| 1. |
- Aminoff, Hedvig, et al.
(author)
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Modeling the implementation context of a telemedicine service: Work domain analysis in a surgical setting
- 2021
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In: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 5:6
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Journal article (peer-reviewed)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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| 2. |
- Aminoff, Hedvig, et al.
(author)
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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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In: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 8:4
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Journal article (peer-reviewed)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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| 3. |
- Engström, Christina, et al.
(author)
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Understanding needs and requirements in applications for identifying clinically relevant similarities between patients with liver related diseases
- 2009
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In: HEALTHINF 2009. - SETUBAL, Portugal : INSTICC-INST SYST TECHNOLOGIES INFORMATION CONTROL & COMMUNICATION ESQUERDO. - 9789898111630 ; , s. 187-192
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Conference paper (peer-reviewed)abstract
- We present a field study at a surgical clinic of what data that is relevant in order to identify clinically relevant similarities. We have observed discussion meetings in which different medical specialities decide how to treat patients with severe diseases in the liver. Our study also includes interviews with medical personnel, and examination of two data sources, the electronic patient records and the local quality liver registry used within the clinic. Our findings include a model of data that can be useful when searching for clinically relevant similarities between patient cases, as well as requirements on the functionality of an application that can identify clinically relevant similarities.
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| 4. |
- Fredriksson, Johan, et al.
(author)
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Effects of mobile video-mediated communication for health care professionals in advanced home care of children
- 2014
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In: 27th IEEE International Symposium on Computer-Based Medical Systems. - Los Alamitos, California : IEEE Computer Society. - 9781479944354 ; , s. 363-368, s. 363-368
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Conference paper (peer-reviewed)abstract
- In this paper we explore the use of a mobile video-conferencing tool (MVCT) in advanced home care of children. We present the results from a qualitative study where we have evaluated mobile video communication between the patient's home and the hospital unit. Our results show that mobile video enhances communication between home care teams and medical staff at the unit, makes more effective use of practitioners' time and that the equipment have additional values for staff that extend beyond video communication. Challenges identified are related to technical problems, limitations in the MVCT's design and the concern that the inability to handle problems may affect health care professionals' role as an authority. The benefits of the MVCT rely to a great extent on individual users' creativity and the willingness of key actors in the organization's management to find ways of improving the present home care format.
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| 5. |
- Frykholm, Oscar, 1975-
(author)
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Case-based presentation in medical multidisciplinary team meetings : Applied research in CSCW and IxD
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Advanced medical technology is widely used in modern healthcare, as more and more specialised examinations and treatments are performed on patients. In the case of particularly complex diseases, a number of medical specialists, each an expert in their own field, must collaboratively make diagnoses and plan for treatment. In multidisciplinary team meetings (MDTM), the medical specialists present their pieces of the puzzle, stitch them together and in consensus make a decision. A large amount of information from several sources must be taken into account, but the digital tools to support this decision-making are lacking.This thesis describes research in which engineers and medical specialists have cooperatively developed such a tool. The main research question concerns improving patient information visualisation to support the collaborative work in MDTMs; a secondary question concerns the role of interaction design in medical work. Several design activities have been conducted together with the medical specialists by utilising research methods derived from computer- supported cooperative work (CSCW) and interaction design (IxD). The new tool has been evaluated in two simulated MDTMs and even though it was developed with the users, the results cut both ways.Case-based presentation of patients in MDTMs has a positive effect, as more information can be displayed during discussions. It helps the participants keep a shared focus on the patient, her medical history, results from examinations, and decisions made in the meeting. It is a new and aggregated view of the patient and an example of how patient information visualisation can be improved. On the other hand introducing new technology and new ways of interacting with information, in the meetings was not considered entirely positive. The participants have different roles and tasks in the meeting, and the tools should support these without distracting the shared focus.This practical way of working (conducting field studies, design activities and evaluations) together with ingenious medical specialists can make a difference. By exploring and concretising stakeholders’ needs and making long-term commitments, the interaction designer can take a central position in the deve- lopment of digital, collaborative tools for medical work.
