Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system-its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners' awareness of unanticipated consequences that only become evident during HIT implementation.

Since the advent of the Internet, social critics have debated its effects on intimacy and social relationships. I show how, by writing detailed descriptions of their illness experiences, participants in online support groups create emotionally vibrant, empathic communities in which emotional rhetoric frames various moral dilemmas. I illustrate my argument with a detailed analysis of "emotion talk" among members of an HIV/AIDS support group over a 2-year period. My findings add to current debates by encouraging sociologists to consider the emotional dynamics within the online support group as a moral, rather than just psychological or therapeutic, component of interaction.

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