Hameed Chughtai
email: h.chughtai@auckland.ac.nz

Michael D Myers
email: m.myers@auckland.ac.nz

The Entwinement Logic of Practices: Insights from an Ethnography of Young IT Professionals

Keywords: fieldwork, practical rationality, research methods, ethnography, Heidegger, entwinement

This paper seeks to place the phenomenon of technology within the context of everyday practices using the logic of practical rationality. We draw some insights from our ethnography of young professionals and shed light on their everyday technological practices by invoking the concept of entwinement from hermeneutic phenomenology. Our findings reveal that the new generation users are becoming intimately entwined with information technologies in their everyday practices. Our study contributes toward the ongoing debate concerning theorizing of technology and its relationship to practice.

Introduction

The question concerning the nature of one's interaction with technology remains open in information systems (IS) research [START_REF] Leonardi | When Flexible Routines Meet Flexible Technologies: Affordance, Constraint, and the Imbrication Of Human And Material Agencies[END_REF][START_REF] Orlikowski | Sociomaterial Practices: Exploring Technology at Work[END_REF]. This question is further problematized by recent scholarship suggesting a rise of new generation of technology users [START_REF] Vodanovich | Research Commentary: Digital Natives and Ubiquitous Information Systems[END_REF][START_REF] Wang | Digital Natives and Digital Immigrants[END_REF]. The young tech-savvy people, often labelled as Digital Natives, Generation Y, Millenials, or similar, are seen as absorbed in information technology (IT) in their everyday practices. Given that IS scholarship is concerned with the nature of people's interaction with technology, this contemporary phenomenon might shed some light on the key question regarding how to conceptualize IT in everyday practices. For example, if the new younger generation of users are indeed technologically savvy, then some of our IS theories which assume that people either resist technology or at least have some difficulty accepting it, such as technology acceptance model and its variants [17, p. 380], will be challenged and might need to be revised. We find the shift in practices intriguing and begin by inquiring about the nature of one's technological immersion in everyday practices [START_REF] Mannheim | The Problem of Generations[END_REF]. Accordingly, we take the view that in order to interpret practices it is important to see them through the logic of practical rationality; thus, we find an anchor in Heidegger's analysis of being-in-theworld which is grounded in the everyday practices from a practical perspective [START_REF] Heidegger | History of the Concept of Time: Prolegomena[END_REF][START_REF] Heidegger | Being and Time[END_REF]. Heidegger reminds us that we are 'always already' involved in the world in our mundane situations [START_REF] Dreyfus | Being-in-the-World: A Commentary on Heidegger's Being and Time[END_REF]; from this perspective, it is thus possible to interpret a phenomenon from within the practices in which people are already absorbed rather than conceptualizing practices externally, or taking an objective view. We find further support in the critical interpretation of being-in-the-world as entwinement, developed by Sandberg and Tsoukas [START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF]. They suggest that researchers need to study practices from an immersion perspective insofar as, following Heidegger, the people, too, are always already absorbed in their practices. They call this absorption our everyday entwinement in the world and provide a framework to study it. In this way, we find the interpretive concept of entwinement is appropriate for understanding everyday technological practices.

We draw on some of the insights from our critical ethnography of the everyday practices of young IT professionals in a large scale technology organization. The ethnographic method is suited to the study of the practices from an immersed point of view as it allows the field researchers to engage with the participants in their practice worlds [START_REF] Klein | A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems[END_REF][START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF]. Our findings reveal that the entwinement logic of technological practices can be seen from three perspectives namely, purpose, skill and equipment. This multi perspective view sheds light on how young IT professionals are intricately entwined with technology in a holistic way in their everyday practices.

The paper is organized as follows. We first elaborate our theoretical perspective and highlight the significance of practical rationality. Next, we spell out the concept of entwinement from practical rationality, followed by interpreting the everyday practices as entwinement. We then present some evidence from the field regarding entwinement. The article concludes with a brief discussion and a few suggestions for further research.

Theoretical Perspective

We ground our inquiry in the everyday perspective on practices through Heidegger's analysis of being-in-the-world using practical rationality [START_REF] Heidegger | Being and Time[END_REF]. Heidegger's influence regarding the study of practices has been acknowledged in the parallel disciplines of organization [START_REF] Chia | Strategy as Practical Coping: A Heideggerian Perspective[END_REF][START_REF] Gibbs | Heidegger's Contribution to the Understanding of Work Based Studies[END_REF][START_REF] Schatzki | The Sites of Organizations[END_REF][START_REF] Weick | Designing for Thrownness[END_REF], management [START_REF] Sandberg | Returning to Practice Anew: A Life-World Perspective[END_REF][START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF], and computer science [START_REF] Dourish | Where the Action Is: The Foundations of Embodied Interaction[END_REF][START_REF] Winograd | Understanding Computers and Cognition: A New Foundation for Design[END_REF]. Some IS researchers, too, have invoked Heidegger's hermeneutic phenomenology to criticize Cartesian trends in IS research [START_REF] Ciborra | Situatedness Revisited: The Role of Cognition and Emotion[END_REF][START_REF] Ciborra | From Tool to Gestell: Agendas for Managing the Information Infrastructure[END_REF][START_REF] Mingers | Embodying Information Systems: The Contribution of Phenomenology[END_REF]. According to this critique, IS research is dominated by theories that can be best described as espousing scientific rationality [e.g., [START_REF] Leonardi | When Flexible Routines Meet Flexible Technologies: Affordance, Constraint, and the Imbrication Of Human And Material Agencies[END_REF][START_REF] Orlikowski | Sociomaterial Practices: Exploring Technology at Work[END_REF]. In this strand of research, everyday situations are often conceptualized through detached scientific worldviews. However, recent critical organizing scholarship redirects the attention of IS researchers to employ practical rationality, as developed within hermeneutic phenomenology, in order to understand the complex and mundane nature of everyday practices [START_REF] Sandberg | Returning to Practice Anew: A Life-World Perspective[END_REF][START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF]. In this way, it is possible to understand a practical phenomenon from within a practice in which one is usually absorbed rather than looking through an external objective lens.

In the practical immersion perspective, Sandberg and Tsoukas [START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF] suggest, building on the concept of being-in-the-world, that "we are first absorbed in practice before we start reflecting on it" (p. 345). Accordingly, they interpret one's everyday entwinement in practice as follows: the notion of being-in-the-world stipulates that our most basic form of being is entwinement: we are never separated but always already entwined with others and things in [a holistic whole within] practice worlds. (p. 343) Following Heidegger [START_REF] Heidegger | Being and Time[END_REF], they suggest that entwinement is the logic of everyday practices insofar as we can only understand a practice in relation to other practices, things and people in which it is entwined with [START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF][START_REF] Schatzki | The Sites of Organizations[END_REF]. This argument finds further support in Dreyfus [START_REF] Dreyfus | Being-in-the-World: A Commentary on Heidegger's Being and Time[END_REF] who, too, suggests: "we can only describe the phenomena as they show themselves and show how they fit with the rest of human existence" (p. 162). From this perspective, a practice is seen as "noncontingent," Sandberg and Tsoukas [START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF] articulate, inasmuch as "it incorporates distinctions that provide its practitioners with a certain [spatiotemporal] orientation, without which the particular practice would not be what it is" (p. 343). We thus note that the entwinement perspective is found to be holistic as it suggests researchers should take note of a multi perspective 'nexus of practices' of participants within which they are usually absorbed in their everyday situations.

Insofar as the entwinement perspective puts forward an absorbed holistic view, we can then ask the question, how can one grasp the phenomenon if we are always already absorbed in our practices? The answer is found by interpreting instances of temporary breakdowns in established practices [14, 23, p. 344ff]. A temporary breakdown in practice temporarily brings the otherwise unreflective absorbed interaction to the fore and provides an opportunity to understand the practices. Prior IS research has shown that the temporary breakdowns in practice are a fruitful way to understand practices [START_REF] Dourish | Where the Action Is: The Foundations of Embodied Interaction[END_REF][START_REF] Winograd | Understanding Computers and Cognition: A New Foundation for Design[END_REF]. There are two types of temporary breakdowns in practices which reveal the logic of entwinement [23, p. 347ff]: i) first order breakdowns and ii) second order breakdowns. While the former are unforeseen, the latter are caused by active intervention in an ongoing practice; thus the latter are excluded from our research as it contradicts the ethnographic principle of non-intervention. Our inquiry, thus, deals with first order breakdowns in practice which are triggered by unexpected outcomes, deliberate reflection, as well as deviations or becoming aware of differences in an established practice (ibid). Given space limitations, a full scale discussion of breakdowns is not possible here, but for critical research on breakdowns in organizing practices, see Chia and Holt [START_REF] Chia | Strategy as Practical Coping: A Heideggerian Perspective[END_REF], Gibbs [START_REF] Gibbs | Heidegger's Contribution to the Understanding of Work Based Studies[END_REF] and Sandberg and Dall'Alba [START_REF] Sandberg | Returning to Practice Anew: A Life-World Perspective[END_REF]. Next, we develop entwinement as our main lens to understand technological practices.

