Terje Solvoll

Web-based consultations for parents of children with atopic dermatitis: results of a randomized controlled trial

Aim: To analyse how web‐based consultations for parents of children with atopic dermatitis affect self‐management behaviour, health outcome, health resource use and family costs.

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.

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.

Policy-based Awareness Management (PAM): Case study of a wireless communication system at a hospital

The present paper evaluates the use of software agents to identify relevance of information, called awareness. This evaluation is based on existing policies and scenarios in the context of wireless communication of a hospital in Norway. The study is to address the lack of literature for experimental studies on a method to employ software agents for awareness identification. Research in computer supported cooperative work indicates the significant contributions of software agents to assist individuals. There are bodies of work that show awareness provides the means for software agents in which effective cooperation can take place. In addition, the role of the methods to identify awareness is emphasized in the literature of both computer supported cooperative work and software agents. This paper explains a step-wise process, called Policy-based Awareness Management, which allows agents to use policies as a source to identify awareness and thus change their behaviors accordingly. The contribution of this method is based on the concepts proposed by the logic of general awareness. The present study applies Directory Enabled Networks-next generation as the policy structure for the method. The paper evaluates the process via its application to identify the relevance of information in wireless communication scenarios in a hospital. The present study conducts observations, interviews and discussions on the wireless communication system of the hospital to identify the different scenarios happening in the system. The paper presents a set of simulations on these scenarios and concludes that the method is effective and cost-efficient.

Maintaining awareness using policies; Enabling agents to identify relevance of information

The field of computer supported cooperative work aims at providing information technology models, methods, and tools that assist individuals to cooperate. The presented paper is based on three main observations from literature. First, one of the problems in utilizing information technology for cooperation is to identify the relevance of information, called awareness. Second, research in computer supported cooperative work proposes the use of agent technologies to aid individuals to maintain their awareness. Third, literature lacks the formalized methods on how software agents can identify awareness. This paper addresses the problem of awareness identification. The main contribution of this paper is to propose and evaluate a formalized structure, called Policy-based Awareness Management (PAM). PAM extends the logic of general awareness in order to identify relevance of information. PAM formalizes existing policies into Directory Enabled Networks-next generation structure and uses them as a source for awareness identification. The formalism is demonstrated by applying PAM to the space shuttle Columbia disaster occurred in 2003. The paper also argues that efficacy and cost-efficiency of the logic of general awareness will be increased by PAM. This is evaluated by simulation of hypothetical scenarios as well as a case study.

CallMeSmart: An Ascom/Trixbox Based Prototype for Context Controlled Mobile Communication in Hospitals

Hospitals are working environments where information is constantly exchanged between co-workers over a complex communication infrastructure. In order to support the needs of hospital professionals, this infrastructure should provide the possibility to exchange important information as quickly as possible and, at the same time, contact colleagues without interrupting their working activities unnecessarily. Interruptions are unpleasant situations and a source of stress and distraction that may increase the probability of taking wrong decisions. Currently, hospital communication infrastructure relies on the use of pagers which create a large amount of unnecessary interruptions. Wireless phones are less utilized, but as opposed to pagers they provide text and audio services in the same device. With a suitable context-aware system it should be capable of balance interruptions and thereby provide solutions able to efficiently support the work of hospital professionals. The system has been developed using the iterative software engineering approach, Unified Process. The system is able to block and re-route calls directed to users that are not available due to their location, work schedule, activity and role. A number of tests have been carried out after the development, and highlighted some changes that have to be made before being deployed in real hospital environments.

The workload of web-based consultations with atopic eczema patients at home

BackgroundAtopic eczema is a chronic inflammatory non-contagious skin disease characterised by intensive itch and inflamed skin. Due to its chronic and relapsing course atopic eczema imposes a great burden on affected families. Review articles about home care telemedicine have indicated advantageous effects of home telehealth. However, few studies have investigated how home care telemedicine applications affect the workload of the clinician.MethodsThe use of a web-based counselling system was recorded through computerised logging. The doctor who answered the requests sent via the Internet recorded the amount of time needed for reading and answering 93 consecutive requests.ResultsThe time needed by the physician to read and answer a request was less than 5 minutes in 60% of the cases. The doctor spent significantly more time to answer requests that had photographs attached compared to requests without photographs (P = 0.005). The time needed to answer requests received during the winter season (October-March) was significantly longer than the rest of the year (P = 0.023). There was no correlation between the answering time and the age of the patient.ConclusionsIndividual web-based follow-up of atopic eczema patients at home is feasible. The amount of time needed for the doctor to respond to a request from the patient appears to be small. The answering time seems to depend on whether photographs are supplied and also on seasonal variations of disease activity. Since the management of atopic eczema is complex involving many different types of treatments and educational aspects, we expect this type of communication to be useful also to other chronic disease patients requiring close follow-up.