Enabling Change in Healthcare Structures through Teleconferencing (original) (raw)
Computer Supported Cooperative Work (CSCW), 2006
In this paper we describe the process of a multidisciplinary medical team meeting (MDTM), its functions and operation in colocated and teleconference discussions. Our goal is to identify the elements and mechanics of operation that enhance or threaten the dependability of the MDTM as a ''system'' and propose technologies and measures to make this system more reliable. In particular, we assess the effect of adding teleconferencing to the MDTM, and identify strengths and vulnerabilities introduced into the system by the addition of teleconferencing technology. We show that, with respect to the systemÕs external task environment, rhythms of execution of pre-meeting and post-meeting activities are critical for MDTM success and that the extension of the MDTM to wider geographic locations with teleconferencing might disrupt such rhythms thereby posing potential threats to dependability. On the other hand, an analysis of vocalisation patterns demonstrates that despite difficulties related to coordination and awareness in video-mediated communication (evidenced by increased time spent in case discussion, longer turns, decreased turn frequency and near lack of informal exchanges) the overall case discussion structure is unaffected by the addition of teleconferencing technology into proceedings.
Abstract: Based on observations of teleconsultations conducted between a university hospital and a geriatric hospital, this analysis shows the effect of the use of telepresence technology on doctor/patient relations and relations between practitioners, on the organisation of healthcare, as well as on professional practices and knowledge. Use of this technology requires learning and adaptation, and is accompanied by new kinds of cooperation that result, in particular, in the pooling and dissemination of clinical and medical knowledge. Task accomplishment inherent in making a remote diagnosis rests on the delegation of some of the activities that are normally carried out by specialists to geriatricians and paramedical staff at a patient's side. While interprofessional cooperation contributes to the emergence of new forms of communication and to the creation of new work groupings, it also implies a loss of some autonomy for each type of professional involved. Keywords: Telemedecine – Geriatrics – Cooperation – Delegation of tasks – E-health - Tele-health - Telecare technologies - Telepresence
Tele‐handover: Lessons and improvements from a simple change to virtual meeting
BJU International, 2021
Tele-handover: Lessons and improvements from a simple change to virtual meeting COVID-19 has brought unprecedented disruption to medicine, urology and training. Many hospitals have had to provide care for elective patients and emergency admissions on geographically separate, so-called 'hot' and 'cold', sites according to local pandemic infection control protocols [1]. Urology departments have had to effect considerable changes to long-established patterns of work, including patient flow, pathways for acute admissions, on-call rotas, and physical distribution of their clinicians. So-called 'tele-health' solutions have been central in response to these challenges. Tele-health technologies have boomed as hospital teams have adapted to working within restrictions on travel and limits on the number of individuals allowed in a room. The benefits of tele-consultations, tele-clinics [2], teleconferences [3], tele-MDTs and even tele-surgery [4] have been enormous in the last year, and many of these applications seem thoroughly established in hospitals, research and education now.
Electronic Collaboration: Using Technology to Solve Old Problems of Quality Care
The participants of the Electronic Collaboration working group of the 2010 Academic Emergency Medicine consensus conference developed recommendations and research questions for improving regional quality of care through the use of electronic collaboration. A writing group devised a working draft prior to the meeting and presented this to the breakout session at the consensus conference for input and approval. The recommendations include: 1) patient health information should be available electronically across the entire health care delivery system from the 9-1-1 call to the emergency department (ED) visit through hospitalization and outpatient care, 2) relevant patient health information should be shared electronically across the entire health care delivery system, 3) Web-based collaborative technologies should be employed to facilitate patient transfer and timely access to specialists, 4) personal health record adoption should be considered as a way to improve patient health, and 5) any comprehensive reform of regionalization in emergency care must include telemedicine. The workgroup emphasized the need for funding increases so that research in this new and exciting area can expand.
BMC Health Services Research
Background The need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records. Methods eCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant ob...
“Do no harm”: Fortifying MDT collaboration in changing technological times
International Journal of Medical Informatics, 2013
To examine the changes in multidisciplinary medical team activity and practices, with respect to the amount of patient cases, the information needs and technology used, with up to 10 multidisciplinary teams (MDTs) in a large teaching hospital over a 10-year period. Methods: An investigation of MDT meeting activity was undertaken in November 2005 and repeated in November 2012 for the MDTs at a large university teaching hospital. Analysis of data from 8 MDTs was informed through long-term ethnographical study, and supplemented with 38 semi-structured interviews and a survey from 182 staff members of MDTs. Results: Work rhythms change over time as a function of the volume of work and technology changes, such as the use of a picture archive and communication system (PACS), videoconferencing and an electronic patient record (EPR). Maintaining cohesive teamwork, system dependability, and patient safety in the context of rapid change is challenging. Conclusions: Benefits of MDT work are in evidence, but the causes are not fully understood. Instead of asking 'how can technology support more MDT activity?', we ask 'how can we preserve the benefits of human-human interaction in an increasingly technological environment?' and 'how can we ensure that we do no harm?' when introducing technology to support an increasingly demanding collaborative work setting. Introducing technology to streamline work might instead threaten the experienced improvement in patient services.
Proceedings of the 2013 Chilean Conference on Human - Computer Interaction , 2013
Primary health care centers in the Chilean public system implement a family healthcare model with collaboration of several professional disciplines. This collaboration is often through multidisciplinary case analysis meetings, but it has a high cost for each treated case. In order to understand how collaboration is done and how technology supports it, we conducted a study in a healthcare center in Maipú, Chile. We found several problems regarding collaboration: a lack of awareness of the case status and the activities held by each of the professionals, and that the standard Electronic Medical Records System was not able to capture information about collaboration instances, making the awareness more difficult. To solve this, we propose a web-based system that allows the team to visualize the case status and track the cases in just one screen. We evaluated the relevance of this proposal through interviews with team leaders, who had positive opinions about it. Although our study has limitations, we conclude that the main requirements for collaboration in this context are the awareness that must exist about the activities of other team professionals and the possibility to see them at a glance. Future work will implement the proposal for an evaluation with a large number of users. Keywords Computer supported collaborative work (CSCW), collaborative systems, primary healthcare centers, multidisciplinary healthcare teams.
Role of Teleconsultation in Moving the Healthcare System Forward
Asia Pacific Journal of Public Health, 2002
The equitable access to quality healthcare by Malaysians has consistently been the primary objective of the Ministry of Health (MOH). The epidemiological transition to chronic illnesses, advances in medical technology, escalating healthcare costs and rising patient expectations has necessitated the strategic use of information systems in healthcare delivery. Malaysia has broken new ground by implementing a nationwide network to address inadequate access to healthcare, as well as to lower costs and achieve better health outcomes. Teleconsultation refers to the electronic transmission of medical information and services from one site to another using telecommunication technologies. This technology transforms the healthcare system by rapidly matching patient needs with the appropriate level of care however geographically remote they may be. Our findings suggest that even in these early stages of implementation, teleconsultation has led to cost savings, a more efficient allocation of re...