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| 6. |
- Frykholm, Oscar, et al.
(author)
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Interaction design in a complex context : medical multi-disciplinary team meetings
- 2012
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In: The 7th Nordic Conference on Human-Computer Interaction: Making Sense Through Design. - New York, NY, USA : ACM. - 9781450314824 ; , s. 341-350
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Conference paper (peer-reviewed)abstract
- In order to improve collaboration on, and visualisation of, patient information in medical multi-disciplinary team meetings, we have developed a system that presents information from different medical systems to be used as a support for the decision process. Based on field studies, we have implemented a high-fidelity prototype on tablet-sized displays, and tested it in a realistic setting. Our evaluation proved that more patient information can efficiently be displayed to all meeting participants, compared to the current situation. Interaction with the information, on the other hand, proved to be a complicated activity that needs careful design considerations; it should ultimately be based on what roles the meeting participants have, and what tasks they should complete. Medical decision-making is a complex area, and conducting interaction design in this area proved complex too. We foresee a great opportunity to improve medical work, by introducing collaborative tools and visualisation of medical data, but it requires that interaction design becomes a natural part of medical work.
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| 7. |
- Frykholm, Oscar, et al.
(author)
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Medicine meets engineering in cooperative design of collaborative decision-supportive system
- 2010
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In: IEEE 23rd International Symposium on Computer-Based Medical Systems (CBMS). - Perth, WA : IEEE conference proceedings. ; , s. 116-121
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Conference paper (peer-reviewed)abstract
- Researchers in Human-Computer Interaction have worked together with physicians to specify and create prototypes of a system to be used primarily during multi-disciplinary team meetings. Physicians will use the system to aggregate and present relevant patient information during discussions on diagnosis and treatment, and also to coordinate the cases during the patient care pathway. In this paper we present the cooperative design process and activities conducted within the project. The results are two-fold; we report on the progress of creating the decision-supportive system, and describe how the physicians experience the design process. The design activities have made the physicians reflect on: the lack or loss of patient information, how patient information can be improved, break-downs in their work process, how they learn from each other, and the design methodology itself.
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| 8. |
- Frykholm, Oscar, et al.
(author)
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References to personal experiences and scientific evidence during medical multi-disciplinary team meetings
- 2011
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In: Behavior and Information Technology. - 0144-929X .- 1362-3001. ; 30:4, s. 455-466
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Journal article (peer-reviewed)abstract
- We present a field study of medical multi-disciplinary team meetings (MDTMs) where decisions are made concerning the diagnosis and treatment of patients suffering from diseases in the upper abdomen. The study shows how evidence is referred to during weekly team meetings; this evidence is related both to scientific studies and to personal experiences of similar cases. We focus on the conversations during the meetings, on the complicated nature of the cases and on the details in the discussions that led the meeting participants to refer to scientific evidence or previous cases. We identify possibilities for improving the use of already documented information from medical records, in order to identify clinically relevant similarities and to bring additional information into the treatment discussion.
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| 9. |
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| 10. |
- Groth, Kristina
(author)
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A technological framework supporting knowledge exchange in organizations
- 2004
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In: ACM Int. Conf. Proc. Ser.. - New York, NY, USA : ACM. - 1581138571 - 9781581138573 ; , s. 381-384
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Conference paper (peer-reviewed)abstract
- This paper focuses on presenting a technological framework for supporting knowledge sharing in organizations through computer support. The framework is based on the results from three studies of organizational knowledge in three kinds of settings and focuses on communication between people, awareness information about people's activities and availability, and information management. The third study also included an evaluation of a number of prototypes developed based on the three areas focused on in the framework. The results from the evaluation indicate that the framework is suitable for the purpose of supporting knowledge exchange.
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