1. 1 Arild FAXVAAG The Norwegian EHR research centre (NSEP), Institute of neuroscience, Faculty of medicine, NTNU, Trondheim, Norway Co-Operation Support Through Transparency (COSTT)

2. 2 Bilde hentet fra www.helsebygg.no

3. 3 Co-Operation Support Through Transparency (COSTT) domain: development and clinical testing of system for coordination of perioperative work budget: 4-year, 3,3 MEUR researcher project funded by the Norwegian Research Council and the partners principal investigator: Pieter J Toussaint, IDI, NTNU people: faculty from NTNU health informatics, two post docs, 4 PhD students, researchers from partners, programmers partners: NTNU Health informatics, SINTEF, HEMIT, St.Olavs hospital (Trondheim), SONITOR (Oslo), Aker University hospital (Oslo) and Cetrea (Danmark) project kick-off: sept 2008

4. 4 den medisinsk-teknologiske utvikling lidelse skaper behov for forskning forskning skaper ny kunnskap ny kunnskap gir ny teknologi –som kan brukes til å kartlegge sykdom –som kan brukes til å endre sykdomsprosesser ny teknologi skaper behov for nye, mer spesialiserte arbeidsmetoder gammel teknologi overflødiggjøres sjelden fullstendig nye arbeidsmetoder gir mer spesialiserte aktører aktørene er (og forblir) ansvarlige for de handlinger de utfører

5. 5 Faxvaag, Samstad and Seim Manuscript in preparation

6. 6 the perioperative domain By Mark Meyer

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8. 8 basic assumptions (1) Traditional workflow systems –Require beforehand knowledge of: Actions to be performed Order of actions Actor(s) responsible for actions –don’t do well in healthcare….. partly because Clinical processes are problem solving activities Existing systems don’t support training and research

9. 9 Chares P Friedman J Am Med Inform Assoc. 2009;16:169-170

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11. 11 basic assumptions (2) theoretical perspective from CSCW, and from Daniel Dennett: Dennett: we try to understand the world around us by interpreting other actor’s intentions –the intentional stance CSCW: people are good at coordinating their work.. and will become even better at coordinating their work if they are provided with information about what’s going on in adjacent places – awareness

12. 12 our approach: information about the patient trajectory — what actually happens with the patient — can enhance the actors’ ability to coordinate themselves information about the patient trajectory can be sampled automatically and made available to the actors in real-time

13. 13 Chares P Friedman J Am Med Inform Assoc. 2009;16:169-170

14. 14 we are developing a prototype that will retrieve representations of relevant digital and physical events, –examples: physical event: That a person enters, or leaves a room, that the anesthesia machine is turned on, that the diathermy knife kicks in digital events: –that a healthcare professional opens the medical record of patient x –that the operation room planning system signals that the operation should have started infer which healthcare act might be unfolding –examples: patient + surgeon is present + the anesthesia machine is running = ongoing surgery patient present + surgeon has left the room + nurse assistant present = patient about to leave the operating theatre and on his way to the recovery room

15. 15 the prototype, contd. and visualize representations of the patient trajectory on wall mounted boards in operating rooms, coordination rooms, recovery and bed ward the prototype is being developed with techniques from participatory design, and successive iterations of the prototype will be tested in our usability lab

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18. 18 the information security challenges information must be displayed simultaneously to many users in a collaborative environment wall mounted boards project information to all persons in a room most often not one single user the privacy of the patient, as well as the actors must be protected –The patient; the level of detail of clinical and identifying data should be kept at a minimum to minimize the risk of exposing sensitive information –The clinicians; the identity of those participating in the care of a patient may in itself be considered sensitive information, and visualizing the location of personnel may pose a threat to employee’s privacy

19. 19 techniques to be employed access control: –the principle of least privilege should be enforced the persons with the least access rights will determine what information is available –location-based access control –proximity-based access control flexible de-identification logging: –of individuals’ as well as teams’ use of information visualizations

20. 20 de-identification by de-coupling of actor and role –replacing name of actor with name of role that the actor enacts abstracting –replacing “patient with a tumor in ileum” with “patient with neoplastic disease” replacing direct identifiers with pseudonyms

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22. 22 status in the project Interviews with and observations of key roles in the peri- operative process. –Gained insight into information needs and –Circumstances of information use. Performed a risk analysis for information security Basic platform installation of an awareness creating system for the OR (Cetrea Surgical) and Indoor Positioning System (Sonitor) Will organize ‘future workshops’ with clinicians soon.

23. 23 summary and conclusion: the system will be developed iteratively we will publish technical reports about the constructs as well as about the testing of prototypes in the lab as the project advances the clinical testing is expected to begin in Q2/Q3 2010 More info: pieter.toussaint @ idi.ntnu.no andreas.seim @ sintef.no arild.faxvaag @ ntnu.no web: http://costt.no