Finn Kensing

Designing for collaborative interpretation in telemonitoring: Re-introducing patients as diagnostic agents

PURPOSE We investigate why clinicians experience problems interpreting implantable cardioverter-defibrillator (ICD) data when the patient is absent, and we explore how to re-introduce patients into the socio-technical setup of telemonitored interpretation practices. METHOD An action research study with a design interventionist perspective was conducted to investigate the telemonitoring arrangement for chronic heart patients with ICDs and to identify the nature of the collaborative practices involved in ICD data interpretation. We diagnose the main challenges involved in collaborative interpretation practices. These insights were used to re-design the socio-technical setup of the telemonitoring practices by designing and building a web-based, patient-centric, collaborative application, myRecord, to re-introduce the patients as active participants into the telemonitoring setup. Finally, we introduce myRecord at Copenhagen University Hospital and evaluate the new practices and the collaborative technology related to the transformed role of the patients. RESULTS The interpretation of ICD data is a collaborative practice engaging clinicians and patients and involving three separate collaborative processes: interpretation of numbers; interpretation of general condition; and patients interpretation of own condition and ICD data. In a collocated setup, these three interpretation processes are entangled and seamlessly interrelated. However, in the current telemonitoring setup, only the interpretation of numbers process is fully supported, neglecting the two other processes, and, in particular, the role of the patient. By re-introducing patients into the socio-technical setup of telemonitoring through myRecord, our design acknowledges the collaborative nature of the interpretation process. However, re-introducing patients transforms their role, and leads to new transformed telemonitoring practices, different from both the current telemonitoring setup as well as from the collocated setup. CONCLUSION Telemonitoring practices of patients with ICDs involve three entangled collaborative processes, whereas the existing socio-technical setup only mediate one. myRecord is designed as an add-on collaborative technology to mediate the two remaining collaborative processes. We argue that myRecord solves some of the problems with ICD data interpretation inherent in telemonitoring practices by providing a collaborative, asynchronous space for healthcare practitioners and patients to mediate the two processes that are otherwise lost. Our new socio-technical design also transforms the role of patients considerably, thus new studies should take these insights into consideration.

A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients

INTRODUCTION The implementation of telemedicine often introduces major organizational changes in the affected healthcare sector. The objective of this study was to examine the organizational changes through the perception of the healthcare professionals regarding the implementation of a telemedical intervention. We posed the following research question: What are the key organizational factors in the implementation of telemedicine in wound care? METHODS In connection with a randomized controlled trial of telemedical intervention for patients with diabetic foot ulcers in the region of Southern Denmark, we conducted an organizational analysis. The trial was designed as a multidisciplinary assessment of outcomes using the Model of ASsessment of Telemedicine (MAST). We conducted eight semi-structured interviews including individual interviews with leaders, and an IT specialist as well as focus group interviews with the clinical staff. A qualitative data analysis of the interviews was performed in order to analyze the healthcare professionals and leaders perception of the organizational changes caused by the implementation of the intervention. RESULTS The telemedical setup enhanced confidence among collaborators and improved the wound care skills of the visiting nurses from the municipality. The effect was related to the direct communication between visiting nurses and specialist doctors. Focus on the training of the visiting nurses was highlighted as a key factor in the success to securing implementation. Concerns regarding lack of multidisciplinary wound care teams, patient responsibility and lack of patient interaction with the physician were raised. Furthermore, the need for clinical guidelines in future implementation was underlined. CONCLUSIONS Several influential factors were demonstrated in the analysis including visiting nurses wound care training, focus on management, economy, periods with absence from work and clinical care. However, the technology used here could provide an additional option to offer patients after an individual assessment of their health condition.

