Pernille Bertelsen

Video Observation in HIT Development: Lessons learned on Benefits and Challenges

BackgroundExperience shows that the precondition for the development of successful health information technologies is a thorough insight into clinical work practice. In contemporary clinical work practice, clinical work and health information technology are integrated, and part of the practice is tacit. When work practice becomes routine, it slips to the background of the conscious awareness and becomes difficult to recognize without the context to support recall. This means that it is difficult to capture with traditional ethnographic research methods or in usability laboratories or clinical set ups. Observation by the use of the video technique within healthcare settings has proven to be capable of providing a thorough insight into the complex clinical work practice and its context - including parts of the tacit practice. The objective of this paper is 1) to argue for the video observation technique to inform and improve health-information-technology development and 2) to share insights and lessons learned on benefits and challenges when using the video observation technique within healthcare settings.MethodsA multiple case study including nine case studies conducted by DaCHI researchers 2004–2011 using audio-visual, non-participant video observation for data collection within different healthcare settings.ResultsIn HIT development, video observation is beneficial for 1) informing and improving system design 2) studying changes in work practice 3) identifying new potentials and 4) documenting current work practices.ConclusionsThe video observation technique used within healthcare settings is superior to other ethnographic research methods when it comes to disclosing the complexity in clinical work practice. The insights gained are far more realistic compared to traditional ethnographic studies or usability studies and studies in clinical set ups. Besides, the data generated through video recordings provide a solid basis for dialog between the health care professionals involved. The most important lessons learned are that a well considered methodology and clear formulated objectives are imperative, in order to stay focused during the data rich analysis phase. Additionally, the video observation technique is primarily recommended for studies of specific clinical work practices within delimited clinical settings. Overall, the video observation technique has proven to be capable of improving our understanding of the interwoven relation between clinical work practice and HIT and to inform us about user requirements and needs for HIT, which is a precondition for the development of more successful HIT systems in the future.

eHealth Education of Professionals in the Baltic Sea Area

In this paper we present a study on the extent, level and content of e-Health in existing formal educational systems in Lithuania, Germany, Finland, Norway and Denmark with the objectives of identifying future educational needs within this area. The study was carried out as a desk-top study and took place within the context of the ICT for Health project. The results of the study on the one hand revealed a wide range of programs and courses that included e-Health, but on the other hand also showed that in the educations of health care professionals (physicians, nurses etc.) the integration of e-Health elements are often marginal or non-existing. Thus the study indicates that there is a need for a higher integration of e-Health in the education of health care professionals. We discuss what kind of knowledge of e-Health is needed and how it could or should be integrated in these educations. We argue that providing possibilities for applying and experimenting with e-Health system in a concrete and tangible manner is central in order to raise the acceptance and capabilities of health care professionals to use e-Health systems.

The work practice of medical secretaries and the implementation of electronic health records in Denmark

The introduction of electronic health records will entail substantial organisational changes to the clinical and administrative staff in hospitals. Hospital owners in Denmark have predicted that these changes will render up to half of medical secretaries redundant. The present study however shows that medical secretaries have a great variety of duties, and often act as the organisational ‘glue’ or connecting thread between other professional groups at the hospital. The aim of this study is to obtain a detailed understanding of the pluralism of work tasks the medical secretaries perform. It is concluded that clinicians as well as nurses depend on medical secretaries, and therefore to reduce the number of secretaries because electronic health record systems are implemented needs very careful thinking, planning and discussion with the other professions involved.

Challenges in Improving Health Care by Use of Health Informatics Technology

This chapter discusses the complementary role of Techno-Anthropological methodologies in relation to classical quantitative and qualitative methodologies. The chapter addresses the importance of evidencing the problems in health informatics and how these problems are framed in order to find appropriate solutions. It is the claim that problem based learning approaches (PBL) and inter-disciplinary teamwork is paramount in order to meet the current challenges of development and implementation of health informatics in the health care system. The triple aim of providing better health, better care at lower cost on a societal level is complemented by similar aims on an institutional and individual level in order to frame health informatics on a more holistic level. In order to achieve this goal we have to embrace concepts like co-creation and co-construction with users and actors. The aim of the chapter is condensed in methodological recommendations for Techno-Anthropological work in health informatics contexts.