Interpreting Technological Practices as Entwinement

Insofar as IT is increasingly becoming ubiquitous in everyday practice [START_REF] Vodanovich | Research Commentary: Digital Natives and Ubiquitous Information Systems[END_REF][START_REF] Yoo | Computing in Everyday Life: A Call for Research on Experiential Computing[END_REF], the new generation of users are often described as being deeply absorbed in their everyday technological practices. Consistent with the hermeneutic of entwinement, people are, thus generally seen as interacting transparently with IT [START_REF] Wang | Digital Natives and Digital Immigrants[END_REF], or simply entwined with it. Accordingly, as one engages with IT, mundane disruptions such as device failure temporarily bring the otherwise transparent practices to the fore. The technological practices, thus, becomes available for inquiry by the virtue of temporary breakdowns in practice. As shown earlier, an instance of breakdown might reveal the complex logic of entwinement in terms of our material interaction as well as the aspects of time and space within which the practice breakdown occurs.

In the entwinement perspective, a practice is both sociomaterial and spatiotemporal by the virtue of our being-in-the-world [START_REF] Sandberg | Returning to Practice Anew: A Life-World Perspective[END_REF][START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF]; here, a practice is interpreted as an "organized, open-ended spatial-temporal manifold of actions" and is always found to be in a holistic 'nexus of practice' [24, p. 471]. In this way, a practice is intelligible only when it is interpreted in the light of other entwined practices in a nexus. Accordingly, we take IT as holistic equipment which is entwined in our everyday practices through our being-in-the-world and thus dispersed over space time. A nexus of practice thus beckons to take a multi perspective view on the phenomena. According to Heidegger [START_REF] Heidegger | Being and Time[END_REF] the things that we relate to must be understood as part of the world that we also are part of, arguing thus: an instrument is what it does and this in a context of assignments. Accordingly, following Heidegger [START_REF] Heidegger | Being and Time[END_REF], and building on critical interpretations developed by Dreyfus [START_REF] Dreyfus | Being-in-the-World: A Commentary on Heidegger's Being and Time[END_REF] and Sandberg and Tsoukas [START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF], we note, IT when seen through the dialectic logic of entwinement is argued to be what it is in terms of, 1. Skills -in terms of actual usage of IT, 2. Equipment -as a holistic whole of IT in relation to one another, and 3. Purpose -within a situation and in relation to the holistic equipment and skills.

The concept of entwinement, hence, paints the dialectic as a circular relationship with no specific center (Figure 1): we can understand the purpose of technology that is referenced in the actual use; the purposeful use is, then, related to skills and yields meaning in a practice; and, similarly, the skills make sense through the purposeful use and also determines the use of a technology by assigning it to a task in order to achieve a goal. When one aspect is broken, or a perspective is not taken into account, the dialectic faces a practice breakdown. The conceptual understanding, as illustrated in our suggested entwinement model, stems from Heidegger's [START_REF] Heidegger | Being and Time[END_REF] being-in-the-world analysis, through the interpretations Meaning Purpose Skills Equipment developed by Dreyfus [START_REF] Dreyfus | Being-in-the-World: A Commentary on Heidegger's Being and Time[END_REF] and Schatzki [START_REF] Schatzki | The Sites of Organizations[END_REF], to reveal the logic of everyday technological practices. Heidegger's insight concerning the entwined trinity of equipment, skills and purpose in everyday practices is already used in seminal studies of complex tool use in IS scholarship [START_REF] Winograd | Understanding Computers and Cognition: A New Foundation for Design[END_REF]. In this way, we support and extend the concept of entwinement which, too, builds on Heidegger's thesis, arguing thus: the entwinement logic of practices suggests taking the holistic being-in-the-world perspective in order to interpret the everyday use of technology. When taking the holistic understanding of technology, the entwinement perspective discloses that the cyclical triad logic of our everyday practices is perpetual, or trialectic in nature. Thus, the technological practices are seen as transparent as long as we fluidly interact with our surrounding world; only a breakdown in any of the relations will bring the dynamics of practices to the fore. Recent developments in critical scholarship have suggested that such breakdowns are not necessarily destructive since a moment of critical reflection may allow us to develop new skills [START_REF] Gibbs | Heidegger's Contribution to the Understanding of Work Based Studies[END_REF][START_REF] Lok | On the Plasticity of Institutions: Containing and Restoring Practice Breakdowns at the Cambridge University Boat Club[END_REF]. Subsequently, the newly acquired skills tend to move to the background of everyday practices as they persist in everyday use, the entwinement, too, becomes transparent once again.

Thus, we can say that the technology in everyday practices of younger generation can be seen as deeply entwined as holistic equipment always available (e.g., ubiquitous IT), which is then persistently used for various purposeful use leading to acquisition of new skills as well as everyday understandings. In this way, the entwinement logic can reveal how IT is conceptualized in the everyday practices of new generation users. We will now discuss the details of our ethnographic inquiry from which the entwinement lens stemmed, followed by some evidence from our fieldwork.

Research Method

We conducted a critical ethnography, spanning over eight months, amongst young IT professionals in order to study the nature of their interaction with IT in their everyday organizing practices. The research site is a large scale provider of technology services, GenOrg, a pseudonym. Our reason for choosing this organization was the presence of a high number of young IT professionals engaged in complex technological practices within an organization. Further, we followed interpretive field research guidelines [START_REF] Klein | A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems[END_REF] in our ethnographic inquiry [START_REF] Myers | Qualitative Research in Information Systems[END_REF][START_REF] Myers | Investigating Information Systems with Ethnographic Research[END_REF].

After the initial contact with GenOrg, followed by a series of meetings with their senior management, one of the researchers, the first author, joined their IT department, GenTeam, in August 2013. The onsite researcher worked as a part-time software engineer. Thus, the field researcher was at the coalface of organization as a working member of a project team. Further, being an employee meant that complete access was provided to the GenOrg IT systems as well as a window of opportunity to be absorbed in their practices.

The GenTeam consisted of mostly fresh graduates or people in their first two years of employment whereas the managers were more experienced. Interestingly, as we will reveal, in their technological practices, the actual use of IT is found to be blurred and any stereotypical generational references were absent. This is perhaps due to the highly technical nature of organizational work which further problematizes their absorption in IT. Thus, we find ourselves in a complex mesh of technological practices.

By the virtue of being an active member, as also suggested by Sandberg and Tsoukas [23, p. 350], the researcher's role was extended from a mere observer to "a temporary participant" thus acquiring the capacity to observe temporary breakdowns in the transparent practices of participants from their perspective on the field practice. In this way we were also able "to get practitioners to step back from what they routinely do" (Ibid) and reflect on their practices. We thus also found participants as "interpreters and analysts" of our ethnography as we immersed deeper in their field practices [12, p. 74].

Consistent with the ethnographic method, the data was collected primarily through participant observation. The field researcher being an active team member allowed us to document field notes containing "thick description[s]" [7, pp. 3-30] of weekly project's meetings and user groups' meetings, video-conferencing logs, informal chats, internal instant messaging service logs, internal communications using organization's email service, photographs, audio notes and working with organization's internal knowledgebase. All our field notes were documented either on the spot, where the situation permitted, or soon afterwards. By the virtue of an active team member, it was often possible to document events while being absorbed in the field practices, or often as an event unfolded. Further, on many occasions the participants were aware as the field researcher switched between the ongoing practices to documenting the field notes. The field notes were almost always taken digitally, usually on a workstation or using a mobile device where possible.

We also conducted 10 semi-structured qualitative interviews with select participants [START_REF] Myers | The Qualitative Interview in IS Research: Examining the Craft[END_REF]. The interviews ranged from an hour to two hours. While most interviews were semi-structured, some participants were quite candid during the interview and thus tended towards being more unstructured insofar as we followed the narrative painted by the participants. Further, we adhered to the guidelines suggested by Myers and Newman [START_REF] Myers | The Qualitative Interview in IS Research: Examining the Craft[END_REF] regarding qualitative interviews. Finally, all of our data was captured and coded using NVivo. Given the massive amount of data collected over eight months, we draw on just a fragment of this evidence for this paper.

Evidence from the Fieldwork

Here we present our interpretation of a single significant issue from three different perspectives in an attempt to shed some light on the intricacies of the entwinement. All examples are written from the field researcher's point of view.

