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  • 1.
    Alaqra, Ala Sarah
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Mathematics and Computer Science (from 2013).
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Fischer-Hübner, Simone
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Computer Science. Karlstad University, Faculty of Economic Sciences, Communication and IT, Centre for HumanIT. Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Mathematics and Computer Science (from 2013).
    Manuscript: A Qualitative Study on Homomorphic Encryption in eHealthManuscript (preprint) (Other academic)
  • 2. Asmussen, L.
    et al.
    Nyren, Andersson M.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    The Experience of Healthcare Workers Following the Implementation of an IT-System in a Home for the Aged2017In: Irish Journal of Medical Science, ISSN 0021-1265, E-ISSN 1863-4362, Vol. 186, no Suppl.4, p. S161-S161Article in journal (Refereed)
    Abstract [en]

    We report on how health personnel at a home for the aged wereaffected by the introduction of an IT-system to help when nursedocumentation of patient activity and condition. The design of ITsystems for documentation by care-givers in healthcare is topicalbecause of the challenges posed by the need for high levels of safety,confidentiality and ethical responsibility. Health care staff work underextreme time-pressure including emergency situations. It is criticallyimportant to have IT-systems that are easy to use: to find informationand make records.This qualitative study utilises observation and interviews to gaindeep understanding. Observation data guide the interviews. Interviewswith nurses (10) and an IT analyst (1) are reported.Lack of time is a contributing factor as to why health personnel donot have a positive attitude to the use of IT documentation systems.Nurses feel that the lack of time does not afford them the opportunityto learn properly about the IT-system, and many of the staff haveworked with paper for over 20 years. It is also seen as a problem thatthere are many steps (clicks) before one can make a note or findinformation. One of the advantages reported with using IT-systems isthat all information is at one site. Everything is safety copied andconfidentiality is easier to secure.Using IT documentation systems facilitates the use of careplansthat are individualized for patient needs, instead treating all patientswith a particular disease, e.g. dementia, in the same way

  • 3. Cameirano, Serena
    et al.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Demonstration: Mobile annotation and recording at Multidisciplinary medical team meetings2007In: Proceedings of the 10th European Conference on Computer-Supported Cooperative Work,, ACM: Association for Computing Machinery (ACM), 2007Conference paper (Refereed)
  • 4.
    Curran, A. J.
    et al.
    Professorial Department of Otolaryngology, Head & Neck Surgery, Dublin, Ireland.
    Smyth, D.
    Professorial Department of Otolaryngology, Head & Neck Surgery, Dublin, Ireland.
    Kane, Bridget
    St. James's Hospital Dublin, Ireland.
    Toner, M.
    St. James's Hospital Dublin, Ireland.
    Timon, C. I.
    Professorial Department of Otolaryngology, Head & Neck Surgery, Dublin, Ireland.
    Exfoliated malignant cells in glove and instrument washings following head and neck surgery1996In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 21, no 3, p. 281-283Article in journal (Refereed)
    Abstract [en]

    Loco-regional recurrence following resection of squamous cell carcinoma of the upper aero-digestive tract is a major problem. Cells exfoliated from malignant tumours have been considered capable of implanting and giving rise to local recurrence or metastatic deposits. A prospective study was performed examining washings from the gloves and instruments used in major head and neck operations to determine if exfoliated cells were indeed present. Following removal of the main tumour specimen all surgeons washed their hands in a solution containing a cell fixative and all instruments were soaked in the solution. Samples were then centrifuged and stained using a modified PAP technique. On occasions nuclear fragments consistent with squamous cell carcinoma were present in both glove and instrument washings. We recommend that all surgeons change gloves and instruments following removal of the main tumour specimen and prior to irrigation of the operative field with a tumoricidal agent.

