Information handoffs in critical care and their implications for information quality: A socio-technical network approach.

OBJECTIVE: The design of health ICTs, as well as human factors, have been shown to influence patient information quality. The aim of this study was to understand how patterns of interaction between these factors influence information quality aspects in a critical care environment. METHOD: We conducted an ethnographic study of socio-technical information handoffs in a critical care unit. Data collection methods included non-participant observations and semi-structured interviews. Methodological principles from network analysis (SNA, VNA) were used to develop visual network diagrams, as well as to analyze the composition of the information network and its influence on patient information quality. RESULTS: The network patterns that emerged uncover that human actors have many information processing and dissemination roles at the critical care unit. However, ICTs play key network roles, acting as information intermediaries and gatekeepers. We further identify three types of information handoffs in the critical care environment - human-human, human-ICT and ICT-human. On the one hand, we find that human-human and ICT-human handoffs influence contextual and intrinsic aspects of patient information, such as information completeness and accuracy. On the other hand, human-ICT handoffs influence information accessibility and representational quality, such as consistency and interpretability. DISCUSSION: The results suggest that standardizing change of shift handoff communication may not be sufficient to prevent information decay in complex care trajectories. In particular, we argue that ensuring information consistency and interpretability across disciplines and professions is as important as ensuring information completeness and accuracy during change of shift handoffs. ICT and workflow design opportunities are discussed as means to address overlapping or conflicting information needs across disciplines and professions, increase information consistency, and reduce information redundancy across the network.

Mobile Health in Chronic Disease Management and Patient Empowerment: Exploratory Qualitative Investigation Into Patient-Physician Consultations.

BACKGROUND: Chronic diseases often present severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients' lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, the ability of patients to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening patients' voices and enabling them to assert control over their health and treatment. Mobile health (mHealth) provides cost-efficient means to support self-management and foster empowerment. OBJECTIVE: There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. The objective of this study is to address this knowledge gap by investigating how mHealth affects consultations and patient empowerment. METHODS: We relied on data from an ethnographic field study of 6 children and adolescents diagnosed with juvenile idiopathic arthritis. We analyzed 6 patient-physician consultations and drew on Michel Foucault's concepts of power and power technology. RESULTS: Our results suggest that the use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and correct their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients' lives related to the disease being ignored; thus, inadvertently, patients' voices may be silenced. CONCLUSIONS: Our results show that concrete uses of mHealth may conflict with extant literature on empowerment, which emphasizes the importance of strengthening the patients' voices and enabling patients to take more control of their health and treatment. We contribute to the state-of-the-art knowledge by showing that the use of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations.

Eliciting Information Needs of Child Patients: Adapting the Kano Model to the Design of mHealth Applications.

BACKGROUND: Health care services are increasingly being digitized, but extant literature shows that digital technologies and applications are often developed without careful consideration of user needs. Research is needed to identify and investigate best-in-class methods to support user-centered design of mHealth applications. OBJECTIVES: The article investigates how the Kano model can be adapted and used for the purpose of eliciting child patients' information needs during the design phase of mHealth application development. The aim is to demonstrate its applicability for collecting and analyzing patient-centered data that are key to designing technology-supported solutions for health management. METHODS: The article is based on a mixed-methods case study, which includes interviews with 21 patients aged 6 to 18. Structured interviews are analyzed based on prescriptions of the Kano model. Semi-structured interviews about child patients' information needs are analyzed thematically. RESULTS: The results demonstrate several improvements to the Kano model that take into account the difficulties of effectively communicating with child patients. The combination of two types of interviews offers unique insights into the what, how, and why of patients' needs. Adaptation of the Kano model, simplification of response options, and participation of child patients' parents in interviews facilitate data collection. CONCLUSION: The article shows how the Kano model can be adapted to provide an effective means of eliciting child patients' needs. Adapting the model by combining structured and semi-structured interviews makes it a powerful tool in designing mHealth applications.

The paradox of project success despite lack of the "My Pathway" telehealth platform usage.

The article investigates the paradoxical success of a Danish telehealth project introducing the "My Pathway" platform to reduce the length of patient stays while maintaining patient satisfaction. These goals were achieved in the project, which was considered successful despite the lack of actual platform usage. Based on a qualitative, longitudinal case study we investigate this paradox by showing how barriers and facilitators have influenced telehealth adoption and use in the post-implementation process, affecting the overall success of the project. The study makes two contributions. First, it describes dynamics of adoption barriers, that is, that barriers are interrelated and influence adoption to varying degrees over time. Adoption barriers resulted in the telehealth platform not being used and it consequently only influenced the actual project success and goal achievement indirectly. Second, it highlights information management as a critical facilitator in telehealth adoption and use. Information management facilitated achievement of project goals despite the lack of actual use of "My Pathway," which explains the paradoxical project success. Based on these interpretations, we point to information management as a critical facilitator of the success of telehealth initiatives and provide recommendations for research and practice.

Mobile App Support for Cardiopulmonary Resuscitation: Development and Usability Study.

BACKGROUND: The user requirements for in-hospital cardiopulmonary resuscitation (CPR) support apps are understudied. To study usability, functionality, and design based on user requirements, we applied a mixed methods research design using interviews, observations, and a Kano questionnaire to survey perspectives of both physicians and nurses. OBJECTIVE: This study aims to identify what an in-hospital CPR support app should include to meet the requirements and expectations of health care professionals by evaluating the CprPrototype app. METHODS: We used a mixed methods research design. The qualitative methods consisted of semistructured interviews and observations from an advanced life support (ALS) course; both provided input to the subsequent questionnaire development. The quantitative method is a questionnaire based on the Kano model classifying user requirements as must-be, one-dimensional (attributes causing satisfaction when present and dissatisfaction when absent), attractive, indifferent, and reverse (attributes causing dissatisfaction when present and satisfaction when absent). The questionnaire was supplemented with comment fields. All respondents were physicians and nurses providing ALS at hospitals in the Central Denmark Region. RESULTS: A total of 83 physicians and nurses responded to the questionnaire, 15 physicians and nurses were observed during ALS training, and 5 physicians were interviewed. On the basis of the Kano questionnaire, 53% (9/17) of requirements were classified as indifferent, 29% (5/17) as attractive, and 18% (3/17) as one-dimensional. The comments revealed 7 different categories of user requirements with noticeable differences between those of physicians and nurses: technological challenges, keep track of time, documentation and history, disturbing element, improvement areas: functions, improvement areas: design, and better guidance. CONCLUSIONS: The study provides recommendations to developers on the user requirements that need to be addressed when developing CPR support apps. Three features (one-dimensional attributes) must be incorporated in an in-hospital CPR support app: reminder of rhythm check, reminder of resuscitation drugs, and differentiate between adults and children. In addition, 5 features (attractive attributes) would result in higher user satisfaction: all functions on one side, access to the patient journal in the app, automatic time recording when cardiac arrest is called, sound to guide the chest compression rate (metronome), and send CPR history to the DANARREST(Danish in-hospital cardiac arrest registry) database.