Entwinement Perspective -Purpose

We begin with a seemingly mundane event from the fieldwork when I was asked to join an expert user group meeting. Although the meeting was routine for GenOrg, we documented an instance of a temporary breakdown in practice during the discussion of the GenWeb architecture. The meeting was quite informal and steered by a young technical analyst, Tom. During the course of the meeting, it became quite clear that some of the users were struggling to grasp the latest infrastructural level changes in their flagship software product. Many of such people were longtime users and considered themselves confident in the use of the GenWeb software tools. However, we observed that the new changes, although subtle, were significant as they threatened and thus revealed the otherwise transparent practices of the users. He went on to reflect that instead of attributing the failure to the technologies, the organization users need to find more clever ways to interact with the new tools. Later on, he brought back the question of intuitive purposeful use of technology in everyday organizing practices and emphasized that most of the users face difficulty because they take IT with an inherent purpose either as a 'fixed' solution or something 'special' which needs to be used only in a set way. Consider the following remarks as Tom discusses with the user group how they can use the GenWeb technologies as a tool and encourage them to modify it up to their purpose and needs: When you are using [GenWeb], it is a tool, and as a tool it can be used well, it can be used badly. And, I think, the number one thing that you can always do to create success is [by]… being intuitive with it. (Excerpt from the usergroup meeting) He then listed several technical examples of complex use of organizational tools. Elsewhere in the field, we observed the use of GenWeb as a tool within the GenTeam everyday practices as well. Many people used the organizational software services for more than one purpose, sometimes entwining personal and organizational lives. For instance, the IT platform that hosted GenWeb knowledgebase was also found to be used for personal notes, work notes, as well as a communication medium within the organization. Many participants casually told me that such uses were not intentional but increasingly became part of their practices. Further, the purposeful use of organizational equipment, driven by the skills of users, revealed that the practical purposeful use of technology mattered to these participants quite a lot. As Tom said:

[IT] is all about your personal choice, and it is driven by your personal interest, all you have to do it then just use it as you like it. (Excerpt from the interview) Here, we observe the participant puts emphasis on the use of IT through personal involvement (rather than having a fixed use or a static purpose). We can, then, say that through entwinement logic of practices the purpose is disclosed as a plastic concept. Tom, and many others, linked the unintentional but purposeful use of IT to their acquisition of skills. This is discussed next.

Entwinement Perspective -Skills

After a few months in the field, we observed that some young participants were quite often playing with new technologies on their own accord. Same participants were also working on the latest software solutions. While there were others who were not participating in such endeavors, they were at least aware of their skill level. As one young participant, Amy, (who was not working in a pure technical role), gasped after praising a programming solution, as developed by a colleague, "I wish I could do that, but this is not for me." When I inquired casually, why the programming skill is 'not for her? she explained that she is curious and finds it as an interesting skill but she had 'no purpose' to do so. She was somewhat doubtful about simply gaining the skill without engaging in a purposeful use. She recalled that once a colleague tried to teach her programming skills, "I just didn't know what to do with it; there was no real task anyway," she giggled timidly. The question concerning technological skills was further problematized by a young developer, Tom. Despite being a keen programmer, Tom painted a mundane picture of technological practices and says the young people, as he discussed and mirrored his own perspective, 'seem to have better skills' but they are simply using it intuitively rather than 'thinking about it'. In an interview, Tom reflected on this very phenomenon regarding new generation's practices as something banal:

[We are] the people who can naturally pick up new technologies, and are intuitive… [for example] learning a new smartphone is so simple, it's easy [because] it makes sense… people [like me] who are at least grown up with enough technologies to know, how it happens, how it generally works, you know. They are not double-clicking the thing that needs single clicking and so forth (laughs). (Excerpt from the interview) Astonishingly, his confessional insight became a prophecy as we witnessed a similar breakdown event in a project meeting soon afterwards. The meeting involved a demo for GenWeb mobile features on a touch screen tablet device. In this demo, the users were required to perform 'right-click' functionality. However, insofar as the touch screens usually do not have right-click due to absence of mouse like interfaces, it caused some confusion among some team members; thus, a breakdown in ongoing practice, as documented in this excerpt from the field notes:

The [touch screen tablet] is passed around to see a specific touch functionality, [a senior manager] wonders: "but how do you rightclick on this thing,"… [a young participant] then teaches her how right click works [on the tablet] and [the manager] looks genuinely surprised on this discovery, but asks: "but why do you need to right click on a tablet, it doesn't make sense," and [the younger participant] reply is affirmative: "I think it's for the people who are stuck in the old design. (Excerpt from the field notes)

The breakdown incident further reveals two interrelated concepts; first, the technological skills actualized differently for different people. For instance, the manager who didn't know how to interact intuitively, thus a breakdown occurred in technological practices. However, as the breakdown brought forth the practices for inspection by becoming aware of a phenomenon, the manager correctly recognizes the flaw is in the design not his or her own practice. Thus, the senior manager's skills converge toward new practices. Second, a conflict in practice actualization triggers another subtle temporary breakdown via unexpected outcome i.e., click functionality. Thus, it brought the entwinement to the fore again as the young participant reflected on the nature of design which, again, usually remains hidden. We thus observe how skills are subtly entwined with purpose and equipment.

Entwinement Perspective -Equipment

Perhaps the entwinement of technology in everyday practice is best seen from the equipment perspective. We observed in the field how fluidly members of GenTeam interacted with IT in their practices. We also acknowledge that, from the periphery, it might appear as an 'organizational norm' to be amidst many technologies; however, the case in point is to precisely open up the said taken for granted practices for scrutiny especially as technology is increasing becoming ubiquitous in everyday life (as well as at work). For instance, Tom, like many other participants, worked on multiple technologies simultaneously, often including virtual IT solutions where a physical machine was not present; further, he revealed that he was also an avid gamer in his spare time.

In this perspective, he compared the ubiquity of IT in his mundane affairs to the complex organizing technological practices and found a failure is equally 'annoying' insofar as certain technologies are seen as essential as 'a feature of life':

[a technological tool] breaking down [is frustrating after] it becomes accepted technology [as] a feature of your life, and [because] you come to accept that it is there [whether at work or home], and you come to accept that it is working, and so, you are used to that and start to forget about it. (Excerpt from the interview)

We thus began to observe an obvious characteristic of participants' practices that technologies are seen entwined as integral and ubiquitous parts which are deemed to be working all the time. Further, a breakdown is seen as a breakdown in the life of individuals where entwinement is usually transparent and fluid. Interestingly, other participants shared this significance but their interpretations varied. For instance, Julie, a young developer, found the ubiquitous IT as an opportunity to switch to other equipment in case of a failure. Her perspective, too, brings us closer to entwinement as Heidegger [10, p. 97] points out "there 'is' no such thing as an equipment." Similarly, IT is not a thing on its own but always seen from one practical perspective to other things. In this way, we note the ubiquitous IT, as Tom finds, hides with persisted use in practice in that it becomes taken for granted.

The entwinement logic of practice thus begins to reveal IT as transparent holistic equipment in everyday practice. Further, IT is understood vis-à-vis the actual involved use in practices, as Julie once described how technological work practices transparently entwine with her everyday practices. Within this absorbed involvement with technology, when asked if she thinks a technology qua technology, she replied:

What is there to think about? Honestly. Her insight remains unanimous among all the participants at GenOrg as most of them readily endorse the holistic view of IT as equipment. For instance, Tom, too, said, for him, interacting with IT is akin to an invisible tool which he transparently uses whereas others find it is holistically pervasive everywhere. Thus, it is not surprising, in this instance, the use of technology is found to be analogous to playing an invisible game, arguing thus: insofar as interacting fluidly with ubiquitous IT, as if being immersed in a game, is seen as intuitive, transparently purposeful, it requires absorbing oneself in the practice, and thus influences (and is itself conditiond by) practical skills. We thus suggest that the entwinement logic of practices uncovers a multi perspective view which could help IS researchers to conceptualize IT in everyday practices.

Discussion

Our study is concerned with one of the central questions in IS scholarship: how do people engage with technology in their everyday organizing practices? We provide a partial solution by looking at the new generation of users from their absorbed perspective. Our solution takes the form of interpreting the interaction with technology using entwinement logic of practice. Following Dreyfus' [START_REF] Dreyfus | Reflections on the Workshop on "The Self[END_REF] critical approach, we reinstate to "begin with practices" in order to make sense of our complex interaction with technology.

Numerous calls have been made to pay attention to the ubiquity of technology in everyday practice [START_REF] Vodanovich | Research Commentary: Digital Natives and Ubiquitous Information Systems[END_REF][START_REF] Yoo | Computing in Everyday Life: A Call for Research on Experiential Computing[END_REF]. We respond and show that researchers and organizations can learn a lot from the everyday practices of younger generations' use of ubiquitous technology. The new generation users are found to be intuitively comfortable with technology, contrary to the traditional view which holds that people generally resist new technologies. As IT becomes ubiquitous in the everyday practices, the new users develop a rather complex automatic relationship with technology. This insight is significant for organizations to manage the younger workforce which are shown to be entwined with technology. A disruption in a fluid technological practice is seen as a dis-ruption in everyday life. We further extend this insight to invite IS researchers to examine design practices to develop tools in a way that are 'invisible' and transparent in practice. Here, Heidegger's [START_REF] Heidegger | Being and Time[END_REF] insight has begun to manifest itself in contemporary software practices of solution designing which are, as demonstrated, intimately entwined in our everyday practices. Stroustrup [25,p. 19] remarks concerning the design of innovative technological solutions: "[g]ood software is invisible…[yet] [we] can be annoyed or hurt if it doesn't do what it is supposed to do. We can be annoyed or hurt if what it is supposed to do doesn't suit our needs." Accordingly, we have witnessed the same phenomenon in the field; thus, we can say a new conceptualization of design practices might be required in the light of the entwinement logic of practices.

