Elin Rønby Pedersen

Relating documents via user activity: the missing link

In this paper we describe a system for creating and exposing relationships between documents: a users interaction with digital objects (like documents) is interpreted as links - to be discovered and maintained by the system. Such relationships are created automatically, requiring no priming by the user. Using a very simple set of heuristics, we demonstrate the uniquely useful relationships that can be established between documents that have been touched by the user. Furthermore, this mechanism for relationship building is media agnostic, thus discovering relationships that would not be found by conventional content based approaches. We describe a proof-of-concept implementation of this basic idea and discuss a couple of natural expansions of the scope of user activity monitoring.

Research trails: getting back where you left off

In this paper, we present a prototype system that helps users in early-stage web research to create and reestablish context across fragmented work process, without requiring them to explicitly collect and organize the material they visit. The system clusters a users web history and shows it as research trails. We present two user interaction models with the research trails. The first interaction model is implemented as a standalone application, which presents a hierarchical view of research trails. The second interaction model is integrated with the web browser. It shows the users research trails as selectable and manipulable visual streams when they open a new tab. Thereby, the NewTab page serves as a springboard in the browser for a user resuming an ongoing task.

Diabetic Retinopathy and the Cascade Into Vision Loss

ABSTRACT Vision loss from diabetic retinopathy should be unnecessary for patients with access to diabetic retinopathy screening, yet it still occurs at high rates and in varied contexts. Precisely because vision loss is only one of many late-stage complications of diabetes, interfering with the management of diabetes and making self-care more difficult, Vision Threatening Diabetic Retinopathy (VTDR) is considered a “high stakes” diagnosis. Our mixed-methods research addressed the contexts of care and treatment seeking in a sample of people with VTDR using safety-net clinic services and eye specialist referrals. We point to conceptual weaknesses in the single disease framework of health care by diagnosis, and we use the framework of “cascades” to clarify why and how certain non-clinical factors come to bear on long-term experiences of complex chronic diseases.

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management

BackgroundNovel telemedicine platforms have expanded access to critical retinal screening into primary care settings. This increased access has contributed to improved retinal screening uptake for diabetic patients, particularly those treated in Federally Qualified Health Centers (‘safety net’ clinics). The aim of this study was to understand how the implementation of telemedical screening for diabetic retinopathy within primary care settings is improving the delivery of critical preventative services, while also introducing changes into clinic workflows and creating additional tasks and responsibilities within resource-constrained clinics.MethodsA qualitative approach was employed to track workflows and perspectives from a range of medical personnel involved in the telemedicine platform for diabetic retinopathy screening and subsequent follow-up treatment. Data were collected through semi-structured interviews and participant observation at three geographically-dispersed Federally Qualified Health Centers in California. Qualitative analysis was performed using standard thematic analytic approaches within a qualitative data analysis software program.ResultsThe introduction of telemedicine platforms, such as diabetic retinopathy screening, into primary care settings is creating additional strain on medical personnel across the diabetes eye care management spectrum. Central issues are related to scheduling patients, issuing referrals for follow-up care and treatment, and challenges to improving adherence to treatment and diabetes management. These issues are overcome in many cases through workarounds, or when medical staff work outside of their job descriptions, purview, and permission to move patients through the diabetes management continuum.ConclusionsThis study demonstrates how the implementation of a novel telemedical platform for diabetic retinopathy screening contributes to the phenomenon of workarounds that account for additional tasks and patient volume. These workarounds should not be considered a sustainable model of health care delivery, but rather as an initial step to understanding where issues are and how clinics can adapt to the inclusion of telemedicine and ultimately increase access to care. The presence of workarounds suggests that as telemedicine is expanded, adequate resources, as well as collaborative, cross-sectoral co-design of new workflows must be simultaneously provided. Systematic bolstering of resources would contribute to more consistent success of telemedicine screening platforms and improved treatment and prevention of disease-related complications.