Digi-Care: Exploring the Impacts of Digitization on Nursing Work in Switzerland

In this paper we present first findings of the Digi-Care project, a multidisciplinary, multi-stakeholder research project investigating the impacts of digitization on nursing work practices and in particular the transmission of patient care information within and beyond nursing work practices. We completed the initial data collection of the funded 3-year research project and report on a plethora of significant and critical IT-related events. Some of them can be attributed to usability issues

Natural-Setting PHR Usability Evaluation using the NASA TLX to Measure Cognitive Load of Patients

While personal health records (PHRs) carry an array of potential benefits such as increased patient engagement, poor usability remains a significant barrier to patients’ adoption of PHRs. In this mixed methods study, we evaluate the usability of one PHR feature, an intake form called the pre-visit summary, from the perspective of cognitive load using real cardiovascular patients in a natural setting. A validated measure for cognitive load, the NASA Task Load Index, was used along with retrospective interviews to identify tasks within the pre-visit summary that increased participants’ cognitive load. We found that the medications, immunizations, active health concerns, and family history pages induced a higher cognitive load because participants struggled to recall personal health information and also due to user interface design issues. This research is significant in that it uses validated measures of cognitive load to study real patients interacting with their PHR in a natural environment

A new ERA? Electronic records in ambulances: a research programme.

In order to support the continued shift to out of hospital care, ambulance clinicians need to be able to decide which patients will benefit from being left at home, refer to alternative care providers, and ensure that appropriate patient information is passed on to them. Technology can help in a number of ways. Firstly, apps and referral tools can aid decision-making at the scene. Secondly, technology can facilitate the transfer of patient information to ambulance clinicians at the scene or even before arrival, e.g. by sharing information on past contacts with a GP, or on a DNACPR directive. Thirdly, it can support real time remote sharing of information so that, for example, an ED consultant can advise about the appropriate conveyance and care decisions while the patient is still at home. Fourthly, it can support the easy transfer of patient information to other care providers like GPs. Finally, electronic records can make data more readily available for audit, research and evaluation (Morrison et al., 2014). Data can be used in future research to inform service improvements, as well as providing ambulance services with a valuable store of information to run automated clinical and management reports, as well as defending against medico-legal action

The Weight of User Decision Making During Online Interactions - Planning an Experiment

This paper lays out the design of a research study, using eye tracking technology, to measure participant cognitive load when encountering decision constructs during webpage interactions. It elaborates and improves on a pilot study that was used to test the experiment design. Cognitive load is discussed in detail, in both physiological and subjective terms, as well as techniques to capture participants’ thoughts and feelings immediately after the experiment. This mixed method approach will generate a more holistic comprehension of participants’ decision making and their rationale; and hopefully, improve information systems design ethics

‘The Going Digital Study’ – The implementation of electronic patient records in a paediatric tertiary hospital: Understanding the benefits and challenges for patients, parents and staff and the practical, ethical and legal implications

BACKGROUND: The Going Digital Study uniquely captured the experiences of all user groups before and after digital transformation of Great Ormond Street Hospital for Children (GOSH) whilst implementing an electronic patient record (EPR) system with a tethered patient portal in April 2019. This was critical and core to GOSH becoming a digital hospital, with benefits anticipated, yet challenges for all. AIM: To investigate the practical, ethical and legal considerations of implementing an EPR in a children’s tertiary hospital involving three stakeholder groups: children and young people (CYP), parents and staff. METHODS: A three phase, concurrent mixed methods, pre/post study design was utilised including both quantitative (survey) and qualitative (World Café workshops/interviews/focus group) data collection, analysis and synthesis. A systematic review of the literature was also conducted and was key to informing the examination of the experiences of users of an electronic patient record system in a children’s hospital setting and interpretation of the findings. RESULTS: Despite the challenges experienced by all stakeholders, including ethical and legal issues associated with CYP and parents accessing health data for the first time through the patient portal, meaningful portal access can be achieved from the age of 12 years of age. Families need support accessing health information via the portal. Clinicians need to have early conversations with parents about truth-telling and sharing diagnoses and/or prognoses, supporting families through the process of disclosure. Staff need prolonged support to balance clinical demands during implementation of and adjustment to the new clinical system, whilst continuing care provision and managing families’ expectations. CONCLUSION: Implementation and transition to an EPR system with a tethered patient portal is complex and takes time to embed. Setting realistic expectations and involving all stakeholders at all stages is paramount if benefits for all are to be fully realised. Managing this change process well, with prolonged engagement over time with all stakeholders, is essential if future utility is to be achieved. This requires an inclusive culture, in which the voice of all children and young people and parents is valued, and enabled through investment of appropriate resources, with equity of access a key priority

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

INTRODUCTION: The National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals. METHODS: Two high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions. RESULTS: Attitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD. DISCUSSION: The paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally

Watching People Making Decisions: A Gogglebox on Online Consumer Interaction

This paper presents a research study, using eye tracking technology, to measure participant cognitive load when encountering micro-decision. It elaborates and improves on a pilot study that was used to test the experiment design. Prior research that led to a taxonomy of decision constructs faced in online transactional processes is discussed. The main findings relate to participants’ subjective cognitive load and task error rates

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces