Methods to identify, study and understand End-user participation in HIT development

<p>Abstract</p> <p>Background</p> <p>Experience has shown that for new health-information-technology (HIT) to be suc-cessful clinicians must obtain <it>positive clinical benefits </it>as a result of its implementation and <it>joint-ownership </it>of the decisions made during the development process. A prerequisite for achieving both success criteria is <it>real </it>end-user-participation. Experience has also shown that further research into developing improved methods to collect more detailed information on social groups participating in HIT development is needed in order to support, facilitate and improve real end-user participation.</p> <p>Methods</p> <p>A case study of an EHR planning-process in a Danish county from October 2003 until April 2006 was conducted using process-analysis. Three social groups (physicians, IT-professionals and administrators) were identified and studied in the <it>local, present </it>perspective. In order to understand the interactions between the three groups, the <it>national, historic </it>perspective was included through a literature-study. Data were collected through observations, interviews, insight gathered from documents and relevant literature.</p> <p>Results</p> <p>In the local, present perspective, the administrator's strategy for the EHR planning process meant that there was no clinical workload-reduction. This was seen as one of the main barriers to the physicians to achieving real influence. In the national, historic perspective, physicians and administrators have had/have different perceptions of the purpose of the patient record and they have both struggled to influence this definition. To date, the administrators have won the battle. This explains the conditions made available for the physicians' participation in this case, which led to their role being reduced to that of clinical consultants - rather than real participants.</p> <p>Conclusion</p> <p>In HIT-development the interests of and the balance of power between the different social groups involved are decisive in determining whether or not the end-users become real participants in the development process. Real end-user-participation is essential for the successful outcome of the process. By combining and developing existing theories and methods, this paper presents an improved method to collect more detailed information on social groups participating in HIT-development and their interaction during the development. This allows HIT management to explore new avenues during the HIT development process in order to support, facilitate and improve real end-user participation.</p

User needs elicitation via analytic hierarchy process (AHP). A case study on a Computed Tomography (CT) scanner

Background: The rigorous elicitation of user needs is a crucial step for both medical device design and purchasing. However, user needs elicitation is often based on qualitative methods whose findings can be difficult to integrate into medical decision-making. This paper describes the application of AHP to elicit user needs for a new CT scanner for use in a public hospital. Methods: AHP was used to design a hierarchy of 12 needs for a new CT scanner, grouped into 4 homogenous categories, and to prepare a paper questionnaire to investigate the relative priorities of these. The questionnaire was completed by 5 senior clinicians working in a variety of clinical specialisations and departments in the same Italian public hospital. Results: Although safety and performance were considered the most important issues, user needs changed according to clinical scenario. For elective surgery, the five most important needs were: spatial resolution, processing software, radiation dose, patient monitoring, and contrast medium. For emergency, the top five most important needs were: patient monitoring, radiation dose, contrast medium control, speed run, spatial resolution. Conclusions: AHP effectively supported user need elicitation, helping to develop an analytic and intelligible framework of decision-making. User needs varied according to working scenario (elective versus emergency medicine) more than clinical specialization. This method should be considered by practitioners involved in decisions about new medical technology, whether that be during device design or before deciding whether to allocate budgets for new medical devices according to clinical functions or according to hospital department

Where does the interaction break down? The stakeholder map of health IT systems development and use in Finland

Prior research shows that clinical users’ experience of healthcare IT systems in Finland is poor. Research shows further that physicians are highly critical of the perceived lack of user participation in systems development, but developers of the same systems argue that they do work with users and are highly interested in their views. This study aimed at mapping the stakeholders involved in the user–developer interaction network, in order to identify the spots where the interaction breaks down. A method for depicting the healthcare landscape was adapted for depicting the healthcare IT systems development landscape. Experts selected through purposive sampling were interviewed to identify stakeholders and problems. Content analysis was used to categorise problems into development spots. A stakeholder map was drawn, consisting of 22 organization types, nine activities within them, and two groups of individuals. Seven development spots were identified, within and between the healthcare provider and the software provider but also related to other stakeholders. A significantly larger number of stakeholders are involved in healthcare IT system development than what was initially evident. They all influence the end-user experience in some way. It is not only the software product itself (whether with good or bad usability), but also several other factors that may affect user experience. Further research can now focus on what can be done and by whom to address the development spots

