Assessing Support Requirements for Multidisciplinary Team Meetings (original) (raw)
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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.
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.
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.
On Record Keeping at Multidisciplinary Team Meetings
This paper explores issues related to record keeping at multidisciplinary medical team (MDT) meetings. Based on questionnaire and interview data with MDT members of various specialities, roles and teams, the information priorities for inclusion in a MDT meeting are identified. The utility and need for records after the meeting is discussed, and methods for gathering the information considered. Concerns are expressed that real-time data gathering at the meeting takes more time and risks turning the meeting into a group form-filling exercise. The value of interactive discussion among multidisciplinary peers is restated. The difficulties identified are discussed in the context of design implications for record-keeping at meetings. The role of records as a co-ordinating mechanism for tasks conducted after the meeting is emphasised, The dichotomy of having a record of a i) detailed prescriptive treatment plan, or ii) detailed diagnostic information with little treatment plan articulated, is explained.
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.
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.
Process Design for Multidisciplinary Patient Care Meetings: Considering the Human Factor
IFAC Proceedings Volumes, 2007
This paper describes a study of content and communication processes in multidisciplinary meetings of healthcare professionals, using a Human Factors engineering approach. The goal of the study, which took place in a teaching hospital Toronto, Canada, was to understand the processes of collaboration and information exchange that take place in the meetings, and to identify potential supports for the meetings, including the use of information technology. The methodology included data collection through observation of the multidisciplinary patient care meetings, and quantitative analysis of verbal exchanges in those meetings. The results suggested the need for a standardized approach to information exchange using structured language.
Team Interactions and Health IT Use during Hospital Multidisciplinary Rounds
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2016
Multidisciplinary rounds (MDRs) are an important form of team-based process in health care. Team members coordinate patient care and make decisions on care plans jointly. Health IT used during MDRs should be designed to facilitate the team interactions given the specific context or work system where MDRs occur. This study examines and compares team interactions and health IT use in three hospital services (contexts): hospitalist, cardiology and critical care. There were few differences in team interactions and health IT use across services. However, health IT use was different for different rounding tasks and team members. Therefore, health IT should be designed to support team interactions and users’ needs during MDRs in different contexts.
Journal of Multidisciplinary Healthcare
The multidisciplinary team (MDT) approach has long been considered the optimal way in which to deliver a high standard of care to patients with breast cancer. With a growing number of patients and ever-increasing complexity of cases, the strain on time and resource of the MDT is becoming increasingly evident. It is therefore essential that local hospital departments adapt their MDT processes to better streamline discussions and optimise efficiency. The Royal United Hospital in Bath is a district general hospital in the UK. Approximately 500 patients with cancers are treated annually, and the MDT discusses approximately 60 patients per week. Methods: To improve our MDT meeting processes and increase productivity, we created a concise MDT template using Microsoft Access™: giving all clinicians the ability to add patients and information in real time. We also allocated weekly preparation time whereby a senior clinician ensured all patients were prepared prior to the meeting with results and potential outcomes prepopulated where possible. Results: We recorded the time spent discussing patients during 6 MDT meetings before and after implementation of changes. Cases were classified by pathology category to determine if there were differences following the preparation changes. Overall, we significantly reduced our average MDT discussion time (p=0.02). We significantly reduced average discussion time in postoperative malignant cases (p<0.0006) and expected benign core biopsy cases (p<0.0047), allowing appropriate redistribution of time towards discussion of more complex cases, reflected by the significant increase in time spent discussing complex radiology cases (p<0.025). Conclusion: We offer an effective method for improving the MDT meeting preparation and presentation by ensuring each patient is appropriately prepared prior to the meeting, and outcomes for those simple cases are already prepopulated. This creates additional time within the meeting to discuss more complex clinical cases while allowing all members of the team an opportunity to discuss all patients if needed.
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...