Pieter J. Toussaint

From Low-Level Events to Activities - A Pattern-Based Approach

Process mining techniques analyze processes based on event data. A crucial assumption for process analysis is that events correspond to occurrences of meaningful activities. Often, low-level events recorded by information systems do not directly correspond to these. Abstraction methods, which provide a mapping from the recorded events to activities recognizable by process workers, are needed. Existing supervised abstraction methods require a full model of the entire process as input and cannot handle noise. This paper proposes a supervised abstraction method based on behavioral activity patterns that capture domain knowledge on the relation between activities and events. Through an alignment between the activity patterns and the low-level event logs an abstracted event log is obtained. Events in the abstracted event log correspond to instantiations of recognizable activities. The method is evaluated with domain experts of a Norwegian hospital using an event log from their digital whiteboard system. The evaluation shows that state-of-the art process mining methods provide valuable insights on the usage of the system when using the abstracted event log, but fail when using the original lower level event log.

Shared decision making needs a communication record

Increasing dependability in collaboration work among health professionals will directly improve patient outcomes, and reduce healthcare costs. Our research examines the development of a shared visual display to facilitate data entry and validation of an electronic record during multidisciplinary team meeting discussion, where specialists discuss patient symptoms, test results, and image findings. The problem of generating an electronic record for patient files that will serve as a record of collaboration, communication and a guide for later tasks is addressed through use of the shared visual display. Shortcomings in user-informed designed, structured data-entry screens became evident when in actual use. Time constraints prompt the synopsis of discussion in acronyms, free text, abbreviations, and the use of inferences. We demonstrate how common ground, team cohesiveness and the use of a shared visual display can improve dependability, but these factors can also provide a false sense of security and increase vulnerability in the patient management system.

Instant messaging at the hospital: Supporting articulation work?

INTRODUCTION Clinical work is increasingly fragmented and requires extensive articulation and coordination. Computer systems may support such work. In this study, we investigate how instant messaging functions as a tool for supporting articulation work at the hospital. PURPOSE This paper aims to describe the characteristics of instant messaging communication in terms of number and length of messages, distribution over time, and the number of participants included in conversations. We also aim to determine what kind of articulation work is supported by analysing message content. METHODS Analysis of one months worth of instant messages sent through the perioperative coordination and communication system at a Danish hospital. RESULTS Instant messaging was found to be used extensively for articulation work, mostly through short, simple conversational exchanges. It is used particularly often for communication concerning the patient, specifically, the coordination and logistics of patient care. Instant messaging is used by all actors involved in the perioperative domain. CONCLUSION Articulation work and clinical work are hard to separate in a real clinical setting. Predefined messages and strict workflow design do not suffice when supporting communication in the context of collaborative clinical work. Flexibility is of vital importance, and this needs to be reflected in the design of supportive communication systems.

Coping with the unforeseen in surgical work

OBJECTIVE The purpose of this study was to investigate how staff working in the perioperative domain copes with unforeseen events and in what way, if at all; they are supported in this by formal systems such as information systems. DESIGN Case study. We conducted our study in the Department of Surgery in a large academic hospital in Norway. The department consists of eight operating rooms for planned surgery. The study included observations and interviews, in addition to one design workshop with health personnel. We focused on planned surgery. RESULTS Our observations showed that unforeseen events that cause deviations from plans are characteristic and that staff apply different coping strategies to make the plan work regardless. Support of these coping strategies by formal systems is poor. DISCUSSION We used the concept of high-reliability organisations as proposed by Weick and Sutcliffe, 2007, to analyse the observed coping strategies. The coping strategies can be seen as examples of the principles for managing the unexpected that Weick and Sutcliffe propose. IT support for this must include both awareness-creating systems and systems that enable workers to control the effects of unforeseen events once they have occurred.

Personal health information on display: balancing needs, usability and legislative requirements.

Large wall-mounted screens placed at locations where health personnel pass by will assist in self-coordination and improve utilisation of both resources and staff at hospitals. The sensitivity level of the information visible on these screens must be adapted to a close-to-public setting, as passers-by may not have the right or need to know anything about patients being treated. We have conducted six informal interviews with health personnel in order to map what kind of information they use when identifying their patients and their next tasks. We have compared their practice and needs to legislative requirements and conclude that it is difficult, if not impossible, to fulfil all requirements from all parties.

Enriching events to support hospital care

In this paper, we describe event processing in the medical domain, a domain which poses a number of extra challenges to event processing. A preliminary event middleware architecture is presented along with the objectives (and research methods used) with relation to the COSTT project. We conclude with some preliminary results and further work.

Exchange of Information Between Hospital and Home Health Care: A Longitudinal Perspective.

In this paper we present a longitudinal perspective of exchange of information providers in hospital and home health care. More specifically we address how this practice has changed over the last six years. In three different studies we have investigated how the information exchange between hospital and home health care throughout a patient transition from admission to discharge has changed over the last six years. The information processes have gone from being mainly paper-based to being digitalized. However, there are still professional challenges to overcome which may contribute to improvements for patients in transition.

Patients in Transition: E-Messages as a Tool for Collaboration between Hospital and Community Healthcare -- A Norwegian Case

To strengthen collaboration between hospitals and community healthcare in Norway, an electronic messaging system was introduced. We argue that technology support for collaboration can be understood in terms of the concepts of collaboration embedded in the technology (workflow, information exchange, and communication). We analyze the e-messaging system from these three perspectives and show that its relative success is a result of how the system supports all three collaboration ideas.

Developing a framework for evaluation of technology use at multidisciplinary meetings in healthcare

Identifying an appropriate method to evaluate the use of technology during patient case discussions at multidisciplinary medical team (MDT) meetings, is problematic. A number of approaches conducted over an extended period of study are described and the lessons learned are explained. A framework is proposed to serve as a basis for evaluation of technology use in these complex collaborative work settings that incorporates hospital, technology and people perspectives.

Validity and responsiveness of the Rehabilitation Activities Profile (RAP) in patients with rheumatoid arthritis

Objective: To investigate the internal consistency, validity and responsiveness of the Rehabilitation Activities Profile (RAP; a rehabilitation tool structuring the multidisciplinary team care process) in patients with rheumatoid arthritis. Methods: In 85 rheumatoid arthritis patients admitted to a rheumatology clinic the RAP was applied at admission, at discharge, and six weeks thereafter. Additional assessments included measures of physical and psychological functioning, disease activity and quality of life. The internal consistency of the RAP was determined with Cronbachs alpha. Associations between the RAP and other outcome measures were determined by Spearman rank correlation coefficients. Responsiveness measures included the standardized response mean (SRM), effect size (ES) and responsiveness ratio (RR). Results: Cronbachs alpha of the RAP total score was 0.78. The RAP total score correlated significantly with all other outcome measures. The mean RAP total score improved from 15.2 to 13.2 at discharge (change -2.0; 95% confidence interval (CI) -3.4 to -0.7) and to 11.5 (change -3.7; 95% CI -3.9 to -1.5) six weeks thereafter. The responsiveness of the RAP total score was low (standardized response mean -0.34, effect size -0.30) to high (responsiveness ratio -0.87) at discharge and moderate (standardized response mean -0.54, effect size -0.55) to high (responsiveness ratio -1.56) six weeks thereafter. Conclusions: The RAP appeared to be an internally consistent, valid and responsive measure to reflect limitations on the level of activities and participation in patients with rheumatoid arthritis admitted for multidisciplinary team care.