Constructive eHealth evaluation:Lessons from evaluation of EHR development in 4 Danish hospitals

Abstract Background Information and communication sources in the healthcare sector are replaced with new eHealth technologies. This has led to problems arising from the lack of awareness of the importance of end-user involvement in eHealth development and of the difficulties caused by using traditional summative evaluation methods. The Constructive eHealth evaluation method (CeHEM) provides a solution to these problems by offering an evaluation framework for supporting and facilitating end-user involvement during all phases of eHealth development. The aim of this paper is to support this process by sharing experiences of the eHealth evaluation method used in the introduction of electronic health records (EHR) in the North Denmark Region of Denmark. It is the first time the fully developed method and the experiences on using the CeHEM in all five phases of a full lifecycle framework is presented. Methods A case study evaluation of the EHR development process in the North Denmark Region was conducted from 2004 to 2010. The population consisted of clinicians, IT professionals, administrators, and vendors. The study involved 4 hospitals in the region. Data were collected using questionnaires, observations, interviews, and insight gathered from relevant documents. Results The evaluation showed a need for a) Early involvement of clinicians, b) The best possible representation of clinicians, and c) Workload reduction for those involved. The consequences of not providing this were a lack of ownership of decisions and negative attitudes towards the clinical benefits related to these decisions. Further, the result disclosed that by following the above recommendations, and by providing feedback to the 4 actor groups, the physicians’ involvement was improved. As a result they took ownership of decisions and gained a positive attitude to the clinical benefits. Conclusions The CeHEM has proven successful in formative evaluation of EHR development and can point at important issues that need to be taken care of by management. The method provides a framework that takes care of feedback and learning during eHealth development. It can thus support successful eHealth development in a broader context while building on a well-known success factor: end-user involvement in eHealth development

Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges.

BACKGROUND: In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as "poor fit" of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. OBJECTIVE: The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. METHODS: Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. RESULTS: The quantitative SUS results revealed that the application may be described as having "marginal-high" and "good" levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. CONCLUSIONS: Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets

Hvordan påvirkes arbeidsprosesser ved innføring av EPJ og velferdsteknologi på sykehjem

Masteroppgave i helse- og sosialinformatikk HSI500 - Universitetet i Agder 2018In order to be better equipped in the challenges of the future, with an increasing number of elderly and fewer professionals to care for them, the government emphasizes the importance of service innovation in the healthcare sector. Change is required to gain socioeconomic benefits, particularly in work processes. More frequent and better use of electronic medical record (EMR) and welfare technology is necessary. The purpose of this study was to bring information and knowledge about how using technology in the nursing homes has transformed the work processes. Qualitative, exploratory method with semi-structured interviews has been used. The informants consist of employees at several different nursing homes. Selection criteria are experience with both paper and EMR documentation and welfare technology. This study finds that EMR and welfare technology is a part of the daily work processes in nursing homes today, and that this leads to better care and safety for the residents. The study also shows the need for comprehensive integrated solutions between EMR and welfare technology, and across institutions. Finally, it shows the need of standardization of ethical evaluation procedures. The work processes need to be continually studied, because the technology is evolving fast and the organizations are trailing behind. More research on nursing homes with fully integrated EMR and welfare technology, and the interaction between institutions is needed. Key words: work processes, nursing homes, EMR, EHR, EPR, welfare technolog

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Implication des utilisateurs dans le développement des innovations médicales : une analyse sociotechnique de la collaboration et de ses enjeux pour l’organisation des soins