We suggest the concept of entwinement might also be significant for IS research methods as it might help us review our theoretical and practical approaches in the light of contemporary technological practices. For instance, a key finding from our fieldwork is that entwinement is quite strong in young people's practices: insofar as technology is ubiquitously available, the technological practices tend to be more transparent. As one participant succinctly puts, 'it just makes sense'. Taking a cue from field evidence, we can, then, suggest taking a practical approach using practical rationality toward conceptualizing information technology. In this way, it might be helpful for researchers to understand how a technological phenomenon manifests in practice and, then, interpret it according to and from within the very practice which envelops it [START_REF] Dreyfus | Being-in-the-World: A Commentary on Heidegger's Being and Time[END_REF][START_REF] Heidegger | Being and Time[END_REF][START_REF] Sandberg | Grasping the Logic of Practice: Theorizing Through Practical Rationality[END_REF]. Taken together with the preceding insight concerning transparency of technology, we note that the entwinement perspective can further bring the design and practice aspects within IS scholarship closer to develop better tools and systems.

We have also shown the significance of an absorbed perspective on practices to grasp IT in everyday situations. In our ethnography of young professionals, who are found to be absorbed in their technological practices, we have uncovered that for the new generation users, IT is increasingly seen as a hidden tool interwoven in their transparent practices. Further, our fieldwork reveals that new generation users find using the technological tools as intuitively engaging in an invisible play like dialectic. This evidence strongly relates to the entwinement's underlying roots of absorption in practices [5, p. 66], and within such absorption, "not only is equipment transparent; so is the user." As shown earlier, only a breakdown in practices brings our attention to technology with which we are invisibly engaged in, our entwinement otherwise remains hidden. In this perspective, this is exactly what we have observed and interpreted as the entwinement logic in the field practices.

Our field evidence thus endorses the view that information technology can be seen as holistic 'invisible' equipment which not only remains hidden in practice but in fact should remain in the background for one to work smoothly [START_REF] Weiser | The Coming Age of Calm Technology[END_REF]. Although practice breakdowns are critical to inquire about the practices, the researchers and organizations need to ensure the breakdowns are minimal. To sum it up, the ubiquitous IT is becoming increasingly transparent, it is only when it breaks down that we find how deeply entwined we are with it in our everyday practices [10, p. 188ff, 15, p. 282, 303].

Conclusion

We have suggested the entwinement lens as a significant theoretical and practical tool to study the shifting ways of engaging with technology. Contrary to the prevailing perspectives grounded in scientific rationality of practices, we offer an absorbed perspective to interpret the practical phenomena from within contemporary everyday practices using the practical rationality of entwinement. In this way, IS researchers can critically examine the everyday practices by stepping in rather than stepping out of the practices. The entwinement perspective thus invites field researchers to be closer to field practices. Some researchers in parallel disciplines of organizing and management studies have begun to investigate entwinement in more depth, specifically in terms of practice breakdowns [START_REF] Lok | On the Plasticity of Institutions: Containing and Restoring Practice Breakdowns at the Cambridge University Boat Club[END_REF] and sense making within organizations [START_REF] Holt | Phenomenology and Organization Theory[END_REF][START_REF] Sandberg | Returning to Practice Anew: A Life-World Perspective[END_REF]. A fruitful avenue for IS researchers is to inquire the said strands in the context of technological practices. For instance, insofar as the practical rationality of entwinement discloses a play like dialectic, how can we further understand the complex spatiotemporal dynamics of such dialectic in organizing practices? Another possible way is to shed light on the significance of entwinement in skill acquisition vis-à-vis engagement with equipment through practical rationality. Thus, we find the entwinement logic of practices potentially opens up new avenues for IS scholars and practitioners alike and creates possibilities to conconceptualize and theorize complex everyday practices in a coherent manner.

Fig. 1 .

 1 Fig. 1. Entwinement logic of technological practices

  Tom listened to the many critical conversations, regarding the proposed change in established technological practices, and then demonstrated, on a large screen, how intuitive the new changes were. Contrary to the claim of some users, his point was that many people are simply sticking to 'the decade old technological practices'. This is what he said:We are in the future, people… And have you ever noticed [that with] the technology… you can do some amazing things, like stream in real time [etc.] but people don't get excited because they are used to it and they just expect it to work so if anything [referring to GebWeb soft-

ware] stop working, people [complain]: 'ah, typical technology, not working anymore' (smiles). (Excerpt from the usergroup meeting)

  If something is new … like a new game … do you think about it when you play it? No, you don't. You just play it. Same thing is for technologies, like [social networks], it's just there. I give it a try, see if I like it or not. Most of things, well, you don't know whether you like it or not unless you try. So, just use it. (Excerpt from the interview)


Hamish Robertson
email: h.robertson@neura.edu.au

Nick Nicholas

Tuly Rosenfeld

Joanne F Travaglia
email: j.travaglia@unsw.edu.au

Materiality, Health Informatics and the Limits of Knowledge Production

Keywords: knowledge production, health informatics, critical analysis, materiality

Contemporary societies increasingly rely on complex and sophisticated information systems for a wide variety of tasks and, ultimately, knowledge about the world in which we live. Those systems are central to the kinds of problems our systems and sub-systems face such as health and medical diagnosis, treatment and care. While health information systems represent a continuously expanding field of knowledge production, we suggest that they carry forward significant limitations, particularly in their claims to represent human beings as living creatures and in their capacity to critically reflect on the social, cultural and political origins of many forms of data 'representation'. In this paper we take these ideas and explore them in relation to the way we see healthcare information systems currently functioning. We offer some examples from our own experience in healthcare settings to illustrate how unexamined ideas about individuals, groups and social categories of people continue to influence health information systems and practices as well as their resulting knowledge production. We suggest some ideas for better understanding how and why this still happens and look to a future where the reflexivity of healthcare administration, the healthcare professions and the information sciences might better engage with these issues. There is no denying the role of health informatics in contemporary healthcare systems but their capacity to represent people in those datascapes has a long way to go if the categories they use to describe and analyse human beings are to produce meaningful knowledge about the social world and not simply to replicate past ideologies of those same categories.

Introduction

In this paper we argue that while the conceptual distinction data-informationknowledge (and wisdom) [START_REF] Rowley | The Wisdom Hierarchy: Representations Of the DIKW Hierarchy[END_REF] is ubiquitous in the information sciences, is remains, poorly understood and actualized in some informatics sub-fields, and in particular in health informatics. We then consider how the political economy of new technology can be taken for granted or unexamined in ways which serve to naturalise the 'inevitability' of technological innovations [START_REF] Breen | Information Does Not Equal Knowledge: Theorizing the Political Economy of Virtuality[END_REF]. We show how the teleological orientation of the health sciences, as a seemingly dominant secular mythology of progress and virtue is in actuality compromised by the carrying forward of some questionable intellectual constructions (including concepts, ideas and ideologies) and the failure to integrate other emergent information science constructions that are prevalent outside of health informatics. We go on to explore number of specific examples of a problematic aspect of health informatics as a site of skewed knowledge(s) about human beings as individuals and as social beings as well as loci of illness and disease. These examples demonstrate the persistence of deeply ideological social constructions reproduced through the: taxonomies of database structures applied in health informatics (with an absence of sustained critical inquiry on the same); highly reductive nature of what passes for patient information in many of these systems and: data exclusions that can occur in establishing and maintaining such systems.

Leaving aside important questions of political and organizational motivations in the particular, we focus primarily on the structuration of data inputs to information systems and especially health information systems with their materialist consequences for knowledge production, in general, utilizing case studies such as the 'hot spotting' of vulnerable groups. Taxonomic structures and classificatory systems about human beings are deeply implicated in the support and reproduction of historical social hierarchies and inequalities, by creating the illusio of 'objective scientific' (that is, empirical and therefore by implication or assertion ideological neutral) discussions of social divisions such as class, socio-economic status, 'race' and the like [START_REF] Bourdieu | Distinction: A Social Critique Of the Judgement of Taste[END_REF][START_REF] Bourdieu | An Invitation to Reflexive Sociology[END_REF]. We discuss some examples of why and how this happens as well as the ways in which this limits (and delimits) the boundaries of scientific practice in the health informatics domain. The central relationship between theory and practice is also key aspect of this discussion. The issue of not asking certain types of questions or failing to analyze particular kinds of data we leave for a later discussion.