Methods & tools: constructive interaction and collaborative work: introducing a method for testing collaborative systems

This article focuses on how the constructive interaction method helps system designers determine whether the basic concepts underlying a system are well understood by users and whether its implementation, usability, and utility are satisfactory. We describe our experiences in using a form of constructive interaction to test a software package that supports a particular collaborative activity. The difference between our use of the constructive interaction method versus other models is that our test subjects use separate workstations in the same room to discuss their common tasks. Having thus adjusted the setting to the specific characteristics of computer-supported collaborative work, we asked each person to carry out separate sets of predefined tasks that were linked. Simply asking people whether they are satisfied with a newly introduced system does not suffice, because the reasons they give may not reflect their actual views or behavior [1]. To avoid the shortcomings of such a straightforward approach, the thinking aloud method has been used in order to both gain a more adequate understanding of how a person views a system and test the system’s usability [7]. In a standard thinking aloud test, a person has to work on a predefined task while continuously verbalizing his or her thoughts. This method yields a set of verbal utterances combined with actions about the task. The behavior of the person tested can be audioor videotaped, and analyzing several of those tests may reveal how people understand or misunderstand the computer system and how to reduce misunderstanding. However, this method clearly has drawbacks. First, interaction is limited because the user In trying to determine how people use

Participatory Design in Information Systems Development

This chapter deals with IT design in an organizational setting – be it a medium sized service company, a large industrial company, a small entrepreneurial knowledge company, or a public company or institution. In such work settings we often find a complex organizational structure, including several management levels, diverse professional groups, workplace cultures, and established working relations where new IT projects challenge the established ways-of-working. This is also the domain of ‘classic’ information systems development (ISD) approaches. This chapter presents the principles, key ideas, and experiences from using the participatory design method known as the ‘MUST method’, developed by the authors (Bodker et al. 2004).

Special issue on information infrastructures for healthcare: The global and local relation

Editorial Special issue on information infrastructures for healthcare: The global and local relation Information infrastructure for healthcare is a particular theoretical perspective that emphasizes the fundamental socio-technical nature of technology and practices. It stipulates that we need to include socio-material relations as part of the entangled infrastructures if we are to comprehend the complexity of information systems within healthcare. relations between patients and various healthcare institutions [2], disease management [14], patient sorting [15], and standardization [6,11], etc. While research within the field of healthcare information infrastructure is diverse, it is based upon some universal assumptions about information infrastructure: (a) it is embedded within social arrangements and technologies, (b) it is transparent in use by invisibly supporting routine tasks and activities, (c) it is spatial and temporal in scope – since the infrastructure might reach beyond single local sites and across time – (d) it is the embodiment of standards, and finally, (e) it only becomes visible during breakdowns [9, p. 35]. Clearly, information infrastructures in healthcare form many different entities, and it is within this field that researchers examine the precise nature of the various infrastructures that hold healthcare practices together. Although no journals dedicated exclusively to the field of information infrastructure for healthcare, the research community has been publishing in a range of very different venues. Based on a workshop dedicated to this topic, Bansler and Winthereik edited a special issue of the International Journal of Integrated Care [19]. In 2009, Bansler and Kensing organized the 2nd International Workshop on Information Infrastruc-tures for Healthcare, which formed the basis for a special issue of the journal Computer Supported Cooperative Work [5] focus-ing on the connection between practices across institutional and professional boundaries. These workshops and special issues helped foster an emerging international research community focusing on information infrastructures in healthcare. In the same period, and addressing perspectives and issues overlapping with the above initiatives, the International Journal of Medical Informatics published two special issues: one on socio-technical approaches [1], and another on collaborative practices [17]. Thus, this current special issue of the International Journal of Medical Informatics adds to a strand of research within IJMI and it puts special focus on the links and relations between the local and the global in information infrastructures for health-care. With local/global we refer to a distinction between the concrete practical circumstances of work in, for example, a small clinic (the local) and how …

Empowerment reconsidered

In this paper, we discuss the notion of empowerment in relation to healthcare and IT systems. By unfolding strategies to empower patients in healthcare, based on a specific case, we wish contribute to the discussion of IT based empowerment.