  • 5.
    Fahey, Paul
    et al.
    University of Dublin, Trinity College, Ireland.
    Harney, Clare
    University of Dublin, Trinity College, Ireland.
    Kesavan, Sajeesh
    University of Dublin, Trinity College, Ireland.
    McMahon, Alana
    University of Dublin, Trinity College, Ireland.
    McQuaid, Louise
    University of Dublin, Trinity College, Ireland.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Human Computer Interaction Issues in Eliciting User Requirements for an Electronic Patient Record with Multiple Users2011In: 24th International Symposium on Computer-Based Medical Systems / [ed] Mark Olive, Tony Solomonides, Bristol, England: IEEE, 2011Conference paper (Refereed)
    Abstract [en]

    Emphasis on usability for all users at the design stage of an Electronic Patient Record (EPR) is directly relative to successful implementation. This article outlines the values of considering the heterogeneity of users in EPR systems. We review the literature available on the design of EPR sys- tems with a focus on its usability principles. A case study of how an outpatient EPR system was successfully implemented in the Epilepsy Unit of Beaumont Hospital, Dublin, with due importance to usability testing for a multidisciplinary team is explored. 

  • 6.
    Gahan, J. A.
    et al.
    Dublin Irland.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Dublin city university.
    Determining User Requirements for an Audiology Information System2018In: Proceedings - IEEE International Symposium on Computer-Based Medical Systems, IEEE, 2018, p. 268-273Conference paper (Refereed)
    Abstract [en]

    This paper examines user requirements for a new audiology information system for use in audiology departments by audiology staff. There is a lack of literature on requirements for an audiology information system. This ethnographic study describes the current audiology service and the equipment used in the diagnosis and treatment of hearing loss. Eliciting user requirements from all the users of a clinical information system provides the best possible outcomes for all user groups: clinical, administration and hearing aid technicians. The study includes a review of audiology internal policies and a survey of all potential end users of a new audiology information system in the Health Service Executive (HSE) community service. The findings identify the six most important user requirements in a new audiology information system. These priority requirements include the storage of all Noah files, multiple patient search options, have all test results stored in the patient's electronic record, be capable of generating IT-based reports and store the audiogram in the patient's electronic record (EHR). Other findings include the desire for a paperless system and for the integration of all audiology equipment and existing IT databases, with up-to-date? information system involving automated processes.

  • 7.
    Gruenloh, Christiane
    et al.
    KTH; TH Köln, Germany.
    Haslwanter, Jean D. Hallewell
    FH Oberösterreich, Austria; TU Wien, Austria.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Lee, Eunji
    SINTEF ICT, Norway.
    Lind, Thomas
    Uppsala University.
    Moll, Jonas
    Uppsala University.
    Rexhepi, Hanife
    University of Skövde.
    Scandurra, Isabella
    Örebro University.
    Using Critical Incidents in Workshops to Inform eHealth Design2017In: Human-Computer Interaction - INTERACT 2017 / [ed] R Bernhaupt, G Dalvi, A Joshi, DK Dalkrishan, J ONeill, M Winckler, Cham: Springer, 2017, Vol. 10513, p. 364-373Conference paper (Refereed)
    Abstract [en]

    Demands for technological solutions to address the variety of problems in healthcare have increased. The design of eHealth is challenging due to e.g. the complexity of the domain and the multitude of stakeholders involved. We describe a workshop method based on Critical Incidents that can be used to reflect on, and critically analyze, different experiences and practices in healthcare. We propose the workshop format, which was used during a conference and found very helpful by the participants to identify possible implications for eHealth design, that can be applied in future projects. This new format shows promise to evaluate eHealth designs, to learn from patients' real stories and case studies through retrospective meta-analyses, and to inform design through joint reflection of understandings about users' needs and issues for designers.

  • 8. Impey, S.
    et al.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Monitoring the Movement of Infection in Hospital: Is There Potential for RFID?2015In: Irish Journal of Medical Science, ISSN 0021-1265, E-ISSN 1863-4362, Vol. 184, p. S349-S349Article in journal (Refereed)
    Abstract [en]

    Limiting the spread and effect of infections in hospital populations is a priority of healthcare providers. Approximately 1 in 20 in-patients develop a hospital acquired infection (HAI) in Ireland, and the rising prevalence of antibiotic-resistance strains forces a shift in focus from a curative to preventative approach to management.

    Addressing issues of infection control in hospital, this paper reviews the potential for radio frequency identification (RFID) to positively impact infection control. A retrospective analysis of patients’ movements through an interventional radiology department (IR) in a busy teaching hospital was conducted to examine infection and cross-infection potential in the course of routine working.

    A literature review was conducted and observations were recorded over a 4-week period. The number of infected patients was noted, along with time spent in establishing if an infection was present.