Lastly, we propose that to make claims to the production of scientific knowledge, including medical scientific knowledge, requires that practitioners meet certain standards of practice in their work. We question whether a technical domain making claims to scientific status and scientific knowledge production should exhibit a greater reflexivity in relation to its implications and application to social issues than is currently exhibited in health informatics. Disciplinary integrity requires a science to do more than simply produce the established knowledge architectures and to inquire more actively on the inclusions and exclusions practiced within the sub-disciplines that the discipline supports. The information sciences have shown significant activity in this area as their methods and theories have expanded in recent decades but, we maintain, this remains a poorly developed aspect of health informatics which remain largely subordinate to, particularly, medicine as the dominant knowledge production and authorizing paradigm in the health sciences generally.

Informatics as Social Scientific Practice

The pervasiveness of information systems and their role in complex scientific and social policy and practice often begs the question of how they are constituted and used in relation to their objects of study. This is especially relevant in the context of the collection of data and information about human beings where the study of humans is, usually by omission, assumed to be as developed as those which are applied to the collection of physical phenomena.

Information systems are designed and developed to collect, structure and analyze data and information to produce domain-specific knowledge, through the application of sets of formal methods and processes including ontologies, classificatory schemata and information taxonomies [START_REF] Bowker | Sorting Things Out: Classification and Its Consequences[END_REF]. Their essential purpose is not simply or solely the neutral collection of administrative or research data but rather the production of knowledge (that is actionable, meaningful data and information) [START_REF] Bhatt | Knowledge Management in Organizations: Examining the Interaction between Technologies, Techniques, and People[END_REF] about some aspect of the world.

Information systems are designed to produce a relatively discrete epistemic domain which informs their audience about some selective aspects of the human and/or natural worlds (meaning philosophical ontology not information ontology in this context). Yet many such systems default to the collection aspect, some to the analysis aspect, and a far lesser proportion to the explicit production of knowledge, in spite of claims to the contrary.

These collection processes range widely from project briefs and business cases on through to interoperability criteria and data sharing protocols. This is a continuously expanding field because the technology, its applications and its users are all in a seemingly un-ending state of development, production and innovation. Growth and diversification are central features of the information sciences in the digital information age [START_REF] Negroponte | Being Digital[END_REF]. Recent developments have led to the 'big data' construct in which the growth in data is characterized by volume, variety, velocity, veracity, variability and value [START_REF] Ahalt | Data Science and the NCDS: Putting North Carolina First in Data through the National Consortium for Data Science[END_REF][START_REF] Bellini | Tassonomy and Review of Big Data Solutions Navigation[END_REF]. The big data construct currently emphasizes the process or processes associated with the acquisition of data, rarely exposing information structures themselves or the processes associated with the collection or classification of such data. This acts we argue, to create what Bourdieu calls an illusio [START_REF] Bourdieu | An Invitation to Reflexive Sociology[END_REF], that is an implicit belief in the value of the data collection process, and at the same time, to hide (through the creation of 'doxa' or taken for granted-ness) [START_REF] Bourdieu | An Invitation to Reflexive Sociology[END_REF] the socially influenced development of the methods themselves: including how data and information are collected; how terms and terminologies are defined; the choice to include or exclude particular information; which individuals, groups or populations are included or excluded in any given collection; and even how data are 'cleaned' [START_REF] Nagel | The View from Nowhere[END_REF][START_REF] Haraway | Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective[END_REF][START_REF] Galison | Objectivity. Zone Books[END_REF][START_REF] Boyd | Critical Questions for Big Data[END_REF][START_REF] Gitelman | Raw Data Is an Oxymoron[END_REF].

Key to any collection process are the decisions made to exclude or include certain kinds of data. This can be seen in some cases, as a mechanism through which there is an acceptance or rejection of the prima facie legitimacy of certain kinds of information. Even the generic claim in the research and information sciences to be collecting 'raw' data can be seen as highly problematic and contestable. As Gitelman argues in the aptly titled Raw Data is an Oxymoron [14, p. 3], "Data need to be imagined as data, to exist and function as such, and the imagination of data entails an interpretive base". All data collection processes are predicated on specific disciplinary and institutional reasoning and constraints, including two of the most common -cost (How much can we afford to collect? Whom can we afford to include in the collection) and belief (What data are important to collect?). This is usually represented as an objective, rationalistic process that produces data uncontaminated by the collectors' and their commission institutions practices and beliefs. Yet such processes necessitate an explicit or implicit rationale for the inclusion and exclusion of certain data or information from the initial development of design through to the final analysis processes.

The other side of this equation, as noted above, is the large amounts of data and information that are not collected at all. No information system, or its producers, is so naïve as to suggest they collect everything. The capacity to collect data is finite even if the potential data domain or sub-domain is seemingly infinite. Exclusions are necessary and even data collected via remote or mediated technical systems automatically exclude the majority of the available information, as information systems are themselves finite [START_REF] Gleick | The Information: A History[END_REF] and as indeed are human perceptual and analytical capacities [START_REF] Duncan | Affect is a Form of Cognition: A Neurobiological Analysis[END_REF]. The point here is not that some data or information will need to be excluded, but that the way in which this exclusion is consistent with the historical and persistent exclusion of minority groups, including women, in research studies [START_REF]Nature: Putting Gender on the Agenda[END_REF][START_REF] Cherubini | The Persistent Exclusion of Older Patients from Ongoing Clinical Trials Regarding Heart Failure[END_REF] and from big data environments, such as national censuses, all the way down to the level of the inclusion or exclusion of specific "non-human" participants [START_REF] Guthrie | Even the Rat Was White: A Historical View of Psychology[END_REF][START_REF] Beery | Sex Bias in Neuroscience and Biomedical Research[END_REF] and the researchers themselves [START_REF] Guthrie | Even the Rat Was White: A Historical View of Psychology[END_REF].

The largely unproblematized illusio that big data does or will somehow by-pass this social, systematic and systemic flaw by the sheer amount of data collected, remains a dominant feature of its value, and virtue, claims. Big data analysis relies on the same systems that systematically exclude certain types of data or individuals, for example census data, where definitions of ethnicity, have been shaped, accepted or rejected according to the power relations within and across countries at any given point in time [START_REF] Saperstein | Capturing Complexity in the United States: Which Aspects of Race Matter and When?[END_REF][START_REF] Simon | Collecting Ethnic Statistics in Europe: A Review[END_REF][START_REF] Simon | Accounting for Ethnic and Racial Diversity: The Challenge of Enumeration[END_REF]. In this sense, the production of data can be understood as a form of practice, in the Bourdesian sense, that is a dialectic between the social structures and systems within which data are generated and collected and the human and organizational agency which determines what should deemed data, and which data are worthy of capturing and preserving [START_REF] Bourdieu | Outline of a Theory of Practice[END_REF][START_REF] Bourdieu | The Logic of Practice[END_REF].

Many data collection systems have been limited by the state of technology available at any specific point in time, this is understandable. But more problematic has been the tendency to ignore aspects of the wider ontological domain in order to validate existing technologies. This can have the effect of constraining epistemic frameworks to what can be physically captured and analyzed. Thus broad physical and social science questions can be delimited by the physical and conceptual tools currently available. In this sense, technical systems (in both the ontological and epistemological sense) can constrain or narrow the growth of knowledge because the investment in their explanatory power requires that their very real limitations are minimized in discourse about them [START_REF] Bourdieu | Is a Disinterested Act Possible?[END_REF].

Problematizing Health Informatics

Health information systems tend to support two major knowledge production domains. The first is clinical practice and its associated sub-domains including pathology, pharmacology, radiography and so on. The second is characterized by the administrative data required by funders, including governments and insurers, usually central to administrative practices such as financial reporting and, in association with classification systems, some data about patients (often summary demographics) and their conditions utilizing the International Classification of Disease and a variety of related taxonomies [START_REF]Centers for Disease Control and Prevention: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)[END_REF].

However, it is reasonable to suggest that patients are not the primary focus of either of these systems and that this might be one reason why the reform of patient information systems, including the development of electronic health records and portable patient records, have proven so problematic in practice. On one side, clinicians may feel that they 'own' their data systems and the information in them while on the other, funders and regulators feel that they own their side of the informatics equation [28: see both article and correspondence]. Since neither party sees patient information as especially central, the idea of divesting any aspect of that ownership (and its attendant organizational authority) is viewed poorly by both parties.

In health informatics this problem is compounded by a number of factors. Health informatics focuses on the applied aspects of clinical and administrative information work, at times shying away from the theoretical as though tacitly accepting the idea that knowledge production does not necessarily, implicitly or explicitly, involve theory [START_REF] Barnes | Scientific Knowledge and Sociological Theory[END_REF]. As a result, such work can be presented as though the researchers have or take no position on the social and political issues that any health system produces and reproduces in its work [START_REF] Anderson | Teaching 'Race' at Medical School Social Scientists on the Margin[END_REF][START_REF] Krieger | Who and What Is a "Population"? Historical Debates, Current Controversies, and Implications for Understanding "Population Health" and Rectifying Health Inequities[END_REF].

At the same time, health systems take social categories to be as materially real and concrete as the categories used for biological and physiological phenomena, pathological indicators, diagnoses and so on. In other words, there is a deep commitment to the materiality of data that supports existing knowledge structures and ideological positions on the nature of knowledge and its importance in the clinical and administrative aspects of health systems and health informatics.

