Enabling Change in Healthcare Structures through Teleconferencing (original) (raw)
Related papers
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.
An Analysis of the Dynamics of Multi-Disciplinary Medical Team Meetings and the Use of Communication Technology. Bridget Kane, Department of Computer Science, Trinity College Dublin. This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or mechanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective. MDTMs are collaborative fora where healthcare specialists come together to discuss patient cases. The principle purpose of the MDTM is to establish a definitive diagnosis and determine the best treatment strategy for the patient. Here, the work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion. This longitudinal study followed the development of a multidisciplinary medical team through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM. System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result. Cases discussed in teleconference are less satisfactory from the users' perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions. Case controlled study reveals a ‘doubling effect’ observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (artefacts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted. Visual needs are identified for both sides of the teleconference interface at MDTMs. Providing more control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make communication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment. The internal temporal structure identified in PCDs prompts the investigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of communication within the health service.
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
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, 2018
Multidisciplinary teams (MDTs) are an integral component in the delivery of health care. This is particularly evident in the delivery of cancer care, where multidisciplinary teams are internationally recognized as the preferred method for service delivery. The use of health information systems and technology are key enabling factors for building the capacity of MDTs to engage in improvement and implementation projects but there is scant research on how MDTs make use of technology and information systems or the kinds of systems needed for them to undertake improvement and implementation research. This paper reports findings on how seven MDTs in cancer care utilized technological and information systems and the barriers and enabling factors that impacted on their uptake. Seven multidisciplinary teams from two large metropolitan hospitals participated in the study. Qualitative methods including structured observations and semi structured interviews that explored how teams engaged in re...
Multidisciplinary medical team meetings
Proceedings of the 20th Australasian Conference on Computer-Human Interaction Designing for Habitus and Habitat - OZCHI '08, 2008
We present an observational study that was conducted to guide the design of an enhanced collaboration platform to support distributed multidisciplinary team meetings between two hospitals. Our goal was to find out how the breast cancer multidisciplinary team collaborates in their face-to-face meetings and in their discussions using an existing videoconferencing system and to identify obstacles and issues to their primary tasks. We identified a set of concerns around the way visibility and audibility affect the social cohesion of the group and impede communication and situation awareness between the distributed team. We also identified a parallel set of concerns around the difficulty of preparing and interacting around the medical images used in the meetings. These issues exposed a complex matrix of technical, social, procedural and organisational factors that affect the collaboration. We suggest potential directions for technical interventions in this setting.
Teleconsultation knowledge sharing in healthcare: resource influences
The purpose of this paper is to examine the resource influences on knowledge sharing in teleconsultation. The study was conducted by interviewing 28 participants from 11 hospitals in the Ministry of Health, Malaysia. Top-down microanalysis of interview data was performed using a descriptive knowledge-sharing framework that focuses on resource influences. The results indicate that resources can influence knowledge sharing opportunities in teleconsultation in areas such as professional development and learning, greater training opportunities, having champions within the hospitals, IT support and the facilitation from administration.
Multidisciplinary medical team meetings: a field study of collaboration in health care
2008
Abstract We present an observational study that was conducted to guide the design of an enhanced collaboration platform to support distributed multidisciplinary team meetings between two hospitals. Our goal was to find out how the breast cancer multidisciplinary team collaborates in their face-to-face meetings and in their discussions using an existing video-conferencing system and to identify obstacles and issues to their primary tasks.