Negotiating scientific knowledge in the development of an eHealth MOOC.

Interdisciplinary team communication in eHealth development is challenging because all disciplines have unique, intrinsic discursive practices, theories and artefacts. Due to these factors, members of interdisciplinary teams can experience problems in communication and collaboration. Through a centered focus, members can benefit individually, inspire one another, and ultimately reach a timely delivery of their common pedagogical goal(s). Using the lens of dialogism, this paper aims to identify the conceptual considerations that arose during the development of a Massive Open Online Course (MOOC) for higher education in eHealth. Methods included auto-ethnography and interdisciplinary dialogue supported by literacy artefacts, including visual material. Results yielded a visual tool for meta-assessment of team communication, and an organizing principle for topics in the MOOC. A major implication is that especially for eHealth, scientific communicative competence of experts-while establishing a common understanding-can lead to a unique and meaningful delivery of high pedagogical quality.

Process mining for healthcare: Characteristics and challenges.

Process mining techniques can be used to analyse business processes using the data logged during their execution. These techniques are leveraged in a wide range of domains, including healthcare, where it focuses mainly on the analysis of diagnostic, treatment, and organisational processes. Despite the huge amount of data generated in hospitals by staff and machinery involved in healthcare processes, there is no evidence of a systematic uptake of process mining beyond targeted case studies in a research context. When developing and using process mining in healthcare, distinguishing characteristics of healthcare processes such as their variability and patient-centred focus require targeted attention. Against this background, the Process-Oriented Data Science in Healthcare Alliance has been established to propagate the research and application of techniques targeting the data-driven improvement of healthcare processes. This paper, an initiative of the alliance, presents the distinguishing characteristics of the healthcare domain that need to be considered to successfully use process mining, as well as open challenges that need to be addressed by the community in the future.

Mobile Sensing in Substance Use Research: A Scoping Review.

Background:Addictive disorders and substance use are significant health challenges worldwide, and relapse is a core component of addictive disorders. The dynamics surrounding relapse and especially the immediate period before it occurs is only partly understood, much due to difficulties collecting reliable and sufficient data from this narrow period. Mobile sensing has been an important way to improve data quality and enhance predictive capabilities for symptom worsening within physical and mental health care, but is less developed within substance use research.Methodology:This scoping review aimed to reviewing the currently available research on mobile sensing of substance use and relapse in substance use disorders. The search was conducted in January 2019 using PubMed and Web of Science.Results:Six articles were identified, all concerning subjects using alcohol. In the studies a range of mobile sensors and derived aggregated features were employed. Data collected through mobile sensing were predominantly used to make dichotomous inference on ongoing substance use or not and in some cases on the quantity of substance intake. Only one of the identified studies predicted later substance use. A range of statistical machine learning techniques was employed.Conclusions:The research on mobile sensing in this field remains scarce. The issues requiring further attention include more research on clinical populations in naturalistic settings, use of a priori knowledge in statistical modeling, focus on prediction of substance use rather than purely identification, and finally research on other substances than alcohol.

When information sharing is not enough.

This paper explores information sharing in multidisciplinary clinical collaboration between three hospitals. Our study draws on qualitative interviews with surgeons and radiologists in two county hospitals and one university hospital. The analysis shows that the actors shared a restricted amount of information about the patients they have in common and that different actors used the shared information in different ways. However, much communication was still needed to clarify and negotiate the meaning of shared data and its implications for collaborative care. To conclude, while the arguments for a shared information space may appear convincing, the communication practice observed should illustrate that IS also needs to support the communicative process in clinical collaborative work.

Research management in healthcare informatics - experiences from Norway.

This paper reports on the experiences with establishing a multidisciplinary healthcare informatics research community at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. A multidisciplinary research group in healthcare informatics must maintain strong connections to computer science, social science, biomedicine and healthcare researchers. Those organizing the research must create a milieu that fosters true collaboration across disciplines. The researchers must have good access to healthcare institutions, to healthcare professionals as well as to patients. A healthcare informatics laboratory creates an arena for experiments as well as for validation of health-it technologies.

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.

Epic's implementation of the Willow module and the healthcare workers involving in standardization.

