1. Supporting Mobile Communication in Hospitals Per Hasvold (NST & UiTø) Jeremiah Scholl, PhD (NST) Eva Henriksen (NST) Gunnar Ellingsen, PhD (UiTø) Per Hasvold (NST & UiTø)Eva Henriksen (NST)PhD. Jeremiah Scholl (NST)PhD. Gunnar Ellingsen (UiTø)Per Hasvold (NST & UiTø)Eva Henriksen (NST)PhD. Jeremiah Scholl (NST)PhD. Gunnar Ellingsen (UiTø)

2. Dilemma We must balance –Access –Availability against –Interruptions –Disturbing social settings –Overloading of resources

3. Dilemma Informing design of mobile and pervasive (ubiquitous) computing –New paradigms in computing –Little experience (knowledgebase) to learn from –We are designing sociotechnical systems for complex environments (Coiera, BMJ 2004)

4. User-Centred Telemedicine At NST this means: –Creating development processes where users are participating in the design –Creating development processes where designers are embedded in the user’s environment –Emphasis is on identifying the basic problem and service – then finding the organisational model and technology

5. Coordination and collaboration...are key ingredients in the work of nurses and physicians –Manage logistics –Handle the large amount of ad-hoc activity and variations in the time processes takes...requires communication

6. Access to Information Resources Healthcare is knowledge intensive This creates a need for: –Consultation with seniors or specialists –Consultation with persons with special responsibilities –Consultation with persons who can make decisions

7. Distributed Work Hospital work span several organisational and geographical borders –Organisational Departments Teams within a department Professional groups, e.g. nurses, physicians, lab Experience, e.g. Interns, residents, chief physicians –Geographical/spatial e.g.: Inpatient wards Outpatient wards Local, physical conditions

8. The Study Objective: Understand the use of mobile communications and assess the potential for mobile communications in hospitals Methods: –Observations of work in a department at the University Hospital of North Norway Apprentice-style (ethnomethodology) –Interviews with a selected group of physicians from this department Semi-structured, open interviews

9. Current technologies Pagers –Ubiquitous, used by “everybody” –Good infrastructure –Simple to use, allows user control of how to respond –Requires user to locate phone to respond DECT phones –Immediate access –More interruptive(?)

10. Future Technologies Integrated mobile information and communication systems –(Instant) messaging services –Voice –Health information system access –Supporting asynchronous and synchronous communication...e.g.: wearable or pervasive computing systems

11. Non-ICT Communication We must also be aware of non-ICT modes of communication: –Face to face –Post-It Notes –Whiteboard –Leave message with others –etc.

12. Classical CSCW Problems Disparity in work and benefit –Difficult to see consequences for others “The Prisoner’s Dilemma” –Selfish behaviour “The Tragedy of the Commons” –Overuse of shared resources destroys it

13. Resource Identifiers Personal –Experience –Knowledge –Known response reaction Role –On call –Must sign or approve action

14. “It is a problem that you never know if a person is available at the hospital or is on leave; on a three week holiday. All messages of any importance – they cannot be sent somewhere to a pager that is not used for a week. That is the problem of connecting a message with a person and not a role.” Physician

15. Access vs. Interruption I want to have easy access to others –Not getting access to resource causes disruption in workflow I don’t want to be interrupted by others –Too many interruptions makes it impossible to carry out work –Certain situations may not allow interruptions

16. “I can imagine that it can be a problem to be accessible at all times. Sometimes it is necessary to have quiet and not get disturbed by phone calls. I do have a DECT-phone, but I don’t bring it to the [inpatient] ward because it would disturb and I always have the pager.” Senior Physician

17. “There are some of the senior physicians that absolutely don’t want a private [mobile] phone, because they never get to be undisturbed. So there are always advantages and disadvantages with availability” Physician

18. “...with a phone it is easier to take the call and explain that you will call back later. I think I would do so, if I have a phone. So, that could be a disadvantage with the phone: that you may get interrupted and allow yourself to get interrupted. You get more easily interrupted by a phone than a pager.” Physician

19. “If, for example, you are in an important consultation with a patient, talking with the patient about serious issues, then it would be wrong to interrupt that conversation to answer a pager that may not be important.” Physician

20. Pagers Personal Role based –Must be responded to ASAP

21. DECT Phones Personal –Often left in office by people worried about too many interruptions –Unlisted numbers Role based –Requires immediate response

22. Context Awareness? Sensors are used to make automatic assumptions of context to adjust availability and allow or disallow interruptions Problems observed: –Availability context changes while in a situation –Several availability contexts are going on at the same time –Available context may rely on future activities and rhythms of work, not just on present situation

23. Design Implications Must be integrated into existing systems or integrate existing services Must allow flexible, individual coping strategies Must support personal and role-based availability

24. Design Implications Presence awareness mechanisms must allow identification of role for each shift It must be possible to pass on roles Standard messages with meta information may help receiver in assessing urgency of pages or calls

25. Risks Misplaced devices may contain private information Devices used in places and situations where patient confidentiality is breached Authentication of user (is the response really from the intended user?) Awareness may be seen as surveillance

26. Contact Information Per Hasvold per.hasvold@telemed.no Jeremiah Scholl, PhD jeremiah.scholl@telemed.no