Jeremiah Scholl

A case study of an EMR system at a large hospital in India: Challenges and strategies for successful adoption

This paper presents an ethnographically inspired interpretive case study of the Electronic Medical Record (EMR) system at Sankara Nethralaya hospital in India. It presents challenges related to the adoption of the system and methods and strategies that were utilized in order to overcome these challenges and help the system be adopted successfully. One of the more notable challenges at the hospital was a user base that included skeptical users, those lacking computing skills, and that had a history of rejecting designs. Despite these barriers the hospital was able to adopt the EMR system successfully. Notable issues related to the success of the system include the design strategy that was eventually used, and critical technical and social features of the system intended to support skeptical users and those lacking IT skills. The study contributes to overall understanding of the environment at large hospitals in developing countries as it relates to the adoption of EMR systems, and helps inform on methods that can be used to improve the adoption of EMR systems in similar contexts in both developed and developing countries.

Managing communication availability and interruptions: a study of mobile communication in an oncology department

Wireless phones and text messaging are tremendously popular in many areas of society. However, they are still relatively unused in hospitals where pagers are a pervasive communication device that is notoriously difficult to replace. This paper studies pager and wireless phone use at the oncology department at University Hospital of North Norway. Participatory observation and interviews with physicians are used to provide qualitative analysis about the use, drawbacks and benefits of both technologies. A number of important issues are addressed that should aid designers of next generation mobile communication systems for hospitals. In particular, the data points towards specific features that will be crucial for the overall usability and acceptance of an integrated device that supports paging, voice and text services. Of particular importance will be features that allow users to manage their communication availability and avoid interruptions.

Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China

BACKGROUND Chinas healthcare system often struggles to meet the needs of its 900 million people living in rural areas due to major challenges in preventive medicine and management of chronic diseases. Here we address some of these challenges by equipping village doctors (ViDs) with Health Information Technology and developing an electronic health record (EHR) system which collects individual patient information electronically to aid with implementation of chronic disease management programs. METHODS An EHR system based on a cloud-computing architecture was developed and deployed in Xilingol county of Inner Mongolia using various computing resources (hardware and software) to deliver services over the health network using Internet when available. The system supports the work at all levels of the healthcare system, including the work of ViDs in rural areas. An analysis done on 291,087 EHRs created from November 2008 to June 2011 evaluated the impact the EHR system has on preventive medicine and chronic disease management programs in rural China. RESULTS From 2008 to 2011 health records were created for 291,087 (26.25%) from 1,108,951 total Xilingol residents with 10,240 cases of hypertension and 1152 cases of diabetes diagnosed and registered. Furthermore, 2945 hypertensive and 305 diabetic patients enrolled in follow-up. Implementing the EHR system revealed a high rate of cholecystectomies leading to investigations and findings of drinking water contaminated with metals. Measures were taken to inform the population and clean drinking water was supplied. CONCLUSIONS The cloud-based EHR approach improved the care provision for ViDs in rural China and increased the efficiency of the healthcare system to monitor the health status of the population and to manage preventive care efforts. It also helped discover contaminated water in one of the project areas revealing further benefits if the system is expanded and improved.

Strategies to reduce interruptions from mobile communication systems in surgical wards

We conducted interviews with two surgeons from the department of gastrointestinal surgery at the University Hospital of North Norway. The results confirmed that interruptions from mobile devices were a problem, especially in surgical theatres, outpatient wards, emergency wards and inpatient rooms. Users in hospitals, especially surgeons and physicians, need a better communication system. Our proposed system would intercept the signals from the existing communication system before they are sent out to the mobile devices. The signals would then be routed through a context-aware system, paired with context information and available rules defined by the doctor, which will decide what to do with the call/page. A single device which integrates both the pager and the phone system, and makes use of context information to control interruptions automatically yet allow the caller to decide whether to interrupt, would be highly appreciated by the users.

LabPush: A Pilot Study of Providing Remote Clinics with Laboratory Results via Short Message Service (SMS) in Swaziland, Africa

Background Turnaround time (TAT) is an important indicator of laboratory performance. It is often difficult to achieve fast TAT for blood tests conducted at clinics in developing countries. This is because clinics where the patient is treated are often far away from the laboratory, and transporting blood samples and test results between the two locations creates significant delay. Recent efforts have sought to mitigate this problem by using Short Message Service (SMS) to reduce TAT. Studies reporting the impact of this technique have not been published in scientific literature however. In this paper we present a study of LabPush, a system developed to test whether SMS delivery of HIV related laboratory results to clinics could shorten TAT time significantly. Method LapPush was implemented in six clinics of the Kingdom of Swaziland. SMS results were sent out from the laboratory as a supplement to normal transport of paper results. Each clinic was equipped with a mobile phone to receive SMS results. The laboratory that processes the blood tests was equipped with a system for digital input of results, and transmission of results via SMS to the clinics. Results Laboratory results were received for 1041 different clinical cases. The total number of SMS records received (1032) was higher than that of paper records (965), indicating a higher loss rate for paper records. A statistical comparison of TAT for SMS and paper reports indicates a statistically significant improvement for SMS. Results were more positive for more rural clinics, and an urban clinic with high workload. Conclusion SMS can be used to reduce TAT for blood tests taken at clinics in developing countries. Benefits are likely to be greater at clinics that are further away from laboratories, due to the difficulties this imposes on transport of paper records.

