| 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)
-
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
-
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
-
In: Behavior and Information Technology. - 0144-929X .- 1362-3001. ; 30:4, s. 455-466
-
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
-
In: ACM Int. Conf. Proc. Ser.. - New York, NY, USA : ACM. - 1581138571 - 9781581138573 ; , s. 381-384
-
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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| 11. |
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| 12. |
- Groth, Kristina, et al.
(author)
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Clinical journal: a collaborative shared medical workspace
- 2011
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In: CSCW '11 Proceedings of the ACM 2011 conference on Computer supported cooperative work. - NewYork, USA : ACM. ; , s. 633-636
-
Conference paper (peer-reviewed)abstract
- We describe our findings from a cooperative design effort of a shared medical workspace used in multi-disciplinary team meetings, as well as during other activities in a patient care pathway for highly specialised care. In collaboration with surgeons, sketches of such a system have been developed and evaluated. Our findings point out the importance of overview and visualisation of the information
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| 13. |
- Groth, Kristina, et al.
(author)
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Context browser : Ontology based navigation in information spaces
- 2006
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In: Information Interaction in Context, Proceedings. - New York, New York, USA : ACM Press. - 9781595934826 ; , s. 75-78
-
Conference paper (peer-reviewed)abstract
- For people working in knowledge intensive organisations, information about specific projects, documents, etc. are important for performing an ordinary workday. Different kinds of problems, large or small, complex or simple, continually arise and need to be dealt with. Finding information or people with specific knowledge to solve the problem may be of crucial importance. Today, a number of technologies exist facilitating this, but they are either not sophisticated enough, i.e., not providing results detailed enough, or too complicated to prepare for, e.g., tagging large amounts of information. As an alternative, we propose using ontologies to facilitate free-text searches. From an ontology, a menu-like interface can be automatically generated. Such a menu can replace searching with navigation. To demonstrate our ideas, we present Context Browser. a tool providing ontology based navigation in structured and unstructured information spaces.
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| 14. |
- Groth, Kristina, et al.
(author)
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Coordination in highly-specialized care networks
- 2013
-
In: Proc. ACM Conf. Comput. Support. Coop. Work CSCW. - New York, NY, USA : ACM. - 9781450313322 ; , s. 143-148
-
Conference paper (peer-reviewed)abstract
- We present a field study of coordination of work in centralized highly-specialized gastro surgical care, with a large number of patients being routinely referred from participating referral hospitals. We provide a description of the organization and coordination of work at the clinic where surgery is performed in this process. A key part of the study is the description of a "Coordinator" role and a fairly rigid workflow system referred to as the Care Chain that is used to help manage interdependencies within the care process.
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| 15. |
- Groth, Kristina, et al.
(author)
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Creating a space for increased community feeling among geographically distributed teachers
- 2005
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In: Proceedings of the 4th decennial conference on Critical computing. - New York, USA : ACM. - 1595932038 ; , s. 145-148
-
Conference paper (peer-reviewed)abstract
- We present the initial stages of a project in which we focuson participatory design methods to build information andcommunication technology support that stimulate knowledgesharing in a group of geographically distributedteachers. Teachers in general spend most of their time in aclassroom leaving few opportunities for social encountersand chats with their colleagues. The prototype we aredeveloping focuses on informality and playfulness, thatwould increase the social communication and thereby thecommunity feeling. In turn, this would ultimately increaselearning among the setting members.
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| 16. |
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| 17. |
- Groth, Kristina, et al.
(author)
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Efficiency in Treatment Discussions : A Field Study of Time Related Aspects in Multi-Disciplinary Team Meetings
- 2009
-
In: 2009 22ND IEEE INTERNATIONAL SYMPOSIUM ON COMPUTER-BASED MEDICAL SYSTEMS. - 9781424448791 ; , s. 88-95
-
Conference paper (peer-reviewed)abstract
- We present a field study of multi-disciplinary team meetings where decisions on treatment of patients with diseases in the upper part of the abdomen are made. These meetings are important for knowledge dissemination and learning. We have studied how different time related aspects affect the efficiency during these meetings. Time is relevant because several physicians attend these meetings, and they have tight schedules as it is. Our analysis focuses on the conversation during the team meetings, and on how aspects such as indistinct discussions, lack of relevant competence and information, and the structuring of medical information affect time efficiency.
