On PDAs in hospitals; introduction to the seminar

Tema: ”Alltid på nett !! ??” i ”Eksperter i team”Faglærer/landsbyleder: Lill Kristiansen

http://www.item.ntnu.no/~lillk//EiT/2009/index.htmlhttp://www.item.ntnu.no/~lillk/EiT/ for EiT info former years (Also

some health related)

Hva er EiT?

• Eksperter i team er et tverrfaglig prosjektemne for alle mastergradsstudentene på NTNU. Intensjonen med emnet er å forberede studentene på tverrfaglig samarbeid i yrkeslivet.

• EiT er normalt obligatorisk i alle mastergradsstudier og profesjonsstudier ved NTNU. Undervisning og deltakelse foregår normalt på onsdager (08-16) hele vårsemesteret.

• I 2009 skal 50% av medisinerstud. ta EiT på denne måte– (De andre 50% skal ta en intensiv variant i januar)

• Jeg har tidligere god erfaring med psykologer, etnografer, og andre fra Dragvoll sammen med studenter fra data og Kom-tek

Agenda today• Presentation around the table

– making name tags x 2 (small + big)• Watching film from RH/UiO

– each: yellow notes• Discussion on the film groups /plenary

– Using the yellow notes– Discussion in relation to St. Olav’s / nsep– Phones/pagers and interrupts (?)

• Lunch untill 1200 (for those interested)– continued discussion with interested persons

• Aims: – Introducing EiT-students to ICT&health care– Discussing beyond the new solutions at St. Olav’s – including telecom solutions (patient signal, pager, phones, multimedia)

Gårsdagens pasientringesystem (bilder fra EiT 2004)

Ved sengaTaket i korridoren

Konsoll ved døra Lampe utafor døra

Pasientsignalsystemet (1/2)

• Fra: – Lange korridorer– Felles display i korridortaket

(”kollektiv push” / ”tilbudstorg”)– Pleier velger et oppdrag/signal

(”individuell pull”)– Pleier avstiller signal ved døra– Finnes ’presence’, men anonym– Ingen PDA/telefon for pleierene

’common GUI’

Pasientsignalsystemet (2/2)• Til:

– Sengetun (bedre felles ’awareness’)– Fjernes displayet i taket/lamper på veggen– PDA til pleiere (i lomma)– Pleier blir ’tildelt’ oppdrag

• (kan også avvise/ignorere)– ”System push til individ”– ’arbeidsliste’ av aksepterte tildelte oppdrag på PDA– Pleier avstiller signal ved døra, først da fjernes det fra

arbeidsliste– signalet har en ’hvilemodus’ når det er på en arbeidsliste

– I prinsippet kan systemet vite ’antall avvis’ pr. ansatt, hvem har tatt dette arbeidsoppdraget mm

– GUI/ UI: (Graphical) User Interface (display, buttons, etc.)

’personal GUI’

’personal GUI’

Nytt konsoll ved dørene (Inne på pasientrommene)

• Dette displayet erstatter dørkonsollet med 2 lamper, og har noe mulighet for å vise tekst

• Slike display kan sees på som det som gjenstår av ’public display’ i det nye sykehuset myntet på pleiere

• (displayet har også lyd)• Teksten er IKKE leselig på

særlig avstand

Arbeidsprosess i teori og praksis(det gamle systemet)

– Nurses will avoid that patients can initiate false alarms (prio High) by not using presence

– Pretending to immediately leave the room, i.e. pressing twice on ‘Tilstede’ as an active choice

– Nurse may not use presence when doing ‘short visits’ – In order for patients to avoid alarms if the nurse must leave

quickly (e.g. due to emergency elsewhere)– This lamp lightning on the console will correspond to ‘state’

‘tilstede’ on figure above

– Loudspeaker on the consol, audible alarms that patient may hear

stille aktivt tilstede alarm

Terminologi

• Jeg ser at St.Olav og Helsebygg ofte bruker ’alarm’ også om det vanlige pasientsignalet.

• Jeg bruker forskjellige ord for å skille på prioritet– (pasient) signal (prio N) – Alarm! (Prio H)

• Begrepet ’assistanseanrop’ (nytt med PDA) tilsvarer ca. et signal med prio N+ (mellom N og H)

Det nye systemet St. Olav

• PDA / telefon til alle pleiere– (bildet viser tel. fra H2008)

• Pas. signal rett til telefonen med arbeidsliste av aksepterte anrop på telefonen

• Mulighet for alt. pas.meldinger (som ’bestille mat’ o.l. -ikke i drift nå)

• Pleier trenger hjelp: – assistanse (går til alle) (”Prio N+”)– Akutt (går til alle), legger seg øverst– (litt uklart om skillet mellom disse 2)

En alternativ løsning

• Tatt fra en film laget av sykepleier/forsker Anne Moen m.fl. På RH / UiO

• Gårsdagens gamle pasientsignal (uendret)• Pleier bruker PDA/MDA i tillegg når hun ’henter’ oppdrag• Scenario: Patient Paul activates the patient signal from

his bed and the nurse Nancy sees this on the display in the ceiling in the corridor. The nurse then checks on her PDA the name and some additional information about this patient. She then enters the patient’s room. Patient Paul expresses a wish to eat.

• Her kan dette realiserer veldig manuelt, eller man kan tenke arbeidsliste og at anropet fjernes fra displayet i taket og fra displayene inne på rommene, straks pleieren sier ’jeg tar dette signalet’

Proposal 1/2

• Instead om carrying out studies inside St.Olav, experiment with coordination and messages in another real physical scenario like ’plan summer party’, arrange ’rebus-løp’ amongst teams etc.