    Thirty-four of the 135 patients who visited IR were infected; MRSA infection was most common. The overall theme to emerge was that while information was available it was fragmented and not easily accessed which makes tracking the movement of infections throughout a hospital difficult.

    Potentially RFID can assist in limiting cross-contamination opportunities. Because RFID technology has the ability to establish an auditable list of contacts between staff and patients, a patient’s journey throughout an organisation can be retrospectively analysed. This information provided can then be used to identify other patients at risk and better inform the use of antibiotics. This ubiquitous approach also reduces time spent tracking infectious incidences. 

  • 9.
    Jing, Su
    et al.
    Trinity College Dublin, Ireland.
    Kane, Bridget
    Trinity College Dublin, Ireland.
    Luz, Saturnino
    Trinity College Dublin, Ireland.
    Automatic Content Segmentation of audio recordings at multidisciplinary medical team meetings2008In: PROCEEDINGS OF THE 2008 1ST INTERNATIONAL CONFERENCE ON INFORMATION TECHNOLOGY / [ed] Stepnowski, A; Moszynski, M; Kochanski, T; Dabrowski, J, IEEE, 2008, p. 309-312Conference paper (Refereed)
    Abstract [en]

    A single recording of a multidisciplinary medical team meeting (MDTM) can be expected to contain several sep- arate discussions on different patients. Automatic speaker segmentation alone does not allow for the separation of in- dividual patient case discussions (PCDs). A novel method is presented here, based on Hidden Markov Models (HMM), to segment audio recordings of MDTMs and facilitate the non-linear retrieval of individual PCDs. The method com- bines professional role interaction with speaker vocaliza- tion patterns. The sequence and duration of vocalization and speakers’ roles are used as training states. Results demonstrate HMM segmentation to have good potential in the development of an MDTM browser. The approach out- lined here can be applied in a wide range of meetings. 

  • 10. Jing, Su
    et al.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Automatic meeting participant role detection by dialogue patterns2010In: Development of multimodal interfaces: Active listning and synchrony / [ed] Esposito, A; Campbell, N; Vogel, C; Hussain, A; Nijholt, A, Springer, 2010, Vol. 5967, p. 314-326Conference paper (Refereed)
    Abstract [en]

    We introduce a new concept of ‘Vocalization Horizon’ for automatic speaker role detection in general meeting recordings. We demonstrate that classification accuracy reaches 38.5% when Vocalization Horizon and other features (i.e. vocalization duration and start time) are available. With another type of Horizon, the Pause - Overlap Horizon, the classification accuracy reaches 39.5%. Pauses and overlaps are also useful vocalization features for meeting structure analysis. In our experiments, the Bayesian Network classifier outperforms other classifiers, and is proposed for similar applications.

  • 11. Jing, Su
    et al.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Utilising Semantic Structures in the Interactions among Speakers at meetings2011In: Health Informatics Society of Ireland (HISI), Dublin: ICS HISI , 2011Conference paper (Refereed)
    Abstract [en]

    In tandem with the introduction of PACS and the adoption of an EPR system at St. James’s hospital, there has been a 237% increase in the number of patients being managed through Breast MDT meetings between 2005 and 2010.

    Methodology: This study forms part of a long-term ethnographic study at St. James's Hospital. Data are gathered at MDT meetings.

    Due to increased numbers of women attending breast triple assessment clinics, and awareness of breast complaints, coupled with new protocols and amended local hospital policies, new strategies were required to be implemented to cope effectively with the increased demand. Strategies include grouping and prioritizing of cases, increased formalisation, and the incorporation of real-time electronic record-keeping at meetings (as opposed to note-taking).

    The Electronic Patient Record (EPR) system allows access to all laboratory test results and the final written pathology report if required during discussion. PACS implementation facilitates direct access to digital radiological imaging such as Mammograms, Breast Ultrasound, Breast MRI, Body CT and Bone Scans. The increase in the number of patient presenting to the breast care services has resulted in more selective use of illustrating images. It is no longer practical to conduct a routine review of all images as may have happened in the past.

    In 2010 a ‘computer-on-wheels’, connected to the hospital wired-network, was introduced to enable real-time data entry of the decisions of the MDT. The lead clinician, at the end of the meeting, validates entries and the report from the MDT discussion is then available in the individual patient record.