BACKGROUND: Implementation of an electronic health record (EHR) that is fully integrated for clinical information, patient scheduling, and billing can effectively be shared by the entire healthcare community, both for the municipality and hospitals in Central Norway. The role and involvement of healthcare workers (HCW) in the implementation process might affect the standardization process. PURPOSE: This article focuses on the HCW' involvement in the Willow module's standardization and how they will support the adapted systems from Epic's implementation process of the electronic health record. METHODS: This is a descriptive 6-month follow-up study, based on observations of 35 directions and building sessions from August to January 2019 in the Willow module. Structured interviews of 20 informants in November were used to cross-check and validate the observations. The analytical approach was conducted in four general contexts: a) traditional, b) practical, c) emotional, and d) analytical, obtained from the contextual-content analysis. This is discussed based on the system theory. RESULTS: A) Traditional: Epic's normative perspective predominates with a tight agenda, questions that should be answered, focuses on standardization of workflow and concepts and had low degree of discussion and involvement, especially in direction sessions. b) Practical: HCW' involvement in standardization provides a high degree of practicality in the sessions, which is also a rational achievement. c) Emotional: The sessions' expressive and affective achievement is guided by the HCW' engagement in standardization, dependent on knowledge and background. d) Analytic: The HCW' intellectual involvement in the standardization of workflows and concepts will be, to some degree, an agreement of objective terms. CONCLUSIONS: HCW' involvement in standardization will have a supportive function. They will be involved in different contexts and be a part of the end product Willow module, even though Epic controls these.

How breast cancer patients want to search for and retrieve information from stories of other patients on the internet: an online randomized controlled experiment.

BACKGROUND: Other patients' stories on the Internet can give patients information, support, reassurance, and practical advice. OBJECTIVES: We examined which search facility for online stories resulted in patients' satisfaction and search success. METHODS: This study was a randomized controlled experiment with a 2x2 factorial design conducted online. We facilitated access to 170 stories of breast cancer patients in four ways based on two factors: (1) no versus yes search by story topic, and (2) no versus yes search by writer profile. Dutch speaking women with breast cancer were recruited. Women who gave informed consent were randomly assigned to one of four groups. After searching for stories, women were offered a questionnaire relating to satisfaction with the search facility, the stories retrieved, and impact of the stories on coping with breast cancer. Of 353 enrolled women, 182 (51.6%) completed the questionnaire: control group (n = 37), story topics group (n = 49), writer profile group (n = 51), and combination group (n = 45). RESULTS: Questionnaire completers were evenly distributed over the four groups (chi(2) (3) = 3.7, P = .30). Women who had access to the story topics search facility (yes vs no): were more positive about (mean scores 4.0 vs 3.6, P = .001) and more satisfied with the search facility (mean scores 7.3 vs 6.3, P < .001); were more positive about the number of search options (mean scores 2.3 vs 2.1, P = .04); were better enabled to find desired information (mean scores 3.3 vs 2.8, P = .001); were more likely to recommend the search facility to others or intend to use it themselves (mean scores 4.1 vs 3.5, P < .001); were more positive about how retrieved stories were displayed (mean scores 3.6 vs 3.2, P = .001); retrieved stories that better covered their information needs (mean scores 3.0 vs 2.6, P = .02); were more satisfied with the stories retrieved (mean scores 7.1 vs 6.4, P = .002); and were more likely to report an impact of the stories on coping with breast cancer (mean scores 3.2 vs 2.9, P =. 02). Three main effects were associated with use of the writer profile search (yes vs no): being more positive about (mean scores 3.9 vs 3.6, P = .005) and more satisfied with the search facility (mean scores 7.1 vs 6.5, P =. 01), and being more positive about how retrieved stories were displayed (mean scores 3.8 vs 2.9, P < .001). For satisfaction with the search facility, an interaction effect was found (P = .03): at least one of the two search facilities was needed for satisfaction. CONCLUSIONS: Having access to the story topics search facility clearly had the most positive effect on patient satisfaction and search success.

Peri-operative communication patterns and media usage--implications for systems design.

