Simon B. Larsen

Telemedical treatment at home of diabetic foot ulcers

The treatment of diabetic foot ulcers may not always be well organized and not all patients have access to expert evaluation. We investigated the use of telemedicine to enable a visiting nurse (in the patients home) to coordinate the treatment with experts (at the hospital). The equipment consisted of a UMTS videophone and an Internet-based patient record. Field studies were carried out at the outpatient clinic and by following visiting nurses. A total of 15 participants were invited to five workshops and experiments held in our laboratories, at the hospital, and between hospital and patients’ homes. Finally, in a pilot test, five patients were offered three teleconsultations at their homes in lieu of visits to the hospital. Preliminary results were promising: (1) both clinicians and patients found the equipment easy to use; (2) the doctor could prescribe treatment at a distance; (3) the visiting nurse had realtime contact with the hospital and treatment could begin immediately according to the doctors orders; (4) the patient saved time in not having to travel to the hospital.

Treatment of diabetic foot ulcers in the home: video consultations as an alternative to outpatient hospital care

The aim of this study was to investigate whether video consultations in the home can support a viable alternative to visits to the hospital outpatient clinic for patients with diabetic foot ulcers. And furthermore whether patients, relatives, visiting nurses, and experts at the hospital will experience satisfaction and increased confidence with this new course of treatment. Participatory design methods were applied as well as field observations, semistructured interviews, focus groups, and qualitative analysis of transcriptions of telemedical consultations conducted during a pilot test. This study shows that it is possible for experts at the hospital to conduct clinical examinations and decision making at a distance, in close cooperation with the visiting nurse and the patient. The visiting nurse experienced increased confidence with the treatment of the foot ulcer and characterized the consultations as a learning situation. All patients expressed satisfaction and felt confidence with this new way of working.

Competence articulation: alignment of competences and responsibilities in synchronous telemedical collaboration

Many studies and concepts within CSCW deal with the temporal, spatial, social, and computational aspects of supporting collaborative work. In this paper we want to pay attention to another central aspect to the achievement of collaborative work, namely the competence of the people involved. In particular, we want to look at the dynamic quality of competences, and investigate how competence is mutually developed in coordinated work. We have termed this process competence articulation, a concept which tries to emphasize competence as well as social development of competence as part of cooperation. The concept has emerged out of a longitudinal participatory design process investigating telemedical treatment of diabetic foot ulcers using video phones. We analyze the transitions occurring with the introduction of synchronous telemedical consultations and detail how the online video facilitates communication options for competence articulation, which again improve collaboration and thus the quality of the treatment.

Cooperation versus coordination: using real-time telemedicine for treatment at home of diabetic foot ulcers

In conventional treatment the patient with a diabetic foot ulcer travels to hospital for consultations with the experts. We conducted an organizational analysis of the cooperation taking place when telemedicine was used for treatment at home instead. In a pilot study, five patients were offered three video consultations in their home, replacing visits to the outpatient clinic. The equipment consisted of mobile videophones and an online ulcer record. The introduction of simultaneous communication between all participants solved the problem of the patient having to act as messenger between the hospital and the visiting nurse; there were other benefits as well. However, this new organization required increased efforts for coordination and may have incurred extra costs in the case of delays. Thus when designing telemedicine systems, the goal should be to facilitate the coordination and lower the barriers to real-time communication, but at the same time provide mechanisms for asynchronous communication in situations where synchronous communication is not possible.

Beyond the Archive: Thinking CSCW into EHRs for Home Care

The current electronic health records (EHR) are not build to adequately support pervasive healthcare, but overcoming certain challenges could change that. In this paper we explicate that point by presenting results of applying participatory design to two scenarios: treating diabetic foot ulcers at home, and providing support for women during their pregnancy. In particular, the contributions of this paper are: (1) to explicate the diversity of the domain, and how this leads to complex issues in practice, (2) to present four particular issues that need to be addressed in the design of EHRs as found through application of participatory design in our two scenarios, (3) to establish promising approaches to handling those four issues, and (4) to present the core of a software architecture that supports these approaches