  • 12.
    Jones, Stephen
    et al.
    Univ Dublin Trinity Coll, Dept Comp Sci, Dublin, Ireland.
    Keane, A.
    Univ Dublin Trinity Coll, Dept Comp Sci, Dublin, Ireland.
    Stawiarski, A.
    Univ Dublin Trinity Coll, Dept Comp Sci, Dublin, Ireland.
    Fatus, R.
    Univ Dublin Trinity Coll, Dept Comp Sci, Dublin, Ireland.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    The Impact of Application System Messages on the Usability of Healthcare Software Applications2016In: 2016 IEEE 29th International Symposium on Computer-Based Medical Systems (CBMS), IEEE, 2016, p. 306-311Conference paper (Refereed)
    Abstract [en]

    The quality and impact of application system messages (ASMs) is an important yet neglected area of human computer interaction (HCI) in healthcare. Complex, techni- cal, uninformative ASMs contribute towards user frustration, lack of acceptance, may lead to interruptions in healthcare workflow, and impact patient safety. ASMs refer to messages displayed within a software application and includes error messages, alerts, reminders and exception technical error messages.

    We report on a usability evaluation and users’ attitudes to system messages in order to inform recommendations for ASM design. A descriptive two part study incorporates a questionnaire and a system usability evaluation of 23 error messages, sourced from four healthcare software applications.

    The majority of participants (56%) indicate that constructive advice within ASMs is insufficient and 48% experience an interruption to workflow as a consequence of the delivery and display of ASMs. Messages evaluated are explicit (95%) and visible (90%) while consistency (68%) and politeness (48%) could be improved. The ASMs encountered lack constructive advice (32%), are imprecise (23%) and do not attempt to reduce workload. All respondents agree that there is a need for system consistency and 92% have preference for consistency of ASM presentation.

    We conclude that the elimination of inappropriate interrup- tions to users will improve healthcare efficiency, and reduce risks to patient safety. A healthcare application that relays constructive advice, is consistent in the implementation of ASMs and is considerate of workflow should ensure a more positive user experience, and improve technology acceptance among healthcare professionals. 

  • 13.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    An Analysis of Multi-Disciplinary Medical Team Meeting Dynamics: An Investigation into Collaboration and Information Flow at Meetings and the Use of Information Communication Technology2010Book (Other academic)
  • 14.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    An analysis of the dynamics of multidisciplinary medical team meetings and the use of communication technology2008Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Multidisciplinary medical team meetings (MDTM)s are collaborative fora where healthcare spe- cialists come together to discuss patient cases, establish a definitive diagnosis and determine the best treatment strategy for the patient. The practice of MDTMs is growing in importance as regulatory agencies advocate their adoption into routine practice.

    This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or me- chanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective. The work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion.

    In this longitudinal study, the development of a multidisciplinary medical team was followed through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM.

    System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result.

    Cases discussed in teleconference are less satisfactory from the users’ perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions compared to co-located meetings. Case controlled study reveals a doubling effect observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (arte- facts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted. Visual needs are identified for both sides of the teleconference interface at MDTMs. Providing

    more control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make com- munication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment.

    The internal temporal structure identified in patient case discussions (PCD)s prompts the in- vestigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of commu- nication within the health service. 

  • 15.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    CBMS 2018 Welcome Message and Preface2018Conference proceedings (editor) (Refereed)
  • 16.
    Kane, Bridget
    University of Dublin, Trinity College Dublin, Ireland.
    Computer support for collaborative work in lung cancer diagnosis: an ethnographic study and critical assessment2003Other (Other academic)
  • 17.
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). University of Dublin, Trinity College, Ireland.
    Facilitating participation by patients and family into hospital based multidisciplinary team decision-making2016In: NordiCHI workshop on Designing E-Health Services For Patients & Relatives – Critical Incidents and Lessons to Learn, 2016Conference paper (Refereed)
    Abstract [en]

    Hospital based multidisciplinary team (MDT) structures typically exclude non-hospital based professionals and carers, including the patient for whom decisions are being made. Here the MDT meeting process is summarised. Although staff present, especially nurses, advocate for patients, there is an acknowledged weakness in not involving patients in the discussion around their disease, prognosis and care. There is also a view that having the patient present would allow members of the team to directly assess (i.e. touch) the patient, which is not possible within the current practice. Difficulties anticipated around having patients attend include logistical, but the anticipated extra time it would take because of the need to change language is the most cited reason. Research on methods by which patients and their carers might be integrated include the use of video recordings and interviews taken pre-meeting, and replayed at the meeting. 

