. (2009, p. e11), understanding how socio-cultural inter-
actions impact knowledge exchange in a distributed environment, such as e-health, represents an opportunity to enhance
how such activities are carried out. The approach described in this paper has the potential to enable the evaluation of aware-
ness using an approach that takes into account and seeks to measure and link all the inputs that go into clinical decision
making ‘in practice’. By contributing a multi-method approach for evaluating e-health cross-boundary clinical DSSs, this
work has the implication to enable more effective decision support and knowledge sharing between clinicians in the devel-
oped and developing countries, and increase the threshold for the adoption of e-health and telehealth applications. Future
work will focus on exploring practice-centered metrics, as a quantifiable measure, for evaluating systems that seek to sup-
port work, collaboration and decision making at the work practice level.