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| 18. |
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| 19. |
- Groth, Kristina, et al.
(author)
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On finding things out: Situating organisational knowledge in CSCW
- 2001
-
Conference paper (peer-reviewed)abstract
- We present a field study of an organisation which designs and constructs precision mechatronic devices, which typically integrate electronics, mechanical assemblies, computer hardware and software. We study how organisation members seek out answers to questions and solutions to problems as they arise in their work. We examine how project documentation is used, how chance encounters are capitalised upon, how advice is sought, the role of meetings, training and competence-enhancing activities, and the use of the organisation‘s information systems. We develop an account of ‘finding things out’ as an orderly and practically situated organisational affair, and compare this with recent studies in CSCW of ‘expertise location’. The paper closes with an examination of potential technology development programs to support people in finding things out in organisations while suggesting the re-specification of research on ‘organisational memory’, ‘knowledge management’ and allied notions in CSCW.
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| 20. |
- Groth, Kristina, 1963-
(author)
-
On knowing who knows : An alternative approach to knowledge management
- 2004
-
Doctoral thesis (other academic/artistic)abstract
- The topic of this thesis is how computer applications can support knowledge sharing between individuals in an organization. The thesis particularly focuses on solutions that facilitate for people to find other persons to share knowledge with, rather than solutions where information is stored in some kind of database for the purpose of being reused by other persons. The thesis describes one shorter and one longer ethnographic study about information and knowledge sharing in two different settings. The studies have shown that what actions people take when they search for information and knowledge depends on the problem itself, and on the situation in which the problem occurs. The results from the studies indicate that supporting people in knowing about others’ activities and availability would be more important when supporting knowledge sharing, than a specific knowledge system with the purpose of storing information to be reused as knowledge. This awareness can be supported in a number of different ways, some based on social activities, and some based on technical solutions. Social activities involve supporting the development of social networks, communities of practice, and other kinds of social activities that facilitate for people to get to know each other and get an opportunity to talk to each other. There exists many technologies that can support people’s knowledge about others’ activities and availability. Awareness systems focus on collecting and presenting information about, for example, where a person is located and how busy a person is. Some awareness systems collect such information automatically using, for example, sensor technology or electronic calendars, while others require the user to enter the information by him- or herself. It is more difficult to get the second kind of systems to work in practice because it requires that the time a user spends on supporting the system is also returning a benefit in the end. Ordinary information systems may also contribute to supporting people’s knowledge about others’ activities and availability, but they need to be structured and searchable in a way that fulfils this purpose. Also, there usually exist more than one documentation repository in an organization among which some may be structured and some not. Based on the studies that have been conducted a number of prototypes supporting knowledge sharing have been developed and evaluated. The technologies focused on are notification systems including mobile solutions to communicate with others, awareness systems focusing on activities and availability, and information management to make already existing written documentation structured and searchable. These prototypes have been evaluated using video recorded scenarios, based on the studies conducted, and focus groups in a medium sized consultancy organization. The results from the evaluation show that the suggested prototypes in the large fulfil the purpose of supporting knowledge sharing in an organization. Based on the three field studies conducted within the work of this thesis, a framework for supporting knowledge sharing through computer support is suggested. The framework focuses on issues such as annoying interruptions, platform independent communication, privacy aspects, and how the information can be presented.
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| 21. |
- Groth, Kristina
(author)
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Personal Home Pages on the World Wide Web–a Simple Version of a Knowledge Net?
- 1998
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In: Trends of communication. ; 4, s. 47-59
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Journal article (peer-reviewed)abstract
- A common type of pages on the World Wide Web concerns individual persons. These "personal home pages" often include information about activities, interest areas etc, and show what knowledge and interests different persons have. In a "knowledge net" the idea is to distribute information about peoples knowledge about different topics. To do this references to "who-knows-what" is given. This report presents an interview study of personal home pages; what information is included, how it is presented etc. The results show that personal home pages can be of use in a, or even seen as a simple, knowledge net.
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| 22. |
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| 23. |
- Groth, Kristina, et al.