  • 18.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Job Design and Work Organisation in Cytology Laboratories: Socio-Technical Considerations1987Other (Other academic)
  • 19.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Groth, Kristina
    Karolinska Univ Hosp, Solna, Sweden.
    Multidisciplinary Work Practices: A Comparison of Three Major European Hospitals2014In: 2014 IEEE 27th International Symposium on Computer-Based Medical Systems, IEEE, 2014, p. 369-375Conference paper (Refereed)
    Abstract [en]

    This paper reviews the practices of multidisciplinary teamwork (MDT) for cancer care in three large teaching hospitals in separate jurisdictions. Ethnographic observations provide the main source of data, which are verified though interviews, and in some cases by surveys and analysis of video recordings. We demonstrate how MDT practices develop among different groups, and in different jurisdictions. Common practices are identified and differences explained. Work practice analysis is an integral part of our research, and this study provides insights into medical teamwork and decision-making. 

  • 20.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Groth, Kristina
    Karolinska institutet.
    Randall, Dave
    Manchester university.
    Medical team meetings: utilising technology to enhance communication, collaboration and decision-making2011In: Behavior and Information Technology, ISSN 0144-929X, E-ISSN 1362-3001, Vol. 30, no 4, p. 437-442Article in journal (Other academic)
  • 21.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Longo, Luca
    Recognising human factors in evaluating user interfaces in healthcare2011In: Health Informatics Society of Ireland (HISI), ICS HISI , 2011Conference paper (Refereed)
    Abstract [en]

    Clinicians often work under high-pressure, because of emergency situations, high volume, or speed required.  Their cognitive state is constant flux and while using digital interfaces, their experience and judgement is likely influenced by their mental state.

     

    Experience in aviation using the NASA-TLX (Task Load Index) tool for assessing Human Mental Workload (HMW) can be usefully applied along with Nielsen usability heuristics for evaluating an Electronic Health Records (EHR).

     

    A pilot study was conducted to assess clinicians’ cognitive state and investigate how HMW imposed by the EHR influences its usability.  Two wards demanding different levels of physical/mental stress for staff, both using the same EHR to document patients’ daily progress, were compared.

    Ward-1: 18 long-stay elderly patients with high dependency scores;

    Ward-2: 10 short-stay elderly patients with low dependency score

     

    Method: Questionnaires incorporating the NASA-TLX model and Neilsen’s design/usability principles were completed by a clinician in each scenario, following each use of the EHR.  The NASA-TLX model measures mental, physical and temporal demands, effort, performance and frustration levels. 

     

    Results:  HMW influences usability for the same EHR interface.  Towards the end of day, clinician performance in using the EHR drastically decreases.  They need to work harder mentally to reach the same level of performance (high HMW).  Pearson correlation for Nielsen/NASA-TLX is significant (Ward-1: r = -0.86;  Ward-2:  r = -0.930).  Increments of HMWs correspond to moderate decrements in usability.  This evidence suggests that an EHR design process should consider more the context of use and the cognitive workload of its clinicians.

  • 22.
    Kane, Bridget
    et al.
    St James’s Hospital, Dublin.
    Luz, Saturnino
    Trinity College Dublin.
    A study of the impact of collaborative tools on the effectiveness of clinical pathology conferences2004In: Computer Human Interaction: 6th Asia Pacific Conference, APCHI 2004, Rotorua, New Zealand, June 29-July 2, 2004. Proceedings / [ed] Masood Masoodian, Steve Jones, Bill Rogers, Springer, 2004, p. 656-660Conference paper (Refereed)
    Abstract [en]

    Multidisciplinary conferences in hospitals are becoming an everyday part of health service delivery and being recommended as a mechanism for ensuring quality patient care and management. This paper reports preliminary findings of an ethnographic study of Clinical Pathology Conferences with Respiratory teams. Educational, patient management and organizational objectives of the conference are identified. The findings so far suggest that collaborative technologies have the potential to improve the effectiveness of clinical conference activity. Time, location and missing artefacts are identified as being issues as well as the coordination of the series of events associated with patient investigative and assessment procedures. The implications of recording data and interactions at the conference are also being investigated.