Les changements technologiques ont des effets structurants sur l’organisation des soins dans notre système de santé. Les professionnels de la santé et les patients – les principaux utilisateurs des innovations médicales – sont des acteurs clés dans les trajectoires suivies par les nouvelles technologies en santé. Pour développer des technologies médicales plus efficaces, sécuritaires et conviviales, plusieurs proposent d’intensifier la collaboration entre les utilisateurs et les développeurs. Cette recherche s’intéresse à cette prémisse sur la participation des utilisateurs dans les processus d’innovation médicale. L'objectif général de cette recherche est de mieux comprendre la collaboration entre les utilisateurs et les développeurs impliqués dans la transformation des innovations médicales. Adoptant un cadre d’analyse sociotechnique, cette thèse par articles s’articule autour de trois objectifs : 1) décrire comment la littérature scientifique définit les objectifs, les méthodes et les enjeux de l’engagement des utilisateurs dans le développement des innovations médicales; 2) analyser les perspectives d’utilisateurs et de développeurs de technologies médicales quant à leur collaboration dans le processus d’innovation; et 3) analyser comment sont mobilisés, en pratique, des utilisateurs dans le développement d’une innovation médicale. Le premier objectif s’appuie sur une synthèse structurée des écrits scientifiques (n=101) portant sur le phénomène de la participation des utilisateurs dans les processus d’innovation médicale. Cette synthèse a dégagé les méthodes appliquées ou proposées pour faire participer les utilisateurs, les arguments normatifs véhiculés ainsi que les principaux enjeux soulevés. Le deuxième objectif repose sur l’analyse de trois groupes de discussion délibératifs et d'une plénière impliquant des utilisateurs et des développeurs (n=19) de technologies médicales. L’analyse a permis d’examiner leurs perspectives à l'égard de diverses approches de collaboration dans les processus d'innovation. Le troisième objectif implique l’étude d’une innovation en électrophysiologie lors de la phase de recherche clinique. Cette étude de cas unique s'appuie sur une analyse qualitative d'études cliniques (n=57) et des éditoriaux et synthèses de connaissances dans des revues médicales spécialisées (n=15) couvrant une période de dix ans (1999 à 2008) ainsi que des entrevues semi-dirigées avec des acteurs clés impliqués dans le processus d’innovation (n=3). Cette étude a permis de mieux comprendre comment des utilisateurs donne un sens, s’approprient et légitiment une innovation médicale en contexte de recherche clinique. La contribution générale de cette thèse consiste en une meilleure compréhension de l’apport des utilisateurs dans les processus d’innovation médicale et de sa capacité à aligner plus efficacement le développement technologique avec les objectifs du système de santé.Technological changes have major effects on health care organization. Health professionals and patients – the main users of medical innovations – are key actors in the ongoing development and refinement of new medical technologies. To develop more efficient, safe and user-friendly medical technologies, many propose enhancing collaboration between technology users and developers. This research investigates the premise of involving users in the medical innovation process. The main objective of this research is to better understand the collaboration between users and developers involved in the transformation of medical innovations. Adopting a sociotechnical approach, this thesis by article has three objectives: 1) Describe how the literature defines the objectives, methods and issues of engaging users in the development of medical innovations; 2) Analyze the perspectives of users and developers of medical technologies with regards to their collaboration in the innovation process; and 3) Analyze how users are mobilized in practice in the development of medical innovation. The first objective is addressed by a narrative synthesis of the scientific literature (n=101) on user involvement in the medical innovation process. This synthesis has identified the methods used or proposed, normative arguments conveyed, and the main issues raised by involving users. Analysis of data from three deliberative focus groups and a plenary involving users and developers (n=19) of medical technology were employed to address the second objective. The analysis details their perspectives on various modes of collaboration in the innovation process. The third objective involves a case study of an innovation in electrophysiology at the clinical research phase. This case study is based on a qualitative analysis of clinical studies (n=57), editorials and reviews in medical journals (n=15) covering a ten year period (1999-2008) and semi-structured interviews with key actors involved in the innovation process (n=3). This study provides insight into how users make sense of, appropriate and legitimize medical innovation in the context of clinical research. The overall contribution of this thesis is a better understanding of user involvement in the medical innovation process and how to more effectively align technological development with the objectives of the health system