(author)
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Saxaren : Strengthening Informal Collaboration among Geographically Distributed Teachers
- 2006
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In: OZCHI '06 Proceedings of the 18th Australia conference on Computer-Human Interaction, Design, Activities, Artefacts and Environments. - New York, USA : ACM. - 1595935452 ; , s. 285-292
-
Conference paper (peer-reviewed)abstract
- For people working in situations with few colleagues around, information technology could be used for increased communication with colleagues at other places. One such group is teachers in rural areas. In our work with teachers in an archipelago school distributed over six islands we have focused on encouraging communication using a digital notice board, providing for quick handwritten notes, connecting all islands. Based on the teachers' collaborative situation, and on the design, implementation and use of the prototype, we illustrate, by a number of recorded notes, how the teachers have been using the prototype, relating the findings to group building, easy access, and playful behaviour.
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| 24. |
- Groth, Kristina, et al.
(author)
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Simple and playful interaction for informal communication and learning
- 2007
-
In: International Journal of Knowledge and Learning. - : Inderscience Enterprises Ltd. - 1741-1009 .- 1741-1017. ; 3:2-3, s. 191-208
-
Journal article (peer-reviewed)abstract
- Teachers in general usually do not have one single office and they seldom have time for face-to-face interaction with their colleagues since they typically spend most of the time in a classroom. Teachers in rural areas have even less colleagues to interact with face-to-face. In our work with teachers in a rural area near Stockholm, in an archipelago school distributed over six islands, we have encouraged informal communication and learning through a digital notice board connecting all six units. This paper discusses three issues that we find important to focus on in our work; the role of shared interactive displays, simplicity and play as a social activity and the role of communication for informal learning.
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| 25. |
- Groth, Kristina, et al.
(author)
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Team Meetings within Clinical Domains : Exploring the Use of Routines and Technical Support for Communication
- 2009
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In: HUMAN-COMPUTER INTERACTION - INTERACT 2009, PT II, PROCEEDINGS. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 9783642036576 ; , s. 975-976
-
Conference paper (peer-reviewed)abstract
- Today, it is common that a team of clinicians, from different disciplines, instead of one single doctor, care for a patient. This is especially true when it concerns more complicated diseases in highly specialised health care. Going from one doctor to a team of doctors raises new dimensions/problems/issues when deciding about the diagnosis and how to treat the patient. Instead of one person deciding, based on the information given from others, a group of people need to agree on a decision. How do the participants during such decision meetings argue for their experience and skill? What kind of technologies are available and how do they support the communication in the meeting? Måseide (2006), for example, focuses on how different forms of evidence influence and regulate the judgements and decisions of medical practitioners during such meetings. Groth et al. (2008), for example, focuses on the technology used during such meetings, with a focus on audio, video, and images.
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| 26. |
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| 27. |
- Groth, Kristina, et al.
(author)
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The role of technology in video-mediated consensus meetings
- 2008
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In: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 14:7, s. 349-353
-
Journal article (peer-reviewed)abstract
- We have studied the use of video-mediated technology to facilitate multidisciplinary meetings where consensus is reached about the diagnosis and treatment of patients. The meetings involved 2-5 sites, with 1-20 participants from each site, and concerned patients with severe diseases in the upper abdomen. During a period of about one year we conducted observations and interviews at the Karolinska hospital and some of the local hospitals. Eight video-mediated consensus meetings were video-recorded and transcribed. The audio and the radiology images presented during the meetings were considered to be most important; video was not critical for the consensus meeting itself, but contributed to a feeling of awareness and social presence. We conclude that video-mediated consensus meetings are affected by the technology used, and certain changes in the technology or environment could improve the meetings. Without the technology, such meetings would lead to more travelling for the patient and for the medical staff involved.
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| 28. |
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| 29. |
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| 30. |
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| 31. |
- Kane, Bridget, et al.
(author)
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Multidisciplinary Work Practices : A Comparison of Three Major European Hospitals
- 2014
-
In: 2014 IEEE 27th International Symposium on Computer-Based Medical Systems. - : IEEE. - 9781479944354 ; , s. 369-375
-
Conference paper (peer-reviewed)abstract
- This paper reviews the practices of multidisciplinary teamwork (MDT) for cancer care in three large teaching hospitals in separate jurisdictions. Ethnographic observations provide the main source of data, which are verified though interviews, and in some cases by surveys and analysis of video recordings. We demonstrate how MDT practices develop among different groups, and in different jurisdictions. Common practices are identified and differences explained. Work practice analysis is an integral part of our research, and this study provides insights into medical teamwork and decision-making.