  • 23.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Achieving Diagnosis by Consensus2009In: Computer Supported Cooperative Work, ISSN 0925-9724, E-ISSN 1573-7551, Vol. 18, no 4, p. 357-392Article in journal (Refereed)
    Abstract [en]

    This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual dif culty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied. 

  • 24.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Assimilating Information and Offering a Medical Opinion in Remote and Co-located Meetings2009In: 2009 22nd IEEE International Symposium on Computer-Based Medical Systems, IEEE, 2009, p. 475-480Conference paper (Refereed)
    Abstract [en]

    Discussion on patient data, among hospital staff, plays an increasingly important role in inter-specialist communication. Effectiveness of a discussion depends, among other factors, on how well its participants perceive, assimilate and interpret information exchanged during a discussion. This paper reports a field study conducted to assess information assimilation among medical observer participants during PCDs in a hospital. Medically trained observer participants undertook a questionnaire at multi-disciplinary medical team meetings (MDTMs) in teleconference and co-located settings. Results show that participants are more likely to offer opinions in teleconference while their expectations on the long-term effects of treatment are more realistic in co-located PCDs than in teleconference PCDs. Surprisingly, the presentation of clinical findings, radiology and pathology is perceived to be clearer in teleconference, and respondents believe that they follow the discussion, know the patient management plan and understand the basis for decisions, better in teleconference than in co-located PCDs. While a higher educational value is attributed to teleconference PCDs, evidence suggests a trend to have more errors in teleconference, less critical evaluation and no expression of disagreement with patient management decisions made in teleconference. 

  • 25.
    Kane, Bridget
    et al.
    Trinity College Dublin, Ireland.
    Luz, Saturnino
    Trinity College Dublin, Ireland.
    Clinical Training and Teamwork: Learning and Feedback2015In: 2015 IEEE 28th International Symposium on Computer-Based Medical Systems, IEEE, 2015, p. 280-285Conference paper (Refereed)
    Abstract [en]

    MDTMs are now a feature of routine hospital work and provide a valuable learning opportunity for education and practice development. The popularity of the forum as a patient management mechanism has had a negative counter effect on the educational function of the forum. Behavioural interventions and technical supports are identified based on long term ethnographic studies to restore the educational benefits of the forum. The potential for re-developing the MDTM into a rich educational resource that will assist in clinical education, professional development, provide an evidence base for guideline development by integrating clinical outcome feedback into the meeting record is proposed.

  • 26.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Collaboration and Multimedia: Identifying Equilibrium in the MDT Information Ecosystem2012In: CSCW 12: Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work Companion, New York, NY, USA: Association for Computing Machinery (ACM), 2012, Vol. 2, p. 119-122Conference paper (Refereed)
    Abstract [en]

    This study of collaboration among a multidisciplinary team of healthcare workers demonstrates that elements intrinsic to the interaction constitute a delicate ecosystem. As the balance between actors, digital media and paper artefacts fluctuates, so too the nature of the interaction and collaboration changes. Intrinsic to the multidisciplinary team (MDT) ecosystem is specialist knowledge, radiological images, pathology samples, together with the interpretation of the patient’s findings, as well as the roles and responsibilities of the active participants and observer collaborators.

  • 27.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    “Do no harm”: Fortifying MDT collaboration in changing technological times2013In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 7, p. 613-625Article in journal (Refereed)
    Abstract [en]

    Purpose To examine the changes in multidisciplinary medical team activity and practices, with respect to the amount of patient cases, the information needs and technology used, with up to 10 multidisciplinary teams (MDTs) in a large teaching hospital over a 10-year period. Methods An investigation of MDT meeting activity was undertaken in November 2005 and repeated in November 2012 for the MDTs at a large university teaching hospital. Analysis of data from 8 MDTs was informed through long-term ethnographical study, and supplemented with 38 semi-structured interviews and a survey from 182 staff members of MDTs. Results Work rhythms change over time as a function of the volume of work and technology changes, such as the use of a picture archive and communication system (PACS), videoconferencing and an electronic patient record (EPR). Maintaining cohesive teamwork, system dependability, and patient safety in the context of rapid change is challenging. Conclusions Benefits of MDT work are in evidence, but the causes are not fully understood. Instead of asking ‘how can technology support more MDT activity?’, we ask ‘how can we preserve the benefits of human–human interaction in an increasingly technological environment?’ and ‘how can we ensure that we do no harm?’ when introducing technology to support an increasingly demanding collaborative work setting. Introducing technology to streamline work might instead threaten the experienced improvement in patient services.