Inter-hospital communication amounts for a great deal of clinicians' work time. While communication is essential to coordinate care, it can also be time consuming and interruptive, and breakdown in communication is an important source of medical errors. One contributor to the interruptive nature of communication is the use of synchronous media, and there is clearly a potential for novel technologies. To assess communication patterns and media usage we performed an ethnographic field study in the peri-operative environment at a Norwegian hospital, as well as interviews with nurses. We analyze the results with regards to choice of media, characteristics of the conversations taking place and meta-messages, and account for addressing, obtrusiveness and information richness in the message exchanges. We find a relative high degree of interruptiveness in communication, and ascribe it to 1) a lack of situational awareness between locations in the peri-operative domain, as well as 2) use of synchronous media. This suggests that design of novel technology for intra-hospital communication should aim at supporting sender-receiver awareness and signaling of availability.

Computer-mediated mobile messaging as collaboration support for nurses.

Collaboration in hospitals is coordinated mainly by communication, which currently happens by face-to-face meetings, phone calls, pagers, notes and the electronic patient record. These habits raise problems e.g., delayed notifications and unnecessary interruptions. Dealing with these problems could save time and improve the care. Therefore we designed and prototyped a mobile messaging solution based on two specific scenarios coming from observations at a cardiology department of a Norwegian hospital. The main focus was on supporting the work of nurses. One prototype supported patient management while another one dealt with messages related to medication planning. The evaluation of the prototypes suggested that messaging-based collaboration support is worth to explore and also gave ideas for improvement.

Visualizing patient trajectories on wall-mounted boards - information security challenges.

Since operating room departments are among the costliest resources at a hospital, much attention is devoted to maximize their utilization. Operating room activities are however notoriously hard to plan in advance. This has to do with the unpredictable, problem-solving nature of the work and that the work is carried out by a multidisciplinary team of health personnel, members of which also have commitments outside the operating room department. We assume that operating room teams have the capacity to coordinate themselves and that coordination might be facilitated by visualizing relevant information on wall-mounted boards. To characterize clinical situations that require coordination and re-planning of the teams' work, we have developed a realistic scenario. We analyse and discuss the information security challenges that follow from displaying information on the whereabouts of other teams, actors and patients on wall-mounted boards in the operating rooms. Information security threats could be mitigated by de-identification techniques. Information demands could thereby be met without sacrificing the privacy of those whose information is displayed.

Revealing Work Practices in Hospitals Using Process Mining.

In order to improve health care processes (both in terms of quality and efficiency), we do need insight into how these processes are actually executed in reality. Interviewing health personnel and observing them in their work, are proven field-work techniques for gaining this insight. In this paper, we will introduce a complementary technique. This technique, called process mining, is based on the automatic analysis of digital events, registered in different information systems that support clinical work. Based on an event log, process mining can help in constructing a model of the process (discovery) or with checking to which extend an actual process confirms to a prescriptive model of it (conformance). This paper will briefly discuss two examples, which illustrate the use of process mining.

Illness stories on the Internet: features of websites disclosing breast cancer patients' illness stories in the Dutch language.

OBJECTIVE: To examine the way in which breast cancer patients' illness stories in the Dutch language are disclosed on the Internet. METHODS: Websites containing Dutch illness stories written by breast cancer patients were selected using a search engine on the Internet. A checklist was developed based on a theoretical framework for analysing communication processes in order to examine the selected websites. RESULTS: None of the websites implements search facilities based on either the content of an illness story, or the personal features of the author. A minority of the websites offers information about the illness stories, such as author's genuineness and editor's review. CONCLUSION: The Internet's opportunities are not fully utilized with respect to disclosing breast cancer patients' illness stories. PRACTICE IMPLICATIONS: In order to support a patient in finding appropriate illness stories in the diverse set of available stories, we are in the process of developing an application that combines symbolic and statistical natural language analysis techniques to facilitate content-based retrieval.

What makes an "informed patient"? The impact of contextualization on the search for health information on the Internet.

