Procurement of artificial intelligence for radiology practice

The development of artificial intelligence (AI) technology for radiology has accelerated in the past decade, but its deployment in radiology practices has been slow. We take a sociotechnical approach and suggest that the limited use of AI in radiology practices can be attributed to a recurring tension between planned and emergent change. The paper contributes with a conceptualization and understanding of the tension during the procurement of AI for radiology. To balance this tension, we suggest that health organizations need to redefine the concept and scope of traditional procurement projects, with well-defined goals and project time. Instead, we propose that health organizations need to conceptualize their procurement and implementation projects of AI technology as evolving change processes. The study is based on an interpretive research approach and informed by the Information Infrastructure framework. Empirically, we study the procurement of AI solutions for radiology at a large health trust in Norway

Scaling AI Projects for Radiology– Causes and Consequences

Artificial intelligence (AI) for radiology has the potential to handle an ever-increasing volume of imaging examinations. However, the implementation of AI for clinical practice has not lived up to expectations. We suggest that a key problem with AI projects in radiology is that high expectations associated with new and unproven AI technology tend to scale the projects in ways that challenge their anchoring in local practice and their initial purpose of serving local needs. Empirically, we focus on the procurement of an AI solution for radiology practice at a large health trust in Norway where it was intended that AI technology would be used to process the screening of images more effectively. Theoretically, we draw on the information infrastructure literature, which is concerned with scaling innovative technologies from local settings, with a limited number of users, to broad-use contexts with many users

Ambivalently awaiting : Norwegian general practitioners' expectations towards a cross-Institutional electronic health record

A cross-institutional Electronic Health Record (EHR) where all healthcare workers can access a patient's record, is seen as an important means to improved access to information, better patient care, and increased efficiency. In Norway, the first EHR of this type (US based Epic EHR) is to be implemented in the Central Norway Regional Health Authority. General practitioners (GPs) are central actors in health service delivery, and consequently it is important that also they use the new system. However, we lack knowledge on GP's expectations and needs for cross-institutional EHRs. Drawing on interviews with 17 GPs, we discuss these topics and conclude that the GPs interviewed are ambivalent towards an EHR of this scale.publishedVersio

Preservation of person-centered care through videoconferencing for patient follow-up during the covid-19 pandemic:case study of a multidisciplinary care team

Background: The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient’s response to “What matters to you?” drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care. Objective: The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions. Methods: This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders. Results: The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination. Conclusions: The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios

User-centred Design of a Digital Care Plan for Patients and Professionals in Cross-organisational Teams

Care for patients with multimorbidity and long-term complex needs is costly and with demographic changes this group is growing. The research project Dignity Care addresses how to improve the care for this patient group by studying how a conceptual shared digital care plan for complex clinical pathways can guide and support cross-organisational care teams. This paper presents the user-centred design process for the digital care plan development. Panels of patients and health care professionals will participate in co-creation user workshops and simulation of complex patients’ pathways. The main contribution from this work is recommendations for how to actively involve user groups in digital health development, applying a partly remote approach of user-centred design methodology during the Covid-19 pandemic

User-centred Design of a Digital Care Plan for Patients and Professionals in Cross-organisational Teams

Care for patients with multimorbidity and long-term complex needs is costly and with demographic changes this group is growing. The research project Dignity Care addresses how to improve the care for this patient group by studying how a conceptual shared digital care plan for complex clinical pathways can guide and support cross-organisational care teams. This paper presents the user-centred design process for the digital care plan development. Panels of patients and health care professionals will participate in co-creation user workshops and simulation of complex patients’ pathways. The main contribution from this work is recommendations for how to actively involve user groups in digital health development, applying a partly remote approach of user-centred design methodology during the Covid-19 pandemic

User-centred Design of a Digital Care Plan for Patients and Professionals in Cross-organisational Teams

Care for patients with multimorbidity and long-term complex needs is costly and with demographic changes this group is growing. The research project Dignity Care addresses how to improve the care for this patient group by studying how a conceptual shared digital care plan for complex clinical pathways can guide and support cross-organisational care teams. This paper presents the user-centred design process for the digital care plan development. Panels of patients and health care professionals will participate in co-creation user workshops and simulation of complex patients’ pathways. The main contribution from this work is recommendations for how to actively involve user groups in digital health development, applying a partly remote approach of user-centred design methodology during the Covid-19 pandemic

From Free-Text to Structure in Electronic Patient Records

We report from the initial steps of a collaboration project between two post-doctoral projects, both using a qualitative action research approach to address challenges related to shifting from a free text to a structured EPR system constituting important preconditions for establishing advanced decision support and reuse of healthcare data. We have started to explore three areas that may influence this process related to: 1) Legislative challenges of getting access to all relevant healthcare data. 2) Challenges of exchanging data between silo systems and open platform systems. 3) Replacing a free text silo EPR with an open platform system – and the practical challenges of defining the content of the context sensitive structured EPR. Hence, we ask the following research questions: How to address challenges related to the shift from free text to structured EPR systems? How will the need for semantic interoperability between different EPRs influence the goal of advanced clinical decision support? Empirically, we draw on the regional FRESK program (2017–2022), in the North Norwegian Health Region, which includes implementing both a new regional open platform based EPR system, and a proprietary medical chart system

Medication Reconciliation as Repair Work

In Norway, the process of developing a national shared medication list has been underway for several years. The shared medication list provides an overview of all the medications used by a patient. However, its proper use requires that it be maintained regularly through so-called medication reconciliation processes in which health personnel clarify – and ask patients – what and how much medication they use. We explore the work embedded in the bedside medication reconciliation process at a hospital, the health personnel conducting this work and the implications for the shared medication list. We argue that reconciliation processes can be conceptualized as collective repair work that needs to be continued after the shared medication list is implemented