Supporting nurses’ information flow by integrating paper and digital charting

Abstract. Information technology has changed the way health care is delivered. Electronic health records which are prevalently deployed to replace or supplement paper documentations have made distributed information access at various points of care and work activity achievable with the use of mobile information devices. Our particular concern is with nurse’s information flow, where nurse’s notes and observations taken at the point of care feed into the electronic record. In these cases, digital technology has not yet entirely replaced paper and pen, because the latter still provide greater ease and flexibility of use when compared to current digital technologies. Even when mobile digital technology is available, clinicians still prefer creating handwritten notes, and then later manually transposing them into the digital medium. Within this context, we created a prototype that integrated digital paper with electronic health charts to retain the benefits of paper and pen, as well as digital medium. A focus group evaluation of this prototype demonstrated promise and potential for its value in a medical environment

Usability in healthcare : overcoming the mismatch between information systems and clinical work

Usability of clinical information technology (IT) systems is an ongoing topic of discussion. The systems should support healthcare professionals in their daily work with patients. However, critics indicate the prevalence of negative experiences and use related problems. The overall goal of the thesis is to examine the usability of current clinical IT systems from the viewpoint of physicians and nurses for the purposes of further user-centred system development. The thesis includes three empirical studies: a digital dictation study, evaluation of nursing documentation systems, and a national usability questionnaire study with physicians. The research was carried out utilizing contextual inquiry, interaction sequence illustration analysis, and tailored usability questionnaire methods. The research resulted in the following findings and conclusions. Currently used IT systems do not support the daily work and clinical tasks of clinicians well. This is due to numerous usability problems, and lack of computer support for multi-professional and cross-organizational collaboration between clinicians. Major improvements are needed to achieve the potential benefits clinical information and communication technology systems offer. Based on empirical studies, themes for potential improvements are: development of efficient and mobile documentation solutions, redesign of system user interfaces, solutions to support communication and collaboration, customisable and context-specific clinical IT systems, and conceptual redesign of nursing documentation system. In the field of health informatics, a need exists to broaden the scope of usability work. Usability is closely associated with evaluation and testing activities instead of design activities. Hence, the scope of usability is more restricted than it is in user-centred design and usability research fields. In order to overcome the current mismatch between IT systems and clinical work, it is important to understand that usability is extremely context-sensitive by nature. The study results indicated shortcomings in user-centred healthcare IT systems design and end-users' abilities to contribute to development work. User-centred design methods provide a variety of means to analyse, design, and evaluate information and communication systems for clinical purposes. However, the characteristics of the clinical context (e.g. privacy and data security issues, and the wide range of IT systems in use) need to be taken into account when applying the methods and performing research in real-life clinical surroundings