The Internet is nowadays a powerful medium and can help patients to become better-informed citizens. Increasingly, citizens are searching for health information on the Internet. The Internet-based resource often acts as a virtual healthcare professional. The effectiveness of the communication between the patient and the virtual healthcare professional depends partly upon the presence of contextual information. The issue here is to what extent the contextualization of information is needed for effective information seeking and for the person's understanding of the retrieved/received information. The impact of contextualization on information search also closely relates to the person's cognitive resources. Using a theoretical communication framework (Te'eni 2001), we explore contextualization in a health website, and discuss the above issues and the possible relevance of contextualized information on the informed patient.

Does revealing contextual knowledge of the patient's intention help nurses' handling of nurse calls?

OBJECTIVES: An inherent part of nurses' work is to handle nurse calls that often cause challenging interruptions to ongoing activities. In situations when nurses are interrupted by a nurse call, they need to decide whether to continue focusing on the task at hand or to abort and respond to the nurse call. The difficult decision is often influenced by a number of factors and can have implications for patient safety and quality of care. The study investigates how technology could be designed to support nurses' handling of nurse calls by allowing patients to communicate a more contextualised message revealing their intention to the nurse when issuing a nurse call. METHODS: Through a qualitative methodology employing a scenario-based design approach, three different nurse call system concepts are evaluated by nurses from different departments of a Norwegian university hospital. RESULTS: Nurses find the uncertainty of not knowing the reason behind a nurse call stressful in situations where they are required to prioritise either the calling patient or a patient they are currently nursing. Providing information about a patient's intention behind a nurse call influences the nurse's decision to various degrees depending on the situation in which they find themselves and the information that is communicated. The nurses' reflections suggested that the message communicated should be designed to contain neither too little nor too much information about the patient's needs. CONCLUSIONS: A nurse call system that allows nurses to discern the reason behind a nurse call allows them to make a more accurate decision and relieves stress. In particular, the information communicated would reduce uncertainty and lessen nurses' dependence on other factors in their decision. The design of such a system should, however, carefully consider the needs of the department in which it is deployed.

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.

Availability Communication: Requirements for an Awareness System to Support Nurses' Handling of Nurse Calls.

The recent development of mobile technologies allows nurses to receive different types of requests anywhere. However, the interruptions generated by these devices often presents a challenge for nurses in their daily work in a hospital department. In previous inquires we have investigated nurses' strategies to managing technology-mediated interruptions in the form of nurse calls. This study reports on an effort to co-design a system that supports an important strategy employed by nurses. Through the involvement of domain experts, the study elicits requirements for an awareness system to support nurses' collaborative effort in handling nurse calls.

The mantra of modeling and the forgotten powers of paper: A sociotechnical view on the development of process-oriented ICT in health care.

The recognition that restructuring care processes is central to effective and efficient health care will result in the emergence of process-oriented electronic patient records (EPRs). How will these technologies come into being? Within informatics, it is often stated that to informate something, we should first model it. This paper queries whether a detailed modeling of work processes and data flows is the primary step that needs to be completed before such EPRs can be developed or tailored. Building upon a sociotechnical understanding of ICT development, we argue for a reinterpretation of 'models' in such development processes. We do so through a reverse engineering of parts of the paper-based medical record, which has received little attention in medical informatics. In process-oriented EPR design, we argue, modeling should not be conceived as the crucial first step in this design, but rather as an intervention in the organizational change-processes that constitute proper ICT development.

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 month's 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.

Managing variations from surgical care plans: challenges for coordination.

INTRODUCTION: In surgical work there is a need for 'continuous planning' among staff to handle the frequently occurring variations from the planned patient treatment. In this paper, we present how three hospital information systems have support for three common patient trajectory variations. PURPOSE: Highlight how deviations from a plan cause different information needs and implications for design of awareness supporting computer systems. METHODS: Participant observations and semi-structured interviews with stakeholders involved in peri-operative work. RESULTS: When trajectories progress according to plan, information needs of staff seem to be minimal, as everything is "running to plan". However, when variations occur the information need increases. In order to provide better support for variations, awareness-support systems need to inform colleagues and other stakeholders about deviations from the plan. Plans and trajectories also need to be connected by projecting estimations of incidental time of ongoing relevant events. Additionally, end-users should have the option to switch between information-sparse and information-rich computer support.