| 1. |
- Aminoff, Hedvig, et al.
(författare)
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Context and Complexity in Telemedicine Evaluation : Work Domain Analysis in a Surgical Setting
- 2021
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Ingår i: JMIR Perioperative Medicine. - : JMIR Publications Inc.. - 2561-9128. ; 4:2, s. e26580-e26580
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Tidskriftsartikel (refereegranskat)abstract
- Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about howto best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growinginterest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation.This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key tounderstanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where atelemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modelingcan provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings.
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| 2. |
- Aminoff, Hedvig, et al.
(författare)
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Modeling the implementation context of a telemedicine service: Work domain analysis in a surgical setting
- 2021
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Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals.Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service.Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative “discovery and modeling” approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened.Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure.Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment.
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| 3. |
- Aminoff, Hedvig, et al.
(författare)
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Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography : Mixed Methods Study of Practitioner Attitudes
- 2021
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Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption.OBJECTIVE: Our objective was to gain a deeper understanding of ERCP practitioners' attitudes toward teleguidance. These findings could inform the implementation process and future evaluations.METHODS: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons' beliefs about teleguidance's contribution to performance and factors that might interact with implementation.RESULTS: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard "Ease of Use" items for "Compatibility and Implementation Climate." In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05).CONCLUSIONS: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes.
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| 4. |
- Aminoff, Hedvig, et al.
(författare)
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Understanding Coordination in Emergency Response
- 2007
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Ingår i: European Annual Conference on Human Decision-Making and Manual Control,2007. - Lyngby, Denmark : Technical University of Denmark.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This paper describes and discusses analysis of an emergency management exercise. In the exercise scenario, different emergency management organizations jointly try to cope with a forest fire and related incidents. The Extended Control Model is utilized for examination of the establishment of en emergent emergency response organization. Ambiguity in how functions are to be handled in a large event, indicating vulnerabilities in face of larger crises; functions moving across roles during the evolving event; and recognizable phases of a response are uncovered. This is assessed by utilizing episodic analysis of the communication between different functions and roles in the participating emergency management organizations. The results indicate requirements for future information and communication technologies, and occurrences that can be explored in future studies.
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| 5. |
- Aminoff, Hedvig
(författare)
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Unpacking the Sociotechnical Complexity of a Surgical Setting : Capturing the Context of Use to Inform Design and Evaluation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on how the implementation context for a surgical telementoringservice can be understood as a complex, adaptive sociotechnical system.Teleguidance was a service for remote surgical consultation in Endoscopic RetrogradeCholangiopancreatography (ERCP), a highly specialized clinical procedure.The solution had been developed in a participatory design setting andhad also been successfully trialed in a pilot study. It was to be deployed atfour additional hospitals, but differences between the implementation contextswould make it challenging to understand clinical outcomes, and could also affectmatters such as adoption.This thesis includes four papers which converge on user needs and the sociotechnicalimplementation context for teleguidance. The aim was to demonstratehow a sociotechnical systems oriented approach could be used to identifyfactors that could interact with the implementation. The first paper describesan investigation of attitudes and expectations among end-users and other stakeholders.The second paper shows how modelling the sociotechnical work systemmade it possible to investigate and proactively identify issues that might influenceimplementation and adoption. The third paper explicates methodologicalaspects of modeling the domain. The fourth paper describes a study designed tocapture early reactions to working with the system. Seen together, the researchrepresents a design science approach, that proposes that the implementationcontext can be viewed as a complex, adaptive system, and provides examplesthat show how focusing on user and stakeholder needs and wider context ofuse is a viable approach for supporting the implementation and evaluation oftelemedicine systems in complex settings.
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| 6. |
- Aminoff, Hedvig, et al.
(författare)
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User Experience in Remote Surgical Consultation : Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service
- 2021
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Ingår i: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- Background:Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood.Objective:We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures.Methods:We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures.Results:In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%).Conclusions:Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes.
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| 7. |
- Frennert, Susanne, et al.
(författare)
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Technological Frames and Care Robots in Eldercare
- 2020
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Ingår i: International Journal of Social Robotics. - : Springer. - 1875-4791 .- 1875-4805.
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Tidskriftsartikel (refereegranskat)abstract
- Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held together by imaginaries of care robots. The technological frame of care robots in use revealed aspects of prospective end-users’ uncertainty of their ability to handle care robots, and their own perceived lack of competence and knowledge about care robots. In addition, the following potential criteria for successful use of care robots were identified: adequate training, incentives for usage (needs and motives), usability, accessibility and finances. The technological frame of care robot strategy was revealed as believed cost savings and staff reduction. The novelty of the results, and their relevance for science and practice, is derived from the theoretical framework which indicates that adoption of care robots will be dependent on how well societies succeed in collectively shaping congruent technological frames among different stakeholders and aligning technological development accordingly.
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| 8. |
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| 9. |
- Larsson, Tore J, et al.
(författare)
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A consumers´testing approach to the usability of medical technology : Insulin pumps and CGM systems
- 2014
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Ingår i: Advances in Safety Management and Human Factors. - 9781495121005 ; , s. 117-128
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Konferensbidrag (refereegranskat)abstract
- Five different insulin pumps and three systems for continuous glucose monitoring were subjected to usability tests at the School of Technology and Health. Each pump was trialed and rated by 30 respondents; 20 students with no experience of diabetes and 10 diabetic pump users. Each of the CGM systems was trialed and rated by 10 non-diabetic students. All participating students were enrolled in Medical Technology (Royal Institute of Technology) or Occupational Therapy (Karolinska Institute). The technical performance of pumps and CGM systems was tested independently. The respondents handled the insulin container, the oftware, the buttons, the screen and the manual through five scenario-based tasks. The trials and the accompanying attitude items were based on the ISO definition of usability. Efficiency was measured as the proportion of respondents succeeding to perform the tasks in less than 15 minutes, combined with the average time to do so. Effectiveness was the quotient of success frequency over average performance time. Satisfaction was the average distribution on the attitude items related to software, screen, buttons and manual. All products were ranked against each other within each separate test and the rank scores accumulated. There were significant differences in the scoring of the individual insulin pumps and CGM systems.
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| 10. |
- Walldius, Åke, 1950-, et al.
(författare)
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Mapping Health Outcome and Costs when Coordinating Local Information
System Redesign
- 2015
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Ingår i: Techno-Anthropology in Health Informatics. - Amsterdam : IOS Press BV. - 9781614995593 ; , s. 242-253
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Bokkapitel (refereegranskat)abstract
- As costs for healthcare are rising in society, information systems are often seen as enablers of new cost-saving healthcare processes. But an on-going deployment of a wide range of new kinds of systems requires close attention to interoperability between new and legacy systems. Another challenge is to assure that the healthcare professions are given realistic opportunities to play an active part in designing the new ways of working that the new, integrated systems are designed to support. We argue that a feasible way to approach such a user participation in design of work processes and systems is to extend well known user-survey and strategy-mapping methods with the new value-based healthcare approach which invites health professionals to participate in strategic assessments of health outcome and costs along the care chain in which they work. We also argue that such a combination of practical research methods resonates well with Techno-Anthropology’s foregrounding of ethical considerations to inform the inter-disciplinary cross-fertilization of interactional competencies in health informatics research.
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