Evaluation of the Technology Acceptance of a Collaborative Documentation System for Addiction Therapists and Clients.

Addiction treatment outcomes are strongly determined by relational factors. We present the interactive documentation system Tele-Board MED (TBM) developed as an adjunct to therapy sessions aimed at enhancing the therapeutic alliance and patient empowerment. The objective of this work is to find factors that predict the acceptance of TBM in face-to-face addiction treatment sessions. We combined the methodologies of survey and focus group and based the data collection and analysis on the Unified Theory of Acceptance and Use of Technology. The studies, which involved therapists (n=13) and clients (n=33), were conducted in an addiction counselling center in Germany. Therapists see a flexible, context-dependent usage as a basic condition for TBM acceptance and its greatest benefit in providing a discussion framework and quick access to worksheets-in both individual and group sessions. Clients are inclined to use the system with the expectation of improved communication and better recall of the discussed topics based on a personal copy of the session notes.

Juggling Doctor and Patient Needs in Mental Health Record Design.

Providing patients access to mental health records is a controversial topic that gains growing attention in research and practice. While it has great potential in increasing the patient engagement, skepticism is prevailing among therapists who fear detrimental effects and face a lack of feasibility when treatment notes are handwritten. We aim at empowering both therapists to new documentation approaches and patients to higher engagement, and develop the collaborative documentation system Tele-Board MED (TBM) as an adjunct to talk-based mental health interventions. We present an evaluation of TBM by comparing four prototypes and testing scenarios, reaching from early simulations to attempts of real-life implementations in clinical routines. This paper delivers a systematic need comparison of therapists as primary users and patients as secondary users, both during and beyond treatment sessions. While patient feedback is thoroughly positive, the therapist needs are only partially addressed; the benefits remain hidden behind the perceived effort.

Establishing Therapeutic Alliance in Mental Health Care via Cooperative Documentation.

In talk-based mental health interventions, treatment outcomes can be decisively improved by enhancing the relationship between patient and therapist. We developed the interactive documentation system Tele-Board MED (TBM) with the goal of supporting patients and doctors in their cooperative task of patient care. The system offers a whiteboard-inspired graphical user interface which allows them to take notes jointly during the treatment session. Two proxy studies were conducted whereby TBM was introduced in a role play that showcased the dialogue in a therapy session. The patient role was played by a volunteer. The audience of human-centered design as well as eHealth experts rated the therapist-patient relationship in a session with and without TBM. The data collected via questionnaires shows that TBM consistently receives a positive rating from study participants (N = 36) in the areas of collaboration, communication, patient-doctor relationship, as well as patient empowerment.

Patient-Provider Teamwork via Cooperative Note Taking on Tele-Board MED.

There is significant, unexploited potential to improve the patients' engagement in psychotherapy treatment through technology use. We develop Tele-Board MED (TBM), a digital tool to support documentation and patient-provider collaboration in medical encounters. Our objective is the evaluation of TBM's practical effects on patient-provider relationships and patient empowerment in the domain of talk-based mental health interventions. We tested TBM in individual therapy sessions at a psychiatric ward using action research methods. The qualitative results in form of therapist observations and patient stories show an increased acceptance of diagnoses and patient-therapist bonding. We compare the observed effects to patient-provider relationship and patient empowerment models. We can conclude that the functions of TBM - namely that notes are shared and cooperatively taken with the patient, that diagnostics and treatment procedures are depicted via visuals and in plain language, and that patients get a copy of their file - lead to increased patient engagement and an improved collaboration, communication and integration in consultations.

Supporting talk-based mental health interventions with digital whiteboards.

The potential of mental health interventions supported by computers has rarely been explored to date, and the use of technology has hence been limited. There is a need for finding new ways of providing engaging psychotherapy services. We introduce the digital whiteboard system Tele-Board MED (TBM) as a new approach of promoting patient-therapist interaction and joint documentation. Based on observations of cognitive behavioral therapy (CBT) sessions and a text material review we identified possibly useful features. We conducted a qualitative and quantitative feedback study with 34 therapists in the form of a questionnaire based on a video showing the system's fundamental concept and features. This allowed us to evaluate the therapists' attitudes and the ability of a system like TBM to meet user needs. We encountered willingness to use the system primarily driven by practical interest in fulfilling administrative and legal requirements. Skepticism regarding patient file transparency and technology use was also found. The main insight is that reestablishing the nature of CBT sessions towards higher patient engagement can more successfully be pursued if technology provides incentives for therapists, such as features that speed up administrative tasks.

My care pathways - creating open innovation in healthcare.

In this paper we describe initial results from the Swedish innovation project "My Care Pathways" which envisions enabling citizens to track their own health by providing them with online access to their historical, current and prospective future events. We describe an information infrastructure and its base services as well as the use of this solution as an open source platform for open innovation in healthcare. This will facilitate the development of end-user e-services for citizens. We have technically enabled the information infrastructure in close collaboration with decision makers in three Swedish health care regions, and system vendors as well as with National eHealth projects. Close collaboration between heterogeneous actors made implementation in real practice possible. However, a number of challenges, mainly related to legal and business issues, persist when implementing our results. Future work should therefore target the development of business models for sustainable provision of end-user e-services in a public health care system such as the Swedish one. Also, a legal analysis of the development of third party provider (nonhealthcare based) personal health data e-services should be done.