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| 32. |
- Kane, Bridget, et al.
(author)
-
Multidisciplinary Work Practices : A Comparison of Three Major European Hospitals
- 2014
-
Conference paper (peer-reviewed)abstract
- This paper reviews the practices of multidisciplinary teamwork (MDT) for cancer care in three large teaching hospitals in separate jurisdictions. Ethnographic observations provide the main source of data, which are verified though interviews, and in some cases by surveys and analysis of video recordings. We demonstrate how MDT practices develop among different groups, and in different jurisdictions. Common practices are identified and differences explained. Work practice analysis is an integral part of our research, and this study provides insights into medical teamwork and decision-making.
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| 33. |
- Nilsson, Marcus, et al.
(author)
-
Interactions with mobile units in collocated MDTMs
- 2011
-
Conference paper (other academic/artistic)abstract
- In this paper a prototype is presented for individual mobileunits in a collocated multi disciplinary team meeting. Thisprototype has been used in a simulated team meeting withauthentic patient information. Preliminary results about navigationin the shared workspace show that participants bothappreciated being able to interact with the group throughmobile units at the same time as they had concerns aboutgiving all participants at the meeting this possibility.
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| 34. |
- Nilsson, Marcus, 1977-, et al.
(author)
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Keeping the remote expert informed : Designing a mediated communication tool for trauma resuscitation
-
Other publication (other academic/artistic)abstract
- We have designed and developed a mobile prototype that sup- ports a remote trauma surgeon that has been given the task to guide a trauma resuscitation at a local hospital. The design is based on field studies of trauma resuscitations, and on using different probes during trauma training sessions. The proto- type was tested in a trauma training session and evaluated in contextual interviews. The design focuses on what informa- tion that the remote trauma surgeon needs in order to support the trauma team and how the information should be presented in order to enhance situation awareness. Our results show that a consideration of the elements in the environment that add to situation awareness can open up for easier inclusion of mo- bile technology. We show the importance to design for the whole flow of information to achieve acceptance of the de- sign among future users.
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| 35. |
- Nilsson, Marcus, 1977-
(author)
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Mediated and Mobile Communication for Experts
- 2014
-
Doctoral thesis (other academic/artistic)abstract
- This thesis focuses on systems for mediated communication that run on mobile technology. The aim has been to give an answer to the question about what require- ments there are for situation awareness for domain experts when communication is secondary and supports the primary task.This thesis originated in a critical approach to the common practice of design- ing mediated communication systems with the face-to-face meeting as a guiding scenario. Instead, this thesis explores a design process that is based on the task and the strength of the technology itself. Different tasks do, of course, make different de- mands on a system, and a task that is strongly connected to the face-to-face meeting will probably be best served by a system that is designed from that perspective.Three cases that are presented in this thesis share three common themes that have characteristics that set them apart from the face-to-face meeting. The first theme is that the communication is a secondary task that is used to support a primary task. The second theme is that the cases involve domain experts active in the primary task. The use of experts implies that communication will be task- centered and also that the need for information to sustain a valuable situation awareness may be different from a person with less experience in the domain. The third theme is that all cases and the corresponding tasks benefit from some kind of situation awareness among the participants for optimal execution of the task. The three cases are based on:Wearable computers using mediated communication with wearable computers and how to handle interruptions for users of such computersMultidisciplinary team meetings improving access to patient information and enabling individual and group interaction with this informationTrauma resuscitation giving a remote trauma expert’s correct and valuable in- formation while minimizing disturbance when supporting a local trauma re- suscitation teamPrototypes are central in all three cases, and different prototypes have been designed and evaluated to validate the benefit of designing tools for communication that do not try to replicate the face-to-face meeting.The main findings in this thesis show that the shift of focus to the primary task when designing mediated communication systems has been beneficial in all three cases. A conflict between the secondary communication that is used to support sit- uation awareness and the primary task has been identified. Full situation awareness should therefore not be a goal in these designs but communication should support enough situation awareness to benefit the primary task with minimal disturbance to it.
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| 36. |
- Nilsson, Marcus, 1977-, et al.
