kth.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems.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
2021 (English)In: JMIR Perioperative Medicine, E-ISSN 2561-9128, Vol. 4, no 2, p. e26580-e26580Article in journal (Refereed) Published
Abstract [en]

Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about howto best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growinginterest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation.This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key tounderstanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where atelemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modelingcan provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings.

Place, publisher, year, edition, pages
JMIR Publications Inc. , 2021. Vol. 4, no 2, p. e26580-e26580
Keywords [en]
Telemedicine, Implementation context, Work domain analysis, sociotechnical systems
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Other Engineering and Technologies not elsewhere specified
Research subject
Technology and Health
Identifiers
URN: urn:nbn:se:kth:diva-307610DOI: 10.2196/26580OAI: oai:DiVA.org:kth-307610DiVA, id: diva2:1634128
Note

QC 20220202

Available from: 2022-02-01 Created: 2022-02-01 Last updated: 2022-06-25Bibliographically 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)
Opponent
Supervisors
Note

QC 2022-02-02

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

Open Access in DiVA

fulltext(1247 kB)127 downloads
File information
File name FULLTEXT01.pdfFile size 1247 kBChecksum SHA-512
e10a77b1fcc3a995e8e2123c52bc9a4d03982827eef4950f88eba63be25d23f4fc2b3d7f28e463e744f2d09665d3b9650791f33c27a3ed9710590b66d4137c82
Type fulltextMimetype application/pdf

Other links

Publisher's full texthttps://periop.jmir.org/2021/2/e26580

Authority records

Aminoff, HedvigMeijer, Sebastiaan

Search in DiVA

By author/editor
Aminoff, HedvigMeijer, Sebastiaan
By organisation
Biomedical Engineering and Health SystemsHealth Informatics and Logistics
Health Care Service and Management, Health Policy and Services and Health EconomyOther Engineering and Technologies not elsewhere specified

Search outside of DiVA

GoogleGoogle Scholar
Total: 127 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 237 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf