design can also be used [ODI 11], as can the analysis of online discourse [MAR 16].
P.3. For a critical approach to digital health communication
While we do not wish to further evoke here the multiplicity of empirical approaches practiced in digital communication, it seems to us necessary to mention the main currents of communicational thinking in health. We believe that all of them are defined by a critical distance towards supporting discourses or organizational projects that aim to make ICTs the all-encompassing solutions to most, if not all, of the health sector problems. This critical distance, the result of observations made as closely as possible to the uses and info-communication practices of patients and caregivers, never precludes an increase in generality involving a systemic questioning of the dominant neoliberal perspectives.
It is in this perspective that Dominique Carré and Jean-Guy Lacroix, in a Franco-Quebec approach that is very similar to ours today, aimed to understand in a general and global way the societal stakes of the computerization of care. Not exclusively focused on organizational issues, their approaches jointly see the beginnings of a mutation of expertise and a technician ideology promoting the empowerment of a patient who is supposed to become an actor of his or her care… online. It is then a question of evaluating the effects of the “computer transplant” [CAR 01b] in a constantly changing health sector, between renewed regulations, major industrial and economic stakes and the imposition of new rationalizing managerial standards. The objective of the two authors is clear: to show the role of communicating information technology in the dual process of merchandizing and managerialization underlying the “outpatient shift”; the latter aiming to reduce the overall costs of hospital care considered too expensive.
The research conducted or highlighted by Carré and Lacroix questions the promotion of sociotechnical empowerment aimed at encouraging patients to co-produce the care they receive by automating part of the medical follow-up [CAR 01a]. They prefigure all or part of the work that we now refer to as “digital communication in health”. Since then, these perspectives have not only been largely updated, but also constitute a particularly lively research subject within the ICS. As a result of the pioneering approach of these two authors, health studies will attract the interest of a growing number of ICS researchers, providing empirical support for the major theoretical currents in our discipline. This work repeatedly questions the issues of the digitalization of today; the field of healthcare is a central terrain for exploring the developments of the digital society. We propose a synthetic panorama of this field in the following sections.
P.4. Digital health communication in the workplace
As an extension of the issues defined by Carré and Lacroix, work on digital communication for health organizations is very much alive in the French-speaking ICS community. It highlights the limits of information technology in health care, obviously at the level of institutions, as well as at the level of so-called “urban” professional practices. In particular, following the initial work claiming a crossover between health and organizational communication [GRO 99], and short of the work aiming to cover the entire problematic field, where computerization is supported by an increasingly commercial logic, as well as an industrial one [SAL 16], the work carried out in digital communication of organizations is focused on more limited areas.
From a critical perspective, they highlight the rationalization processes brought about by the application of neo-management in healthcare institutions [BAZ 08, BON 05] and the increasing computerization of patient care processes by healthcare professionals. In a neoliberal context marked by the disengagement of the State and the need to reduce costs, the implementation of the personalized medical record is an emblematic example [MAY 12]. Rationalization processes, aimed at making healthcare ever more efficient, are then nourished by the monitoring and control possibilities offered by digital technologies. The same applies to services based on quantified self or digital self-measurement, which are becoming widespread via smartphone applications. These applications encourage Internet or mobile users to share their personal health data (e.g. the number of calories they spend on their morning jog) with their online community. The aim is to evaluate a positive or even negative physiological progression or evolution, such as weight gain. This measurement of physiological performance, calibrated to that of other members of the community [ARR 13], reflects a form of cybernetic self-optimization, which is certainly fun, but which reminds us of the automation logic already identified by Dominique Carré in 2001. Moreover, these practices, conveyed by industrial players in the collaborative web economy [BOU 10], reinforce the need to establish and respect a “data ethic”. Indeed, what about the marketing exploitation of individual information concerning intimacy? What can be said about the possible risks of using these data [BER 14], for example, by banking institutions looking for reliable information to establish the insurance rate of a mortgage loan?
On another level, following in particular the above-mentioned work of Anne Mayère, recent research points to tinkering and other misuse of the system by healthcare personnel who refuse to accept the increased bureaucracy induced by the traceability of acts and procedures; traceability that is essentially digital (“paperless” logic) and strongly linked to the implementation of the famous electronic personal medical record [COR 13, GRA 17]. From the same perspective, Luc Bonneville and Sylvie Grosjean attempt to explore digital communication in health as the product of a paradoxical opposition between two social logics: the emancipatory logic of promoting a professional practice free of low added value tasks, in favor of time spent with the patient and/or improving care (“clinical reason”), and the reifying logic of a computerization ratio that standardizes professional practices with a permanent concern for efficiency (“economic reason”), leaving caregivers with no other choice than to bypass them with “tinkered” substitution devices [BON 07].
In the wake of questions concerning the meso info-communication approach of health organizations, work is focusing more specifically on groups or categories of healthcare professionals affected by digital technology, or even emerging through digital mediations. How does digital communication accompany the profound changes in the organization of care in healthcare institutions, outside of hospitals and other clinics, or in networks trying to optimize interprofessional coordination in territories with unequal health resources [BOU 03]? The aim here is to show the emergence of new forms of professionalism based on the “scientific” and “operational” mediation of medical knowledge. As a result, new digital healthcare professions are emerging, using the Internet to create communities of patients led either by healthcare professionals switching to community management or by community managers trained in the specificities, particularly ethical, of digital communication in health [GAL 14].
P.5. Digital communication in health: between strategic communication, public space and empowerment
As a result, between understanding the uses, non-uses and misuses of ICT in the workplace, support for the managerial rationalization of healthcare teams and new professionalization, research into digital communications in healthcare organizations provides an original insight into the challenges of the sector. However, thinking about persuasive digital communication produced by healthcare organizations and professionals cannot be limited to communication at work.
Emerging approaches are also questioning the communication strategies implemented by institutions, independently of the communication of prevention authorities. In an info-communication environment marked by a form of mistrust, or even distrust, of the institutional discourse [PAR 15], this is a question of providing the clearest possible information to make the patient a (convinced) stakeholder in the quality of care. Although this information is massively transmitted via the Internet, public hospitals, particularly in France, are constrained by data security standards not to develop the “communication” function in organizational charts. This results in the dissemination of very practical, not to say administrative, top-down information, which cannot compete with participative and collaborative general public health information systems, such as Doctissimo. This strategic approach to communication in public