(author)
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Remote supported trauma care : Understanding the situation from afar
- 2013
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In: Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems. ; , s. 65-70
-
Conference paper (peer-reviewed)abstract
- We present results from a study of information needs when teleconsultation is used in trauma resuscitation. Three trauma team training sessions including 14 patient cases were observed together with field studies at emer- gency units. Technology probes like headcams and visu- alization of data usually available in the trauma room were used to better understand what information that is impor- tant or not for the remote expert to achieve a satisfactory Situation Awareness to support the trauma resuscitation. It was found that the two major information sources that the remote expert relies on are the vital signs and an overview, not necessarily with high video quality, of the team in the trauma room.
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| 37. |
- Olwal, Alex, et al.
(author)
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Design and Evaluation of Interaction Technology for Medical Team Meetings
- 2011
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In: 13th IFIP TC 13 International Conference, Lisbon, Portugal, September 5-9, 2011, Proceedings, Part I. - Berlin, Heidelberg : Springer. - 9783642237744 - 9783642237737 ; , s. 505-522
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Conference paper (peer-reviewed)abstract
- Multi-disciplinary team meetings (MDTMs) are essential in health-care, where medical specialists discuss diagnosis and treatment of patients. We introduce a prototype multi-display groupware system, intended to augment the discussions of medical imagery, through a range of input mechanisms, multi-user interfaces and interaction techniques on multi-touch devices and pen-based technologies. Observations of MDTMs, as well as interviews and observations of surgeons and radiologists, serve as a foundation for guidelines and a set of implemented techniques. We present a detailed analysis of a study where the techniques’ potential was explored with radiologists and surgeons of different specialties and varying expertise. The results show that the implemented technologies have the potential to bring numerous benefits to the team meetings with minimal modification to the current workflow. We discuss how they can augment the expressiveness and communication between meeting participants, facilitate understanding for novices, and improve remote collaboration.
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| 38. |
- Påhlsson, H. I., et al.
(author)
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Telemedicine : an important aid to perform high-quality endoscopic retrograde cholangiopancreatography in low-volume centers
- 2013
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In: Endoscopy. - : Georg Thieme Verlag KG. - 0013-726X .- 1438-8812. ; 45:5, s. 357-361
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Journal article (peer-reviewed)abstract
- Background and study aims: The aim of this study was to investigate whether telemedicine can help to ensure high-quality endoscopic retrograde cholangiopancreatography (ERCP) in patients living in rural areas. The study was conducted by investigators from two centers: the Karolinska University Hospital, a high-volume center which provided the teleguided support, and the Visby District Hospital, a low-volume center. Patients and methods: From September 2010 to August 2011, 26 ERCP procedures performed at a district hospital were teleguided by an experienced endoscopist at the Karolinska University Hospital. To ensure patient data protection, all communication went through a network (Sjunet) that was separate from the Internet and open only to accredited users. The indications for ERCP were common bile duct stones (n=12), malignant strictures (n=12), and benign biliary strictures (n=2). In 15 cases, this was the patient's first ERCP procedure. Results: The common bile duct was successfully cannulated in all 26 teleguided procedures. The local endoscopist scored the teleguided support as crucial for the successful outcome in 8/26 cases, as an important factor in 8, and as being of less importance in the remaining 10. In the eight cases where the teleguided support was judged to be crucial, six subsequent percutaneous trans-hepatic cholangiography procedures and two repeat ERCPs were avoided. The overall cannulation rate at the district hospital improved from 85% to 99% after teleguided support was introduced. No procedure-related complications occurred. Conclusion: Distant guidance of advanced ERCP procedures in a low-volume center, through teleguided support from a high-volume center, has the potential to improve the quality of care, as reflected in high cannulation rates and the ability to complete the scheduled interventions.
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| 39. |
- Sallnäs Pysander, Eva-Lotta, et al.
(author)
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Pointing in Multi-Disciplinary Medical Meetings
- 2011
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In: 2011 24TH INTERNATIONAL SYMPOSIUM ON COMPUTER-BASED MEDICAL SYSTEMS (CBMS). - NEW YORK, NY : IEEE. - 9781457711909
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Conference paper (peer-reviewed)abstract
- In this paper a field study of using laser-pointing during multi-disciplinary medical meetings is presented. The pointing behaviour adopted by radiologists and surgeons to communicate about and collaboratively analyse patient data such as CT images today is illustrated based on field observations of pre-operative meetings. In a field test, laser-pointers were introduced in pre-operative meetings. How the dialogue and gesturing changed compared to meetings where laser-pointers were not present were investigated. Results from our study show that the multi-disciplinary medical meetings are clearly affected by the introduction of laser-pointer devices and we believe that the participants would benefit from a future gesturing tool if it was carefully designed. The implementation of an application that provides touch feedback in three dimensions of the anatomical structure of blood vessels as well as tumours is described and related to our results.
