Kristina Groth

The role of technology in video-mediated consensus meetings

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.

Medical team meetings: utilising technology to enhance communication, collaboration and decision-making

Medical team meetings : utilising technology to enhance communication, collaboration and decision-making

Efficiency in treatment discussions: A field study of time related aspects in multi-disciplinary team meetings

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.

References to personal experiences and scientific evidence during medical multi-disciplinary team meetings

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.

Telemedicine: an important aid to perform high-quality endoscopic retrograde cholangiopancreatography in low-volume centers

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 patients 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 transhepatic 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.

Interaction design in a complex context: medical multi-disciplinary team meetings

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.

Medicine meets engineering in cooperative design of collaborative decision-supportive system

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.

Pointing in multi-disciplinary medical meetings

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.

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.

Simple and playful interaction for informal communication and learning

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.