This commitment to counting and collecting is partly a result of the deeply social role of medicine and nursing since their development as central activities in healthcare, mostly developing in the nineteenth century during the emergence of the modern territorial nation state [START_REF] Carroll | Medical Police and the History of Public Health[END_REF][START_REF] Elden | The Birth of Territory[END_REF]. Public health systems and health insurance schemes were built in part to support the concept of the nation as a healthy body and this conceptualization of the nation as a singular entity, containing a structured arrangement of multiples, emerged at the same time as scientific racism and eugenics, producing an interlinking of these concepts that persist down to the present day [START_REF] Anderson | One 'Body/Nation': Pathology and Cultural Citizenship in Australia[END_REF][START_REF] Weiss | Non-Darwinian Estimation: My Ancestors, My Genes' Ancestors[END_REF]. The result can be a blurring of the significance of the embodiment of difference between the cytokine count in a biopsy as an indicator of the presence of cancer or the formal and informal use of socio-historical categories of "personhood", and the status of such persons, and the lived experience of the individuals involved [START_REF] Skloot | The Immortal Life of Henrietta Lacks[END_REF].

Missing the Meaningful: Place, Space and the Current Limits of Health Informatics

If, as argued here, health information systems tend to be controlled by the dominant medical perspective then it seems fair to suggest that the knowledge such systems can (be permitted to) produce is likely to be 'approved of', that is accepted as doxa, by medicine. Thus there is already a central aspect to the way in which health information systems are involved in a process of co-production. They legitimate and reinforce the kind of data, information and knowledge that medicine as a discipline finds acceptable. Knowledge that falls outside of these established and often conservative parameters is much less likely to impinge on this dominant paradigm [START_REF] Illich | Medical Nemesis: The Expropriation of Health[END_REF].

There is already an awareness that the focus of many health information systems is not about people as individual human beings. Indeed as Simpson and Novak have observed even Electronic Health Records (EHRs) collect comparatively little data about the broader social and economic context of patent's lives, much of which would be relevant to their potential illnesses, treatment and possible cure [START_REF] Simpson | Place Matters: The Problems and Possibilities of Spatial Data in Electronic Health Records[END_REF].

The micro focus of clinical medicine is poor at integrating the broader social epidemiological context of patients' lives that often impacts directly on their health status. The recent work of Jeffrey Brenner in Camden, New Jersey is an example of how complex systems can collect patient data, such as address, and fail to use it in any clinically meaningful way. Brenner, an emergency department doctor, spent his evenings developing a spreadsheet of his department's 'superutilizers'. He was able to show very quickly that a very high proportion of people with chronic health conditions, low incomes and limited health insurance were all co-located in one public housing building in Camden. Their emergency department visits were far above the average, costing the health system itself considerable amounts of money and leading to a cycle of ill-health for the patients who always sought treatment late in their acute episodes. As a result of identifying this single, ubiquitous fact -the patients' address -he was able to target local interventions which limited or even prevented the need for and use of expensive emergency services and which have resulted in significant reductions in utilization [START_REF] Gawande | The Hot Spotters: Can We Lower Medical Costs by Giving the Neediest Patients Better Care?[END_REF] and improvements in morbidity. 1While the idea that location is important to health has most recently been packaged around the idea of 'hot spotting', it is well known and understood across many disciplines, including medicine, public health and geography. John Snow's famous 1854 cholera map is, in effect, an exercise in medical and public health 'hot spotting' [START_REF] Snow | On the Mode of Communication of Cholera[END_REF]. Yet what the hot spotting study (and the media coverage and funding attention it has attracted) shows is that while the general importance of location may be understood, and locational data routinely and systematically collected from patients, the analysis and application of even the most basic quotidian data was dependent not on information systems but on curious and committed individuals who went beyond the information system as it stood.

The failure to integrate and act on broader contextual information about a patient's (or class of patients) social environment is clearly still an issue for health systems and many of the health professions. Even those health professionals who have the opportunity observe the lived environments of patients such as occupational therapists and community geriatricians, have a limited capacity to collect and apply social information to the bigger picture. The information systems used for acute care systems and community health systems, for example, do not always interact well or even at all. Data collected about medical errors (including errors of omission where patients do not obtain the care required in a timely and appropriate fashion) do not routinely include fields for patients' identity or language spoken. The various emphases of these information silo systems are only rarely what could be called a 'system' in the usual formal sense of the idea. Rather, the complex historical development of such systems, often disconnected and serving the very different needs of very different users, can have little at all to do with lived experience of patients.

One final aspect emerges in the information science domain from this lack of understanding of and capacity to apply locational or place inference in the clinical and administrative domains. The many sciences that currently work with locational information and analysis as central to their activities all emerged at about the same time as medical informatics. They are all largely a result of advances in computational information science that took place during and shortly after the Second World War. The combination of computational science, aerial surveillance and navigational telemetry required for military rockets to travel from one place to another all developed in the same window as medical informatics.

The potential knowledge development associated with the spatial and locational aspects of health that could have occurred did not take emerge, and health and medical geography remain entirely marginal to work conducted in mainstream healthcare and health information systems. Despite these silos the development of geographic information science, including both theory and computer-software approaches, emerged in the 1960's and has gained momentum in recent years as digital technologies have developed and expanded. Goodchild felt that the field had developed sufficiently well to warrant the term 'geographical information science' which took the field beyond the hardware-software computer system nexus to one of specific types of knowledge production [START_REF] Goodchild | Geographical Information Science[END_REF]. In the last decade or so, the emergence of 'virtual earth' software environments such as Google Earth have made the integration of spatial coordinates, of varying levels of precision, a much more viable possibility that at any time previously. Soon we are likely to see the expansion of the concept of 'place-based' knowledge in a variety of sciences and yet the question remains as to what extent this will reflected in healthcare where place has, for so long, had no place [START_REF] Fisher | Place-Based Knowledge in the Digital Age[END_REF].

In the previous sections we have alluded to the way in which the processes of collecting, categorizing and utilizing data is directly influenced by the limits within, placed on, and utilized by, the field of health informatics. One of the issues with current knowledge production is the way in which the field has recently emerged from the basic forms of linking up and bundling together of a variety of clinical and administrative information systems within medicine and healthcare management [START_REF] Vest | Health Information Exchange: Persistent Challenges and New Strategies[END_REF]. Yet, the very definition of the broader (not just medicine) field of health informatics often defaults to a form of medical informatics due to dominance clinically, and more specifically medically, trained personnel in health information management in this field [START_REF] Flynn | Clinical Governance and Governmentality[END_REF][START_REF] Flynn | Structures of Control in Health Management[END_REF].

The convergence of medicine and information technology has a long history of problematic results with many systems experiencing failures in both the development and implementation phases with a variety of clinical and other consequences [START_REF]JCAHO): Safely Implementing Health Information and Converging Technologies[END_REF][START_REF] Goodman | Challenges in Ethics, Safety, Best Practices, and Oversight Regarding HIT Vendors, their Customers, and Patients: A Report of an AMIA Special Task Force[END_REF].

An example of how health informatics can lag behind external developments can be seen in the (to date) limited incorporation of the dimension (and theory) of space within health information systems in particular and health information analysis more generally. Geographic information science and technology have developed rapidly since their emergence in the 1960's. Many sciences make active use of GIS and related software and methods in their work as can be seen from archaeology and anthropology to climate science [START_REF] Kosiba | Mapping the Political Landscape: Toward a GIS Analysis of Environmental and Social Difference[END_REF].

The material world that scientific practices aim to understand and explain is multidimensional including three-dimensional (x, y, z) space, temporality (t) and scalar issues as a fifth dimension as can be seen with any map or time series map [START_REF] Goodchild | Twenty Years of Progress: GIScience in 2010[END_REF]. The twodimensional file requires a huge range of reductionist processes to make that material world conform to traditional information architectures but this process of reducing or even deleting complexity to fit current technologies means that some changes in the field are passing some disciplines by. Indeed, we would argue, reduction as representation is integral to much of what passes for knowledge production across a variety of disciplines.

In the health information sciences the spatial dimension is a fringe area of interest. Many health information systems do not collect useful spatial data or index patient information in analytically useful ways. The developments of spatial sciences are poorly incorporated into health informatics and yet health information systems are increasingly extending outside their traditional domain of the acute care hospital, through the emergence of tele-health, m-health and e-health. These new fields reflect the controlled extension of health informatics via the acceptance and incorporation of certain, selective, aspects of rapidly developing technologies associated with increasing bandwidths, mobile devices and remotely accessible database environments via the cloud. Most of these technologies are highly enabled spatially (e.g. GPS, RFID etc) and many uses have been found in other industries for these spatial capabilities. The potential of space and place factors are on the rise in health informatics but that the a-spatial construction of health informatics around the hospital environment means that the incorporation of spatial thinking is remains limited.