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| 40. |
- Sandor, Ovidiu, et al.
(author)
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Cooperative Learning through ICT : the Case of the Swedish Teachers Abroad
- 2005
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In: 3rd International Conference on Education and Information Systems: Technologies and Applications, Vol 1, Proceedings. - 9789806560338 ; , s. 144-149
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Conference paper (peer-reviewed)abstract
- in this paper we will present the initial stages of a project where knowledge sharing among a group of teachers is targeted using an approach in which a community of practice is initiated and nurtured based on cooperative design principles. The resulting process of transforming a formal organization into an informal community of practice is presented. We outline our approach that has both social and technological components that we believe will enable us to help a community form and thrive in a sustainable manner.
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| 41. |
- Scholl, Jeremiah, et al.
(author)
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Of organization, device and context : Interruptions from mobile communication in highly specialized care
- 2012
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In: Interacting with computers. - : Oxford University Press (OUP). - 0953-5438 .- 1873-7951. ; 24:5, s. 358-373
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Journal article (peer-reviewed)abstract
- This paper presents an ethnographic study of mobile communication at a surgical unit in Sweden involved with highly specialized care for the upper abdomen. The primary focus of the study is interruptions related to usage of mobile communication, with the goal of informing the design of systems that better balance interruptions and availability. The department uses a patchwork of hospital pagers, personal cell phones, and department provided cell phones. Issues related to social factors at the department, technical features of mobile communication devices, and specific contexts where interruptions were identified to be a problem are presented. Some of the salient findings of the study include a generally complex situation with respect to interruptions that is impacted by technical, social and individual factors related to mobile communication, challenges related to managing personal and private communication on the same device, issues related to supporting distributed work in highly specialized care and how this contributes to interruptions, and a more in depth overview of specific contexts where interruptions are problematic than previous studies. Some theoretical perspectives on these issues are presented as well as implications for design.
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| 42. |
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| 43. |
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| 44. |
- Willows, Thomas, et al.
(author)
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Initiation of Levodopa-Carbidopa Intestinal Gel Infusion Using Telemedicine (Video Communication System) Facilitates Efficient and Well-Accepted Home Titration in Patients with Advanced Parkinson's Disease
- 2017
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In: Journal of Parkinson's Disease. - : IOS PRESS. - 1877-7171 .- 1877-718X. ; 7:4, s. 719-728
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Journal article (peer-reviewed)abstract
- Background: Levodopa-carbidopa intestinal gel (LCIG; Duodopa r) is used for continuous infusion in advanced Parkinson's disease. To achieve optimal effect, the LCIG dose is individually titrated, traditionally conducted during hospitalization in Sweden. However, dose adjustment depends on surrounding conditions, physical activity, and emotional stress, which is why titration at home could be beneficial. Telemedicine (TM) using a video communication system offers alternative titration procedures, allowing LCIG initiation at home. Objective: Study objectives were to show the feasibility of TM for LCIG home titration, evaluate resource use, and assess patient, neurologist, and nurse satisfaction. Methods: Four clinics enrolled 15 patients to observe efficiency and feasibility of TM-based monitoring. Results: Patient median (range) age was 67 (52-73) years and time since diagnosis was 10 (7-23) years. Median time between LCIG initiation and end of TM-assisted titration was 2.8 (2.0-13.8) days. Median time required for home titration by neurologists, nurses, and patients was (hours: minutes) 1 : 14 (0 : 29-1 : 52), 5 : 49 (2 : 46-10 : 3), and 8 : 53 (4 : 11-14 : 11), respectively. Neurologists and nurses considered this to be less time than required for hospital titration. TM allowed patients 92% free time from start to end of titration. Technical problems associated with TM contacts were rare, mostly related to digital link, and quickly resolved. Patients, neurologists, and nurses were satisfied using TM. No serious adverse events were reported; there was one device complaint (tube occlusion). Conclusions: In this study, TM-assisted LCIG titration at home was resource-efficient, technically feasible, well-accepted and was deemed satisfactory by patients, neurologists, and nurses.
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