Sistemas interativos e distribuídos para telemedicina

doutoramento Ciências da ComputaçãoDurante as últimas décadas, as organizações de saúde têm vindo a adotar continuadamente as tecnologias de informação para melhorar o funcionamento dos seus serviços. Recentemente, em parte devido à crise financeira, algumas reformas no sector de saúde incentivaram o aparecimento de novas soluções de telemedicina para otimizar a utilização de recursos humanos e de equipamentos. Algumas tecnologias como a computação em nuvem, a computação móvel e os sistemas Web, têm sido importantes para o sucesso destas novas aplicações de telemedicina. As funcionalidades emergentes de computação distribuída facilitam a ligação de comunidades médicas, promovem serviços de telemedicina e a colaboração em tempo real. Também são evidentes algumas vantagens que os dispositivos móveis podem introduzir, tais como facilitar o trabalho remoto a qualquer hora e em qualquer lugar. Por outro lado, muitas funcionalidades que se tornaram comuns nas redes sociais, tais como a partilha de dados, a troca de mensagens, os fóruns de discussão e a videoconferência, têm o potencial para promover a colaboração no sector da saúde. Esta tese teve como objetivo principal investigar soluções computacionais mais ágeis que permitam promover a partilha de dados clínicos e facilitar a criação de fluxos de trabalho colaborativos em radiologia. Através da exploração das atuais tecnologias Web e de computação móvel, concebemos uma solução ubíqua para a visualização de imagens médicas e desenvolvemos um sistema colaborativo para a área de radiologia, baseado na tecnologia da computação em nuvem. Neste percurso, foram investigadas metodologias de mineração de texto, de representação semântica e de recuperação de informação baseada no conteúdo da imagem. Para garantir a privacidade dos pacientes e agilizar o processo de partilha de dados em ambientes colaborativos, propomos ainda uma metodologia que usa aprendizagem automática para anonimizar as imagens médicasDuring the last decades, healthcare organizations have been increasingly relying on information technologies to improve their services. At the same time, the optimization of resources, both professionals and equipment, have promoted the emergence of telemedicine solutions. Some technologies including cloud computing, mobile computing, web systems and distributed computing can be used to facilitate the creation of medical communities, and the promotion of telemedicine services and real-time collaboration. On the other hand, many features that have become commonplace in social networks, such as data sharing, message exchange, discussion forums, and a videoconference, have also the potential to foster collaboration in the health sector. The main objective of this research work was to investigate computational solutions that allow us to promote the sharing of clinical data and to facilitate the creation of collaborative workflows in radiology. By exploring computing and mobile computing technologies, we have designed a solution for medical imaging visualization, and developed a collaborative system for radiology, based on cloud computing technology. To extract more information from data, we investigated several methodologies such as text mining, semantic representation, content-based information retrieval. Finally, to ensure patient privacy and to streamline the data sharing in collaborative environments, we propose a machine learning methodology to anonymize medical images

Coopération asynchrone colocalisée dans l'habitat intelligent en santé

Le Québec vit un vieillissement marqué de sa population et doit faire face aux problèmes que cela engendre. Cette situation soulève des enjeux sociaux et économiques liés à la santé comme l'augmentation des problèmes chroniques de santé en fin de vie, le maintien de la qualité des soins à la population et plus généralement le financement du domaine de la santé. Le Centre de recherche sur les habitats intelligents (CRHI) de l'Université de Sherbrooke cherche à développer une solution technologique socialement acceptable à ces enjeux. Les travaux qui y sont faits visent à favoriser l'autonomie de personnes atteintes de troubles cognitifs afin de leur permettre de demeurer à domicile le plus longtemps possible. Cette recherche doctorale porte spécifiquement sur l'utilisation des technologies de l'habitat intelligent pour soutenir le travail coopératif entre les professionnels de la santé, les intervenants sociaux et les proches aidants. On y aborde la problématique du travail "même lieu/temps différents" dans l'équipe hétérogène sous l'angle du travail coopératif assisté par ordinateur (TCAO). Un collecticiel asynchrone distribué dans l'habitat intelligent a été développé à titre de preuve de concept. Des activités de communication, de coordination et de production des intervenants ont été scénarisées afin de démontrer le fonctionnement du prototype. Le collecticiel C4C intègre notamment des outils de travail éprouvés comme le système de mesure de l'autonomie fonctionnelle (SMAF) qui est utilisé pour déterminer et suivre le niveau de service à offrir à une personne en perte d'autonomie. Notre recherche a permis d'élaborer : - une infrastructure distribuée de services sous l'approche par réseau de pairs pour un habitat intelligent ; - un modèle de gestion de l'information dans une perspective historique et spatiale intérieure tridimensionnelle ; - un modèle de gestion de la coopération en mode "pousser de l'information" basé sur le contexte de travail. Ensemble, ces contributions structurent et définissent le mode de travail dans l'équipe de soins et de maintien à domicile. En facilitant la coopération dans l'habitat intelligent, notre recherche vise la continuité accrue des soins pour permettre à plus de personnes souffrant de limitations cognitives ou physiques de vivre à la maison dans leur communauté