The Power of Taxonomies and Categories in Knowledge Production

The creation and collection of data, information and knowledge occurs, as we have previously discussed, through the use of material and conceptual technologies. One such technology is the use of taxonomies and categories. Bowker and Star have argued that taxonomic systems can have a deep and abiding influence on how we produce accepted knowledge about the world and that the values we attach to concepts constructed and represented through such taxonomic processes [START_REF] Bowker | Sorting Things Out: Classification and Its Consequences[END_REF]. The application of taxonomic processes to human beings can have both a reductive and productive aspect, in that self-definition can be deeply influenced by the social definitions that are supported by the purportedly objective taxonomies of the sciences. Classification is clearly part of how humans function cognitively as human beings. But classification also has its own consequences in that, especially since the 19th century, the elision between scientific and social taxonomies has become difficult to separate and people have become used to, and some would argue indoctrinated in, accepting the authority of science being applied to complex social phenomena without clearly distinguishing between the social and scientific domains [START_REF] Cohn | Colonialism and Its Forms Of Knowledge: The British in India[END_REF][START_REF] Richards | The Imperial Archive: Knowledge and the Fantasy of Empire[END_REF]. The pervasive nature of classification systems and taxonomies often possess an implicit moral hierarchy (poor health behaviours, bad lifestyle decisions, low health literacy, non-compliance) add scientific weight to socially ordered systems of surveillance and control [START_REF] Mayes | Is Nutritional Advocacy Morally Indigestible? A Critical Analysis of the Scientific and Ethical Implications of 'Healthy' Food Choice Discourse in Liberal Societies[END_REF][START_REF] Bacon | Weight Science: Evaluating the Evidence for a Paradigm Shift[END_REF].

Hacking offers an explanatory process for how this knowledge production process operates [START_REF] Hacking | Kinds of People: Moving Targets[END_REF]. First, specific processes permit the production of certain kinds of knowledge through 'engines of knowledge' which are, in order: count; quantify; norm; correlate; medicalize; biologize; geneticize; normalize; bureaucratize; and resist. The last of these is perhaps more indicative of efforts at countervailing knowledge production but, we would suggest, relies on the individual's capacity to recognize the application and power of these other engines in shaping not only how individuals are taught to think as individuals and as social creatures but also their ability to shape and delimit our environments, in Bourdieu's terms, their habitus [START_REF] Swartz | Culture and Power: The Sociology of Pierre Bourdieu[END_REF]. To identify a 'false consciousness' that requires resistance an individual or group needs to have an awareness that these are generated engines of knowledge and not objective data, information and knowledge about the material world.

Systems such as the International Classification of Diseases (ICD) [START_REF]Centers for Disease Control and Prevention: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)[END_REF] and the Diagnostic and Statistical Manual of Mental Disorders (DSM) [START_REF]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-5[END_REF] are two of the more highly recognised classificatory systems in use in the health sciences generally. Both of these experience considerable internal contestation and debate but this is often unclear to external observers who are used to accepting knowledge taxonomies as 'given' [START_REF] Cooper | What is Wrong with the DSM?[END_REF][START_REF] Sadler | Should Patients and Their Families Contribute to the DSM-V Process?[END_REF][START_REF] James | Health Policy Brief: Transitioning to ICD-10[END_REF]. The power of a successful classification process and taxonomic edifice can be seen in its unquestioned acceptance outside of the field of its production. This power has, as Hacking observed, the ability to produce new types of people, as well as to shape the way is such people are permitted to exist. There is a strongly normative dimension to the taxonomic process because it is a powerful form of knowledge production that has, once authorized, the capacity to reproduce, defend and extend itself.

Perhaps more important than this is the capacity for such systems to delimit the scope of further developments in their fields and to regulate and even police the boundaries of knowledge production. Hacking's first engine -that of counting, as we have shown, is neither automatic nor neutral, and the progression of data through subsequent engines, and their conversion from packets of 'facts', through contextualized information and actionable knowledge, to the point where they 'warrants' bureaucratization reflect wider social and power relations, and cannot be seen simply as a neutral or positive process of information gathering. By omission or commission, the transformation of data in health as in every other sector, has real and significant implications for those whom the data is meant ultimately, to represent.

Digital Materiality and the Production of Knowledge

One of the central identifying aspects of contemporary health informatics practice is the gradual expansion of digitally collected data within system that were historically wedded to the written document. Resistance to digitization has been strong is some parts of healthcare and data control is a central aspect of the shift to digitization in medical practice.

Patient safety information can be seen as another example of how information systems can be compromised by disciplinary politics and utilised to protect the interests of practitioners at the expense of those they were established to assist. The introduction of systems designed to collect information about mistakes, errors and failures in health systems has long been in development [START_REF] Beckmann | The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. The Development and Evaluation of an Incident Reporting System in Intensive Care[END_REF]. Even now, many of these systems are problematic because the definitions of harmful practice and harmful outcomes are still largely administered by those within the healthcare system and public involvement, while increasing, remains limited [START_REF] Vincent | Patient Safety: What About the Patient? Quality and Safety in[END_REF]. While they may encourage reporting, studies have found that small scale direct record review -rather than large scale reporting -is more accurate in identifying major errors [START_REF] Sari | Sensitivity of Routine System for Reporting Patient Safety Incidents in an NHS Hospital: Retrospective Patient Case Note Review[END_REF]. In addition, as previously mentioned, many of these systems take a technical perspective that minimizes the collection of data about the patient as a person and instead defaults to an emphasis on the collection of information about 'critical incidents' and the application of an associated terminology of risk. These systems can inadvertently minimize the materiality of the patient (and the clinicians) to whom errors occur and increase, preferentially, the nature and location of the 'incident' in a terminology that defines these events as failures of abstracted and over-arching systems rather than as the direct experiences of humans, and of particular groups.

This inward focus on the collection, classification and review of errors rather than of patients has led to a situation where ever more sophisticated technological systems continue to be based on simplistic conceptual schemata. By not including elements such as ethnicity or disability, these taxonomies ignore the social patterning of errors, which the scant evidence that is available shows, most closely resemble the social determinants of health [START_REF] Davis | Quality of Hospital Care For Maori Patients in New Zealand: Retrospective Cross-Sectional Assessment[END_REF][START_REF] Lawthers | Rethinking Quality in the Context of Persons with Disability[END_REF].

In part then we can see how the 'realness' or materiality of information is a strategic device in the activities where information systems are situated. The data is both 'raw' and 'real' -this validates the information system and the processes as well as the actual outcomes and their applications. The information experts position themselves as objective because this is a central strategy for professional legitimacy in the modern state and economy -professionals produce legitimate and authorizing knowledge. Consequently, it is a strategic process to ensure that the data supports the power of the system within which it is implemented and that it does not provide power, either by accident or purposively, to those outside of that system.

Making the Immaterial Real

The process of digitally producing, instantiating and regulating database taxonomies, categories and fields that rely on social constructs for their deployment has the effect of reifying these constructs. That is the process itself tends to make ephemeral phenomena that are stored in binary coding as real as the events the data claims to capture. In some cases, as we have seen with patient safety information systems, this process can make the data more real to the system than the person to whom the event happened. This has the effect of reducing the individual to the status of data and even, in some cases, less than the data, because so much of their materiality is left out of these digital systems. The reductive processes of classification and data capture leave so little of the individual left digitally speaking that their physical existence can easily be seen as less than that of the system in which their delimited details are held, in essence the digital ghost in these digital machines.

Even the claims made for digitizing individual genetic code still potentially reduce us to the quantified, numericised versions of the biological reality of genes and the bodies that those genes 'inhabit' [START_REF] Barnes | Genomes and What to Make of Them[END_REF]. Thus, except in the most deterministic sense possible, those representations are not us or ourselves but an instrumental and even preferable form of 'us'. Current debates and legal cases about data sharing, with or without consent [START_REF] Boyd | Critical Questions for Big Data: Provocations for a Cultural, Technological, and Scholarly Phenomenon[END_REF], in a variety of jurisdictions make this point very clearly -individuals don't own data about or from about themselves because political and economic systems have priority-making claims to both a higher moral purpose (usually couched as potential future benefits -teleology and transcendence in the one ambit claim) and to the benevolent representation of all of us over any single one of us who might choose to object [START_REF] Rouvroy | Human Genes and Neoliberal Governance: A Foucauldian Critique[END_REF].

Health care systems also make claims to expertise and that expertise supports their authority to act in various ways, often without the possibility of an engaged or informed (or any) response from those whose data is collected, categorised and indexed within these information systems. If we consider that expertise is at least partly informational (medical knowledge, risk knowledge, how the system works, available choices and the lack of them) then it is clear that healthcare information systems primarily support the existing power and authority of health care providers. Information is representational and, as noted above, refined and practiced forms of representation, however problematic on close inspection, can acquire a social life of their own. The equation of expertise authorizing specific systems of representation is an instrument of power in its own right. This links health information systems to Foucault's key concepts of governmentality and biopower through the regulatory frameworks and self-regulation that 'expertise' manufactures and which experts manage [START_REF] Foucault | The Birth of the Clinic: An Archeology of Medical Perception[END_REF][START_REF] Foucault | The Birth of Biopolitics: Lectures at the Collège de France, 1978-1979[END_REF]. In other words, health information systems are a central enactment of this regulatory process which discursively enables self-regulation by manufacturing the limited number of legitimate categories a person and their identity can be permitted to have within such information systems.

