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Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.ORCID iD: 0000-0001-8747-9277
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.ORCID iD: 0000-0003-1126-3781
Department of Computer Science and Media Technology, Internet of Things and People Research Center, Malmö University, Malmö, Sweden.ORCID iD: 0000-0002-9522-5469
2021 (English)In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 5, no 1, p. e20692-e20692Article in journal (Refereed) Published
Abstract [en]

Background:Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption.

Objective:Our objective was to gain a deeper understanding of ERCP practitioners’ attitudes toward teleguidance. These findings could inform the implementation process and future evaluations.

Methods:We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons’ beliefs about teleguidance’s contribution to performance and factors that might interact with implementation.

Results:Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard “Ease of Use” items for “Compatibility and Implementation Climate.” In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05).

Conclusions:Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes.

Place, publisher, year, edition, pages
JMIR Publications Inc. , 2021. Vol. 5, no 1, p. e20692-e20692
Keywords [en]
telemedicine; technology acceptance
National Category
Medical Engineering
Identifiers
URN: urn:nbn:se:kth:diva-294415DOI: 10.2196/20692ISI: 000853668100006PubMedID: 33427670Scopus ID: 2-s2.0-85100010921OAI: oai:DiVA.org:kth-294415DiVA, id: diva2:1554841
Note

QC 20210531

Available from: 2021-05-17 Created: 2021-05-17 Last updated: 2022-09-29Bibliographically approved
In thesis
1. Unpacking the Sociotechnical Complexity of a Surgical Setting: Capturing the Context of Use to Inform Design and Evaluation
Open this publication in new window or tab >>Unpacking the Sociotechnical Complexity of a Surgical Setting: Capturing the Context of Use to Inform Design and Evaluation
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on how the implementation context for a surgical telementoringservice can be understood as a complex, adaptive sociotechnical system.Teleguidance was a service for remote surgical consultation in Endoscopic RetrogradeCholangiopancreatography (ERCP), a highly specialized clinical procedure.The solution had been developed in a participatory design setting andhad also been successfully trialed in a pilot study. It was to be deployed atfour additional hospitals, but differences between the implementation contextswould make it challenging to understand clinical outcomes, and could also affectmatters such as adoption.This thesis includes four papers which converge on user needs and the sociotechnicalimplementation context for teleguidance. The aim was to demonstratehow a sociotechnical systems oriented approach could be used to identifyfactors that could interact with the implementation. The first paper describesan investigation of attitudes and expectations among end-users and other stakeholders.The second paper shows how modelling the sociotechnical work systemmade it possible to investigate and proactively identify issues that might influenceimplementation and adoption. The third paper explicates methodologicalaspects of modeling the domain. The fourth paper describes a study designed tocapture early reactions to working with the system. Seen together, the researchrepresents a design science approach, that proposes that the implementationcontext can be viewed as a complex, adaptive system, and provides examplesthat show how focusing on user and stakeholder needs and wider context ofuse is a viable approach for supporting the implementation and evaluation oftelemedicine systems in complex settings.

Abstract [sv]

Denna avhandling växte fram ur ett större telemedicinprojekt vid Karolinska Universitetssjukhuset, Innovationshubben för vård på distans. Där hade man utvecklat en tjänst kallad teleguidance. Teleguidance utformades för att möjliggöra kirurgisk konsultation på distans i ERCP, en högspecialiserad endoskopisk procedur. Lösningen hade utvecklats i en deltagande designmiljö och hade också framgångsrikt testats i en pilotstudie. Den skulle sättas in på ytterligare fyra sjukhus, och en klinisk studie planerades för att utvärdera resultaten. Det var dock uppenbart att det fanns skillnader i hur ERCP genomfördes på de olika sjukhusen, vilket med stor sannolikhet skulle påverka införandet.

 

De fyra artiklarna som ingår i avhandlingen är konvergerande studier om det organisatoriska och sociala sammanhang i vilket teleguidance skulle introduceras. Syftet var att ta fram en flernivåanalys av de faktorer som påverkar arbetet med ERCP, och som kan förväntas samverka med implementeringen av teleguidance. Det första steget var att undersöka attityder och förväntningar hos slutanvändare och andra intressenter. Det andra steget var att modellera det sociotekniska arbetssystemet för att undersöka och proaktivt identifiera faktorer som kan påverka implementering och införandet av telemedicintjänsten. Det tredje steget var att fånga tidiga reaktioner på att arbeta med systemet. Sammantaget representerar forskningen ett proaktivt tillvägagångssätt för att identifiera organisatoriska konsekvenser av att introducera nya digitala tjänster i en komplex vårdmiljö.

Studierna visar exempel på tillvägagångssätt för att aktivt få en djupare kunskap av användarnas och intressenternas behov samt implementeringskontexten vid teknikinförande, vilket är avgörande för att stödja de anpassningar som krävs för framgångsrik implementering i komplexa miljöer. Resultaten är avsedda att bidra till området digital hälsa genom att ge praktiska exempel på hur sociotekniska metoder kan bidra vid design, implementering och utvärdering av nya teknologier som är avsedda att driva förändringar i sjukvården.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2022. p. 93
Series
TRITA-CBH-FOU ; 2022:8
Keywords
Telemedicine, Implementation, Complexity, Sociotechnical systems, Design Science
National Category
Human Computer Interaction
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-307612 (URN)978-91-8040-136-4 (ISBN)
Public defence
2022-02-22, Rum 9504, Hälsovägen 11c, Zoom: https://kth-se.zoom.us/j/69050531209, Flemingsberg, 13:00 (English)
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Note

QC 2022-02-02

Available from: 2022-02-02 Created: 2022-02-01 Last updated: 2022-06-25Bibliographically approved

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Aminoff, HedvigMeijer, SebastiaanFrennert, Susanne

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