• Solsiden, Nidarosdomen or maybe item-korridor may be used. Usability-lab at NSEP might be too small, I want rather long walking distances as a part of the ’game’

• Experiment with (some of): ring tones, silent modes, call log, ToDo-list/ measures on work load, voice calls, hands busy/ lock screen issues etc.

• Preferanbly also with some public displays • Use of status/location / ’active address book’ may also be used • NSEP could aid in defining work tasks with some similarity with

real nurse-tasks

Proposal 2/2:

• Simulation may take place at Solsiden, (or other place with some location tracking to gather data)– Have real walking distances (like in a hospital, bigger that the

lab at NSEP, real walking distances)– Have real physical work, using hands, carry etc. Work tasks not

health related, but still connected to coordination and communication. Not dealing with emergency and role based pagers, but ’all the rest’

• ’buy 48 bottles of beer and call for help to carry’ – (simulating ’lifting patient’)

• Find out the stock and price of bread in 3 different shops and buy– Information and device gathering distributed

• ’buy a dress’ and ’call upon a colleage to view’ – Simulating ’in sterile’ and/or assistance call/ personal help message

• ’check out product in store, place ...’– Simulating message from nurse to physician (paper or asynchr. text)

Litterature (1/2) • Acharya, A, Berger S, and Narayanaswami, C, Unleashing the Power of Wearable

Devices in a SIP Infrastructure, Proc. Of PerCom 2005, pp 159- 168, 2005 • Ascom. User Manual 9d24 Cordless Telephone, Doc. No. TD 92136GB, Ver. E,

March 2004• Bardram, J. E. and Hansen, T. R., The AWARE architecture: supporting context-

mediated social awareness in mobile cooperation. IProc. CSCW '04. ACM Press, pp 192-201 2004

• Brown, B and Randell, R, Building a Context Sensitive Telephone: Some Hopes and Pitfalls for Context Sensitive Computing, Comput. Supported Coop. Work 13;3-4 , pp 329-345, 2004.

• Coiera E, When Conversation Is Better Than Computation, JAMIA Volume 7 Number 3 May / Jun 2000 pp 277- 286

• Coiera E and Tombs V, Communication behavior in a hospital setting: an observational study. BMJ Vol. 316 pp. 673-676, 1998

• Erickson T, Kellogg WA, Social Translucence: An Approach to Designing Systems that Support Social Processes, ACM Transactions on Computer-Human Interaction, Vol. 7, No. 1, March 2000, Pages 59–83.

• Interaktive Hospital, webpage http://www.ihospital.dk (accessed Oct. 2008)

Litterature (2/2)• Haug et al. Utvidet pasientsignal, (EiT, 2004, ntnu)• http://org.ntnu.no/knappen/ • Harr, R. and Kaptelinin, V. 2007. Unpacking the social dimension of external interruptions. In

Proceedings of the 2007 international ACM Conference on Supporting Group Work (Sanibel Island, Florida, USA, November 04 - 07, 2007). GROUP '07. ACM, New York, NY, 399-408. DOI= http://doi.acm.org/10.1145/1316624.1316686

• Knudsen P.V., Bruk av mobile enheter for kommunikasjon på sykehus, [in Scandinavian Language], master thesis, ifi, UiO, 2007, www.duo.uio.no/publ/informatikk/2007/58888/Knudsen.pdf

• Milewski AE and Smith TM, Providing presence cues to telephone users, In Proc. CSCW‘00. ACM Press, 2000, pp 89-96.

• Moen A, Smørdal O, Kristiansen T, Refseth Y, Mortensen B and Osnes T, Participatory Design and Infrastructures for Coordination and Communication in Interdisciplinary Mobile Health Teams, paper at MedInfo 2004,

• Refseth Y, En dag på sengeposten [video scenario in Scandinavian Language]. Oslo: InterMedia; UiO, 2003.

• Scholl J, Hasvold, P, Henriksen E, Ellingsen G, Managing communication availability and interruptions: A Study of Mobile Communication in an Oncology Department, In Proc. Pervasive 2007. May 13-16, 2007 in Toronto, LNCS 4480, pp. 234–250, 2007

• Wagner, I. A web of fuzzy problems: confronting the ethical issues, Communications of the ACM, 36(6) pp 94-101. 1993

• Wiberg M, Whitaker S, Managing availability: Supporting lightweight negotiations to handle interruptions, ACM Transactions on Computer-Human Interaction, Vol. 12, No. 4, December 2005, Pages 356–387, 2005

– In front of PC, negotiate via NEGOTIATOR to take the phone call later (call is never more important than current task)

• Natalia Romero, Agnieszka Matysiak Szóstek,Maurits Kaptein and Panos Markopoulos, Behaviours and preferences when coordinating mediated interruptions: Social and system influence, L. Bannon, I. Wagner, C. Gutwin, R. Harper, and K. Schmidt (eds.). ECSCW’07: Proceedings of the Tenth European Conference on Computer Supported Cooperative Work, 24-28 September 2007, Limerick, Ireland, Springer, 2007, pp. 351-370

– In front of PC 2 users ’asker’ and ’helper’– A simple quiz is done by helper with heavy time constraints, and with a simple

’awareness measure’ shown to asker• This may be compared to ’length of ToDo-list for nurses, very simple

– Testing ’group’ vs ’team’ (social factor) – And testing ’manual’ vs ’automatic’ help decline (system factor) (’call screening’)

• Asker see no difference from ’declines’ made by sustem and made manually by user, ’so I just asked, trusting the system would screen the requests)

Litterature (on interrupts in general)