Foucault also discussed very early in his writing the importance of space as an avenue for governmentality including the shifting role of the hospital and its organisation of space [START_REF] Foucault | Security, Territory, Population: Lectures at the Collège de France[END_REF]. Elden has taken this idea and developed it in relation to the concept of territory. He suggests that territory need not be physical but instead can be entirely conceptual so long as it is understood as existing in the minds of those who believe in its existence [START_REF] Elden | Plague, Panopticon[END_REF]. This can be seen in the nature of maps representing different claims to the same physical space, expressed as territory. In this sense, the hospital can be seen as a territorial space claimed by medical and nursing personnel on the one side and political, managerial and administrative personnel on the other. The development of the hospital as a physical architecture of knowledge can be seen not only in Foucault's analysis but in the geographical work of Livingstone [START_REF] Livingstone | Putting Science in Its Place: Geographies of Scientific Knowledge[END_REF].

Based on this contruction we can begin to think of health information systems as virtual spaces, even territories, of governmentality. The obsession with governments in tracking all forms of electronic communication in their efforts to ensure a 'secure' state illustrates how easily an information domain becomes an exercise in total governance through the constitution of a digital territory or set of territories.

Informational Biopolitics

Biomedical informatics has been an 'emerging field' for decades [START_REF] Bernstam | What Is Biomedical Informatics?[END_REF]. The concept of biopolitics has a history going back at least to the 1920s and the work of Rudolf Kjellén, with some suggestion that it can be effectively situated in the work of Schopenhauer, Nietzsche and Bergson [START_REF] Lemke | Biopolitics: An Advanced Introduction[END_REF]. Its current formulation emerged mainly from Michel Foucault's work in the mid-1970s [START_REF] Foucault | Society Must Be Defended: Lectures at the Collège de France[END_REF]. Illich's Medical Nemesis emerged at about the same time indicating that philosophy and sociology were beginning to take a serious interest in knowledge production within medicine in particular [START_REF] Illich | Medical Nemesis: The Expropriation of Health[END_REF]. Even McKeown's somewhat older argument about the role played by medicine in human health improvements can be seen as sitting within a cultural discussion about what claims can be made by a discipline to self-represent and actively promote its contribution to societal improvements and the knowledge that supports those claims [START_REF] Mckeown | The Role of Medicine: Dream, Mirage or Nemesis[END_REF][START_REF] Colgrove | The McKeown Thesis: A Historical Controversy and Its Enduring Influence[END_REF]. More recently the notion of 'incidentalomas' has entered the health environment. The term refers to tumors located incidentally through the application of highly detailed scanning technologies. This is part of a broader field of incidental findings understood to exist in medical research and practice, one which research projects have had to accommodate by including provisions for them in various clinical screening activities and the like [START_REF] Ballantyne | To Know or Not to Know[END_REF][START_REF] Wolf | The Law of Incidental Findings in Human Subjects Research: Establishing Researchers' Duties[END_REF]. The procedures identify these 'incidental' tumors while looking for other, suspected, diagnostic features. These tumors often have no clinical symptoms or suspicious characteristics and, as a consequence, there is a growing awareness that new technologies identify phenomena not currently implicated in the pathology of an existing or suspected disease state. Acting surgically on some of these, such as aneurisms, can be almost or even as risky as the potential clinical threat that their presence might lead to at some future point. Advances in scientific and medical technologies, invariably information-based, can produce their own clinical sequelae. They are assumed to be risks because they are imaged as such and our systems and people have been conditioned to act on observable risks even when the consequences are distant in time and potential effect.

Social Hegemony and Information

Information theory is generally accepted as having social and political implications in most if not all of its implementational aspects [START_REF] Laudon | Management Information Systems: International Edition[END_REF]. There is therefore an understanding that information systems produce particular types of knowledge that are then acted on in specific ways, both good and bad, in societal contexts. Even if the knowledge produced through information science were entirely 'objective', the uses to which that knowledge is often put cannot be seen in the same light. Discussions about data security and access rights are one aspect of this discussion but representational issues are another under-explored aspect of the information sciences. Information collection about society and the groups and individuals who constitute society benefited enormously from the development of demography and statistics. The kind of conceptual and taxonomic abstraction required to understand complex social processes only began to take on our 'modern' idea of a scientific activity in the Victorian era. It was then that statistical surveys of the people within nation states began to gain momentum. Prior to this a major difficulty had been to actually map the state cartographically but now with statistical survey instruments, the whole population could be 'captured' as data even in contexts where the definition of what a population actually is have not been resolved [START_REF] Krieger | Who and What Is a "Population"? Historical Debates, Current Controversies, and Implications for Understanding "Population Health" and Rectifying Health Inequities[END_REF]. This required the development of categories and implicitly social taxonomic systems to analyze the information in those categories.

The problem with these categories is that they move beyond mere representation to become the populations they are used to represent in information systems that cannot by their very nature cope with the complexity of individual human beings. Hacking's people-producing processes also find any kind of nuanced difference difficult to deal with and the categories represented by field names in databases take on a normative character of their own [START_REF] Haraway | Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective[END_REF]. There is, across the many disciplines that produce these kinds of knowledge, a cultural dimension that reflects the specific preferences and imbedded understandings of how data is collected, what information is produced and analyzed, and lastly the acceptable representations of those knowledge production processes [START_REF] Knorr Cetina | Epistemic Cultures: How the Sciences Make Knowledge[END_REF].

Information collection has moved far beyond this analogical and descriptive approach to a digitally enabled environment in which there are claims that it will be possible to understand the whole of the material world [START_REF] Breen | Information Does Not Equal Knowledge: Theorizing the Political Economy of Virtuality[END_REF]. One of those claims is that 'data' will ultimately explain both 'society' in the abstract sense and also the actual societies in which we live.

Allied to this is a level of digital surveillance never previously possible and which operates across the entire field of human engagements from government and commerce, through to data collection about individuals' behaviors, habits and beliefs. Marketing and managerial practice are data-informed and those same practices are being gradually incorporated into healthcare including medical practice and health administration. In all these activities there is a claim that 'patients' and 'consumers' (yet again abstract categories claiming to represent real people) will benefit both directly and indirectly from this information collection and analysis. The language of risk, quality, value and choice is pervasive as a rationale for continuous change even in systems where we may not have, as citizen consumers, indicated any specific dissatisfaction with the status quo. Consequently, discourses of risk and quality are employed as strategies for systemic change by corporations and governments whose intention is change regardless of consumer and citizen opinion. The manufacture of informational concepts, which risk and quality have become regardless of their historical origins, makes them instruments for the manipulation of systems claimed to be representative and collaborative. Being able to reposition the meaning of terms and use those same terms as justifications for policy changes within societies makes them highly useful as political strategies. Coole has discussed how these processes work in relation to the shift in aged care policy and political discourse. The increase in data capture about older people may contribute very little to the betterment of older people [START_REF] Coole | Reconstructing the Elderly: A Critical Analysis of Pensions and Population Policies in an Era of Demographic Ageing[END_REF].

Conclusion

In this paper we have sought to explore in a brief and general way in this paper is how information systems are instruments of biopolitical practice and that they influence the social environment by legitimizing some aspects of our material reality and de-legitimizing or even deleting other possibilities for human identity. The nature of information, its collection, analysis and representation within society is not an abstract and objective process but a deeply politically engaged activity. Indeed, the various knowledge claims associated with information including 'raw' data, data objectivity and analytical neutrality as being an ideological representation and a claim for authority which has significant social effects.

As a result, we suggest, information systems and their associated practices which purport to be doing 'objectivity work', are engaged in an often a-theoretical form of political practice. The failure to acknowledge or understand the way data is constituted and becomes information within and across a variety of scientific and social scientific sub-cultures is an epistemic failure in its own right. To make claims about producing legitimate knowledge requires of the producer an informed understanding of what knowledge is, how it is produced and where it comes from. The deeper history of the conceptual primitives apparent in health informatics and the information sciences more broadly need to be subject to scrutiny of this type. The moralizing discourse so prevalent in healthcare and health policy (the selfish 'bed blocking' elderly, the lazy obese, the uncaring mothers, the willful smokers, the ungrateful disabled etc) is so assuredly political in its conception and deployment that there is a risk of intellectual dishonesty in ignoring these links.

The information sciences need to be critically informed and engaged. Some already are, including library science and geographic information science. There needs to be a move from a utilitarian viewpoint which claims to be driven by practical aims serving practical outcomes to a more nuanced inquiry on its own practices, underpinnings and assumptions. The nature of health information science must engage with the power of its political positioning and the influence it has on knowledge and understanding once it is produced and acted on as evidential and true.

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