Training and process change: a collaborative telehealth case study

ABSTRACT

The next generation of telehealth systems running over broadband Internet will offer opportunities to change the way clinicians provide health services. This case study is a component of a larger research project which explores the implications of broadband telehealth in a tertiary healthcare setting. The research question of this case study addresses how to train and prepare clinicians to do their job using the next generation of telehealth systems. This case study presents observations of twelve clinicians during the training sessions conducted for them as they prepared to use a research prototype telehealth system in a pilot trial at their hospital.

The telehealth system was purpose-designed to address the range of needs of the clinicians involved and clinicians very rapidly understood the affordances of the system. Our observations show that the clinicians spent the bulk of the training sessions dealing with process change. They focused on three areas: collaborating with their remotely located clinical assistant, adapting their clinical practice in order to use the system and identifying areas where the telehealth system need to be changed to support their specific needs. Our observations also show that each of the senior surgeons amongst the clinicians (working in a different sub-specialty) dealt differently with the process changes.

We conclude that for complex tertiary healthcare telehealth applications the distinction between training given to the clinicians and process change identified by the clinicians is worth considering when preparing clinicians to use the next generation of telehealth systems. We suggest that teams developing advanced telehealth systems consider these issues of process change as they develop ways to prepare clinicians to use their system.

REFERENCES

• 1: Leila Alem , Susan Hansen , Jane Li, Evaluating clinicians' experience in a telemedicine application: a presence perspective, Proceedings of the 18th Australia conference on Computer-Human Interaction: Design: Activities, Artefacts and Environments, November 20-24, 2006, Sydney, Australia [doi>10.1145/1228175.1228187]
• 2: Michael Boyle , Saul Greenberg, The language of privacy: Learning from video media space analysis and design, ACM Transactions on Computer-Human Interaction (TOCHI), v.12 n.2, p.328-370, June 2005 [doi>10.1145/1067860.1067868]
• 3: Corbin, J. and A. Strauss, Basics of Qualitative Research, 3rd Edition. 2008: Sage Publications.
• 4: Dobke, M., et al., Pilot Trial of Telemedicine as a Decision Aid for Patients with Chronic Wounds. Telemedicine and e-Health, 2008. 14(3): p. 245--249.
• 5: Paul Dourish , Annette Adler , Victoria Bellotti , Austin Henderson, Your place or mine? Learning from long-term use of audio-video communication, Computer Supported Cooperative Work, v.5 n.1, p.33-62, 1996
• 6: William W. Gaver, The affordances of media spaces for collaboration, Proceedings of the 1992 ACM conference on Computer-supported cooperative work, p.17-24, November 01-04, 1992, Toronto, Ontario, Canada [doi>10.1145/143457.371596]
• 7: William Gaver , Abigail Sellen , Christian Heath , Paul Luff, One is not enough: multiple views in a media space, Proceedings of the INTERCHI '93 conference on Human factors in computing systems, p.335-341, May 1993, Amsterdam, The Netherlands
• 8: Griffiths, L., I. Blignault, and P. Yellowlees, Telemedicine as a means of delivering cognitive-behavioural therapy to rural and remote mental health clients. Journal of Telemedicine and Telecare, 2006. 12(3): p. 136--140.
• 9: Hansen, S., Useable and Used: A Case Study of the Role of the Social Sciences in the Development of an Emerging Technology for Healthcare, in School of Social Science and International Relations. 2007, University of New South Wales: Sydney.
• 10: Steve Harrison , Paul Dourish, Re-place-ing space: the roles of place and space in collaborative systems, Proceedings of the 1996 ACM conference on Computer supported cooperative work, p.67-76, November 16-20, 1996, Boston, Massachusetts, United States [doi>10.1145/240080.240193]
• 11: Christian Heath , Paul Luff , Hideaki Kuzuoka , Keiichi Yamazaki , Shinya Oyama, Creating coherent environments for collaboration, Proceedings of the seventh conference on European Conference on Computer Supported Cooperative Work, p.119-138, September 16-20, 2001, Bonn, Germany
• 12: Christian Heath , Paul Luff , Abigail Sellen, Reconsidering the virtual workplace: flexible support for collaborative activity, Proceedings of the fourth conference on European Conference on Computer-Supported Cooperative Work, p.83-99, September 10-14, 1995, Stockholm, Sweden
• 13: Jan, R.-L., et al., An Internet-Based Interactive Telemonitoring System for Improving Childhood Asthma Outcomes in Taiwan. Telemedicine and e-Health, 2007. 13(3): p. 257--268.
• 14: Kratz, M., et al. NGI and Internet2: Accelerating the Creation of Tomorrow's Internet. in Tenth World Congress on Medical Informatics Medinfo 2001. 2001: IOS Press.
• 15: Li, J., et al., Development of a Broadband Telehealth System for Critical Care: Process and Lessons Learned. Telemedicine and e-Health, 2006. 12(5): p. 552--560.
• 16: Doug Palmer , Matt Adcock , Jocelyn Smith , Matthew Hutchins , Chris Gunn , Duncan Stevenson , Ken Taylor, Annotating with light for remote guidance, Proceedings of the 19th Australasian conference on Computer-Human Interaction: Entertaining User Interfaces, November 28-30, 2007, Adelaide, Australia [doi>10.1145/1324892.1324911]
• 17: Reason, P. and H. Bradbury, Handbook of Action Research. 2001: SAGE Publications.
• 18: Toni Robertson, The Public Availability of Actions andArtefacts, Computer Supported Cooperative Work, v.11 n.3, p.299-316, 2002 [doi>10.1023/A:1021214827446]
• 19: Duncan Stevenson , Jane Li , Jocelyn Smith , Matthew Hutchins, A collaborative guidance case study, Proceedings of the ninth conference on Australasian user interface, January 01-01, 2008, Wollongong, Australia
• 20: Stringer, E., Action Research: Third Edition. 2007, Los Angeles: Sage Publications Inc.
• 21: Torppa, M., et al., Patient-nurse-doctor interaction in general practice teleconsultations - a qualitative analysis. J. Telemedicine and Telecare, 2006. 12(6): 306--310.

INDEX TERMS

Primary Classification:
  H. Information Systems
  H.5 INFORMATION INTERFACES AND PRESENTATION (I.7)
      H.5.m Miscellaneous

General Terms:
Human Factors

Keywords:
process change, telecollaborative systems, telehealth, training