Developments in Participatory Design of Health Information Technology – A Review of PDC Publications from 1990–2016

The landscape of Participatory Design (PD) of Health Information Technology (HIT) is diverse and constantly evolving. This paper reviews the publications in the proceedings from the Participatory Design Conferences (PDCs) that have been held every two years since 1990. We used the Matrix Method to identify, describe and synthesise HIT publications from the proceedings. A total of 47 papers were included in the review and analysed in relation to six themes. The analysis reveals a significant volume of HIT research at PDCs, with a large amount of attention to digitalisation of health information, work procedures, records, secondary healthcare and health professionals. However, the analysis also shows a development from a primary focus on health workers and hospitals to a recent attention on HIT in everyday life and PD with patients, relatives, neighbourhoods and citizens in general. Additionally, the review shows a growing number of PD methods being applied. This paper concludes that research on PD and HIT appears to be maturing and developing with ongoing technological and societal development.

Bringing new voices to design of exercise technology: participatory design with vulnerable young adults

Physical activity is important for peoples health, but it can be challenging especially for people who are vulnerable because of mental disorders. This paper contributes to participatory approaches developed to include vulnerable people in the design of exercise technology and situates participatory design to an exercise location and exercise activities. The results expand the current design space of exercise technology, which is dominated by sports enthusiasts and persuasive strategies. Visions for digital support that mediates local social exercise horizons are presented as a design alternative. The results exemplify that a participatory approach, which includes marginalized people in the design of technology, offers new knowledge for making existing and future applications useful to a broader audience. Specifically, the results point to opportunities for opening up the design space of health-promoting technology to support the cooperation of available health resources among residents in a community with attention to people who are in a vulnerable situation.

Using Video Observation to gain insight into complex clinical work practices

Experience shows that the precondition for development of successful health-information-technologies (HIT) is a thorough insight into clinical work practices. In contemporary clinical work practices, clinical work and health information technology are closely integrated. Research within Virtual Centre for Health Informatics at Aalborg University, Denmark have during recent years focused on video observation to supplementing traditional ethnographical research methods in providing insight into complex clinical work practices. The objective of this paper is to argue for the potentials of the video observation method to inform and to improve HIT development compared to traditional ethnographic methods. Based on several studies conducted within the healthcare sector, we find, that the video observation method is superior to other ethnographical research methods when it comes to rapidly disclosing the complexity in clinical sociomaterial work practices. We also find that the video techniques used in the healthcare context allows us to revisit the field of observation through the data, to broaden our initial focus and to share data with both the clinical staff involved and other researchers. Hence, it provides us a more in depth insight in the complex clinical sociomaterial work practices than when observing by the use of pen and paper.

Communication challenges in system development: involvement of system developers in small-scale IT projects.

A well-known challenge in system development is the aspect of user participation. In this paper we shift perspective from how to involve users in system development to how project managers with a clinical background, but without technical system knowledge, can involve system developers in IT projects. Using data from the development of an online patient book (an ICT application for clinical practice), we analyze challenges using the concept of language-games. We conclude that further research and development of participatory and communicative methods to involve system developers in IT projects, based in a clinical context, is needed.

MOVE: A Mobile App Designed for Social Health Relations in Residential Areas

This paper describes the design of MOVE, a mobile app to support people in forming social relations around exercise in residential areas. MOVE was developed in collaboration with residents and health professionals in a neighbourhood identified as a high-risk health area. The app is targeted to those who are motivated but challenged to do exercise and based on a conceptual model to provide users a social horizon of exercise activities in their residential area. We present the design and first evaluation of MOVE, including usability evaluations in controlled and natural settings. Results from these evaluations indicate that MOVE is a promising platform to support local social health relations once the identified usability problems are resolved.

Contradictions in digital health engagement: An activity tracker’s ambiguous influence on vulnerable young adults’ engagement in own health:

Objective Activity trackers are designed to support individuals in monitoring and increasing their physical activity. The use of activity trackers among individuals diagnosed with depression and anxiety has not yet been examined. This pilot study investigates how this target group engages with an activity tracker during a 10-week health intervention aimed to increase their physical activity level and improve their physical and mental health. Methods Two groups of 11 young adults (aged 18–29 years) diagnosed with depression or anxiety participated in the digital health intervention. The study used mixed methods to investigate the research question. Quantitative health data were used to assess the intervention’s influence on the participants’ health and qualitative data provided insights into the participants’ digital health experience. Results The study demonstrated an ambiguous influence from the use of an activity tracker with positive physical and mental health results, but a fading and even negative digital health engagement and counterproductive competition. Conclusions The ambiguous results identify a need for (1) developing strategies for health professionals to provide supervised use of activity trackers and support the target groups’ abilities to convert health information about physical activity into positive health strategies, and (2) designing alternatives for health promoting IT targeted users who face challenges and need motivation beyond self-tracking and competition.