Per Hasvold (NST & UiTø) Eva Henriksen (NST) PhD. Jeremiah Scholl (NST) PhD. Gunnar Ellingsen (UiTø)

Dilemma We must balance • Access • Availability against • Interruptions • Disturbing social settings • Overloading of resources

Dilemma Informing design of mobile and pervasive (ubiquitous) computing • New paradigms in computing • Little experience (knowledgebase) to learn from • We are designing sociotechnical systems for complex environments (Coiera, BMJ 2004)

User-Centred Telemedicine At NST this means: • Creating development processes where users are participating in the design • Creating development processes where designers are embedded in the user’s environment • Emphasis is on identifying the basic problem and service – then finding the organisational model and technology

Coordination and collaboration ...are key ingredients in the work of nurses and physicians • Manage logistics • Handle the large amount of ad-hoc activity and variations in the time processes takes ...requires communication

Access to Information Resources Healthcare is knowledge intensive • This creates a need for: • Consultation with seniors or specialists • Consultation with persons with special responsibilities • Consultation with persons who can make decisions

Distributed Work • Hospital work span several organisational and geographical borders • Organisational • Departments • Teams within a department • Professional groups, e.g. nurses, physicians, lab • Experience, e.g. Interns, residents, chief physicians • Geographical/spatial e.g.: • Inpatient wards • Outpatient wards • Local, physical conditions

The Study • Objective: Understand the use of mobile communications and assess the potential for mobile communications in hospitals • Methods: • Observations of work in a department at the University Hospital of North Norway • Apprentice-style (ethnomethodology) • Interviews with a selected group of physicians from this department • Semi-structured, open interviews

Current technologies • Pagers • Ubiquitous, used by “everybody” • Good infrastructure • Simple to use, allows user control of how to respond • Requires user to locate phone to respond • DECT phones • Immediate access • More interruptive(?)

Future Technologies Integrated mobile information and communication systems • (Instant) messaging services • Voice • Health information system access • Supporting asynchronous and synchronous communication ...e.g.: wearable or pervasive computing systems

Non-ICT Communication • We must also be aware of non-ICT modes of communication: • Face to face • Post-It Notes • Whiteboard • Leave message with others • etc.

Classical CSCW Problems • Disparity in work and benefit • Difficult to see consequences for others • “The Prisoner’s Dilemma” • Selfish behaviour • “The Tragedy of the Commons” • Overuse of shared resources destroys it

Resource Identifiers • Personal • Experience • Knowledge • Known response reaction • Role • On call • Must sign or approve action

“It is a problem that you never know if a person is available at the hospital or is on leave; on a three week holiday. All messages of any importance – they cannot be sent somewhere to a pager that is not used for a week. That is the problem of connecting a message with a person and not a role.” Physician

Access vs. Interruption • I want to have easy access to others • Not getting access to resource causes disruption in workflow • I don’t want to be interrupted by others • Too many interruptions makes it impossible to carry out work • Certain situations may not allow interruptions

“I can imagine that it can be a problem to be accessible at all times. Sometimes it is necessary to have quiet and not get disturbed by phone calls. I do have a DECT-phone, but I don’t bring it to the [inpatient] ward because it would disturb and I always have the pager.” Senior Physician

“There are some of the senior physicians that absolutely don’t want a private [mobile] phone, because they never get to be undisturbed. So there are always advantages and disadvantages with availability” Physician

“...with a phone it is easier to take the call and explain that you will call back later. I think I would do so, if I have a phone. So, that could be a disadvantage with the phone: that you may get interrupted and allow yourself to get interrupted. You get more easily interrupted by a phone than a pager.” Physician

“If, for example, you are in an important consultation with a patient, talking with the patient about serious issues, then it would be wrong to interrupt that conversation to answer a pager that may not be important.” Physician

Pagers • Personal • Role based • Must be responded to ASAP

DECT Phones • Personal • Often left in office by people worried about too many interruptions • Unlisted numbers • Role based • Requires immediate response

Context Awareness? • Sensors are used to make automatic assumptions of context to adjust availability and allow or disallow interruptions • Problems observed: • Availability context changes while in a situation • Several availability contexts are going on at the same time • Available context may rely on future activities and rhythms of work, not just on present situation

Design Implications • Must be integrated into existing systems or integrate existing services • Must allow flexible, individual coping strategies • Must support personal and role-based availability

Design Implications • Presence awareness mechanisms must allow identification of role for each shift • It must be possible to pass on roles • Standard messages with meta information may help receiver in assessing urgency of pages or calls

Risks • Misplaced devices may contain private information • Devices used in places and situations where patient confidentiality is breached • Authentication of user (is the response really from the intended user?) • Awareness may be seen as surveillance

Contact Information Per Hasvold per.hasvold@telemed.no Jeremiah Scholl, PhD jeremiah.scholl@telemed.no

Per Hasvold (NST & UiTø) Eva Henriksen (NST) PhD. Jeremiah Scholl (NST) PhD. Gunnar Ellingsen (UiTø)