Physicians Interrupted by Mobile Devices in Hospitals: Understanding the Interaction Between Devices, Roles, and Duties

Background A common denominator of modern hospitals is a variety of communication problems. In particular, interruptions from mobile communication devices are a cause of great concern for many physicians. Objective To characterize how interruptions from mobile devices disturb physicians in their daily work. The gathered knowledge will be subsequently used as input for the design and development of a context-sensitive communication system for mobile communications suitable for hospitals. Methods This study adheres to an ethnographic and interpretive field research approach. The data gathering consisted of participant observations, non-structured and mostly ad hoc interviews, and open-ended discussions with a selected group of physicians. Eleven physicians were observed for a total of 135 hours during May and June 2009. Results The study demonstrates to what degree physicians are interrupted by mobile devices in their daily work and in which situations they are interrupted, such as surgery, examinations, and during patients/relatives high-importance level conversations. The participants in the study expected, and also indicated, that wireless phones probably led to more interruptions immediately after their introduction in a clinic, when compared to a pager, but this changed after a short while. The unpleasant feeling experienced by the caller when interrupting someone by calling them differs compared to sending a page message, which leaves it up to the receiver when to return the call. Conclusions Mobile devices, which frequently interrupt physicians in hospitals, are a problem for both physicians and patients. The results from this study contribute to knowledge being used as input for designing and developing a prototype for a context-sensitive communication system for mobile communication suitable for hospitals. We combined these findings with results from earlier studies and also involved actual users to develop the prototype, CallMeSmart. This system intends to reduce such interruptions and at the same time minimize the number of communication devices needed per user.

Telemedicine utilization to support the management of the burns treatment involving patient pathways in both developed and developing countries: a case study.

This case study reports on the utilization of telemedicine to support the management of the burns treatment in the islands of Sao Tome and Principe by Taipei Medical University-affiliated hospital in Taiwan. The authors share experiences about usage of telemedicine to support treatment of the burn victims in a low-income country that receive reconstructive surgery in a developed country. Throughout the entire care process, telemedicine has been used not only to provide an expert advice from distance but also to help establish and maintain the doctor-patient relationship, to keep patients in contact with their families, and to help educate and consult the medical personal physically present in Sao Tome and Principe. This case study presents the details of how this process has been conducted to date, on what were learned from this process, and on issues that should be considered to improve this process in the future. The authors plan to create instructional videos and post them on YouTube to aid clinical workers providing similar treatment during the acute care and rehabilitation process and also to support eLearning in many situations where it otherwise is not possible to use videoconferencing to establish real-time contact between doctors at the local site and remote specialists.

Garbage in, garbage out: extracting disease surveillance data from epr systems in primary care

This paper presents an interpretive case study on extraction of disease surveillance data from Electronic Patient Records (EPRs) in primary care. The General Practitioners (GPs) use of the EPR system, and the effect this has on data content, such as symptoms reported by patients and diagnoses reported by GPs, is discussed. The paper contributes to greater understanding of sociotechnical issues related to disease surveillance, and contains illustrative examples of many issues important to CSCW. This includes how data collected in one context may be applied to a different context, and the delicate interplay between organizational and technical design challenges.

The incidence rate and mortality of malignant brain tumors after 10 years of intensive cell phone use in Taiwan.

The issue of whether cell phone usage can contribute toward the development of brain tumors has recently been reignited with the International Agency for Research on Cancer classifying radiofrequency electromagnetic fields as ‘possibly’ carcinogenic to humans in a WHO report. To our knowledge, this is the largest study reporting on the incidence and mortality of malignant brain tumors after long-term use of the cell phone by more than 23 million users. A population-based study was carried out the numbers of cell phone users were collected from the official statistics provided by the National Communication Commission. According to National Cancer Registry, there were 4 incidences and 4 deaths due to malignant neoplasms in Taiwan during the period 2000–2009. The 10 years of observational data show that the intensive user rate of cell phones has had no significant effect on the incidence rate or on the mortality of malignant brain tumors in Taiwan. In conclusion, we do not detect any correlation between the morbidity/mortality of malignant brain tumors and cell phone use in Taiwan. We thus urge international agencies to publish only confirmatory reports with more applicable conclusions in public. This will help spare the public from unnecessary worries.

Of organization, device and context: Interruptions from mobile communication in highly specialized care

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.