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User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service
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 Human Factors, E-ISSN 2292-9495, E-ISSN 2292-9495, Vol. 8, no 4, p. e30867-e30867Article in journal (Refereed) Published
Abstract [en]

Background: Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale upat a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expectedto provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP),which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successfulinnovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicineservices survive long enough to deliver system-level outcomes, the causes of which are not well understood.Objective: We were interested in factors related to usability and user experience of the telemedicine service, which might affectadoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance,a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technologywill actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needshave been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance,and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures.Methods: We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcomemeasures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in directconjunction with real-time use during clinical procedures.Results: In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demandfor teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributedto performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidancewas rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance weregenerally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practicaladvice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%).Conclusions: Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnicalaspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicineservice contributes to performance and outcomes.

Place, publisher, year, edition, pages
JMIR Publications Inc. , 2021. Vol. 8, no 4, p. e30867-e30867
Keywords [en]
UX, Telemedicine, User satisfaction, User Experience
National Category
Computer Sciences
Research subject
Technology and Health
Identifiers
URN: urn:nbn:se:kth:diva-307611DOI: 10.2196/30867ISI: 000787623700015PubMedID: 34851302Scopus ID: 2-s2.0-85122002883OAI: oai:DiVA.org:kth-307611DiVA, id: diva2:1634133
Note

QC 20220523

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)
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Supervisors
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, SebastiaanGroth, Kristina

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