Challenges of participatory design for social innovation a case study in aging society

The purpose of the paper is to further our understanding of conditions for participatory design (PD). We base our reflections on an ongoing project to develop new ICT concepts for social innovation to mitigate consequences of the aging society as faced by a Japanese city. MUST was chosen since it is a PD method that has been successfully applied in commercial contexts in the US and in Scandinavia. However, we found that social innovation is a complex new territory for PD, both as to project management issues and in terms of conditions for applying tools and techniques for participatory analysis and design. Especially, we found that identifying and adequately engaging stakeholders to be problematic. The diverse set of user groups, potential customers, and IT-developers could not all be defined at the start. This calls for a different type of iteration than the MUST method suggests. Further, the method presumes the involved stakeholders to be able to spend more time in the project than the stakeholders in this project could commit to.

Property Determination by Prototyping

In our opinion one of the most serious problems in connection with the use of computers in organizations today, is that the properties of computer based systems (CBS) do not meet the requirements raised during the systems development process (SDP).1

Aligning Concerns in Telecare: Three Concepts to Guide the Design of Patient-Centred E-Health

The design of patient-centred e-health services embodies an inherent tension between the concerns of clinicians and those of patients. Clinicians’ concerns are related to professional issues to do with diagnosing and curing disease in accordance with accepted medical standards. In contrast, patients’ concerns typically relate to personal experience and quality of life issues. It is about their identity, their hopes, their fears and their need to maintain a meaningful life. This divergence of concerns presents a fundamental challenge for designers of patient-centred e-health services. We explore this challenge in the context of chronic illness and telecare. Based on insights from medical phenomenology as well as our own experience with designing an e-health service for patients with chronic heart disease, we emphasise the importance – and difficulty – of aligning the concerns of patients and clinicians. To deal with this, we propose a set of concepts for analysing concerns related to the design of e-health services: A concern is (1) meaningful if it is relevant and makes sense to both patients and clinicians, (2) actionable if clinicians or patients – at least in principle – are able to take appropriate action to deal with it, and (3) feasible if it is easy and convenient to do so within the organisational and social context. We conclude with a call for a more participatory and iterative approach to the design of patient-centred e-health services.

Testing a Smartphone App (Young with Diabetes) to Improve Self-Management of Diabetes Over 12 Months: Randomized Controlled Trial

Background Young people often struggle to self-manage type 1 diabetes during the transition from childhood to adulthood. Mobile health (mHealth) apps may have the potential to support self-management, but evidence is limited and randomized controlled trials are needed. Objective We assessed whether the mHealth app “Young with Diabetes” improved young people’s self-management measured by glycated hemoglobin (HbA1c) and three self-reported psychometric scales. Methods Young people (14-22 years) with inadequate glycemic control and their parents were enrolled in a randomized controlled trial and assigned either to Young with Diabetes and usual care (Young with Diabetes group) or to usual care alone (control). Young with Diabetes use was monitored; functions included a chat room, contact the health care provider, reminders, tips, information about the diabetes department and type 1 diabetes topics, carbohydrate counting, and a parents’ section. Outcomes included HbA1c and three self-reported psychometric scales: Perceived Competence in Diabetes Scale; Health Care Climate Questionnaire; and Problem Areas In Diabetes care survey. Data were collected at baseline and at 2, 7, and 12 months. Results A total of 151 young people were randomized (Young with Diabetes group=76, control=75) and 49 parents agreed to participate. At 12 months, HbA1c was significantly higher (4.1 mmol/mol; 0.4 %) in the Young with Diabetes group, compared to the control group (P=.04); this finding did not occur when comparing app users (Young with Diabetes use ≥5 days) with nonusers. Young people used Young with Diabetes on a mean of 10.5 days. They spent the most time chatting about alcohol and searching for information about sex. Most young people and half of the parents reported that Young with Diabetes helped them. More than 80% would recommend Young with Diabetes to peers. Conclusions Young with Diabetes did not improve HbA1c, but it may be a useful complement to self-management. Qualitative evaluation is needed to explore benefits and shortcomings of Young with Diabetes. Health care providers should address young peoples’ knowledge about sensitive topics, provide them with peer support, and be aware of parents’ need for information about how to support Trial Registration ClinicalTrials.gov NCT02632383; https://clinicaltrials.gov/ct2/show/NCT02632383 (Archived by WebCite at http://www.webcitation.org/6zCK2u7xM)