  • 28.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Expanding the HCI Agenda in Healthcare2014In: 2014 IEEE 27th International Symposium on Computer-Based Medical Systems, IEEE, 2014, p. 382-385Conference paper (Refereed)
    Abstract [en]

    Designing technology for use in healthcare, and its evaluation in the healthcare setting, deserves special attention because of the nature of the special context of use. Biological hazards and the risk of infection, issues of privacy and security, system response times, as well as human factors and patient safety are identified as areas deserving of special attention. We give examples and quote from clinician interviews for illustration, and we argue that increased focus from the HCI community on these areas will bring tangible benefits of health information systems to healthcare staff, and ultimately improve patient services. 

  • 29.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Information sharing at multidisciplinary medical team meetings2011In: Group Decision and Negotiation, ISSN 0926-2644, E-ISSN 1572-9907, ISSN ine, Vol. 20, no 4Article in journal (Refereed)
    Abstract [en]

    Results of a study of multidisciplinary medical team meetings (MDTMs) are presented, with focus on information presentation, collaboration, sharing and decision-making issues. The MDTM forum is shown to be an important juncture in the patient care pathway where prior work is reviewed, future work is planned, and decisions are made by consensus. It is shown that while all participants perceive that they benefit from their attendance, the benefit for most active participants is directly proportional to their contribution. Record keeping of the decision agreed and the basis for that decision poses a challenge, particularly in the context of electronic patient record (EPR) keeping. This study also reveals the multi-faceted nature of the event and the fact that new knowledge is generated during the meetings. In addition to its main function in patient management, the MDTM has an educational role and fulfils hospital functions in planning and co-ordination of service delivery. These findings are analysed in terms of their implications for the information sharing needs of partic- ipants according to their roles; and requirements for technology support at individual, group and organisational levels are discussed.

  • 30.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Knowledge Generation at Multidisciplinary team Meetings2009In: Health Informatics Society of Ireland, ICS HISI , 2009Conference paper (Refereed)
    Abstract [en]

    Recent controversies concerning cancer misdiagnosis have highlighted 

    recommendations for specialist centres and the current standard of multidisciplinary 

    team (MDT) working for cancer patient care.  While MDT is often considered in the 

    context of triple assessment in diagnosis, the MDT is also central to the choice of 

    treatment option and patient management following the diagnosis by consensus.  

    Information is being generated and communicated in new ways and patient care 

    pathways are undergoing change. 

     

    This paper examines why the MDT is now central to the diagnosis and management 

    of a wide range of diseases, including cancer.  There is a shift from diagnosis by an 

    individual specialist, such as pathologist, to diagnosis and disease staging  being 

    agreed by team consensus at a meeting.  There is also a change in how patients are 

    being managed following diagnosis. As treatments are developed and refined, modern 

    management for a range of diseases may include medical, surgical, medical oncology, 

    radiation oncology and intervention radiology specialities.  Paramedical specialities, 

    for example nursing, dietetics and physiotherapy, occupy a growing role in patient 

    management.  These treatments may be carried out in sequence, concurrently or in 

    combination (of sequence / concurrent) and decisions at the MDT meeting, agreed by 

    consensus, determine the protocol to be adopted in any individual patient case. 

     

    Although responsibility for an individual patient continues to rest with an individual 

    clinician, a shift is being experienced from individual clinician responsibility to group 

    responsibility and accountability.  These changes in medical practice pose particular 

    challenges for record keeping, at hospital and individual patient levels. 

  • 31.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Medical teamwork, collaboration and patient-centred care2015In: Journal of Behaviour and Information Technology, ISSN 0144-929X, Vol. 34, no 6, p. 543-547Article in journal (Other academic)
  • 32.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Multidisciplinary Medical Team Meetings: An Analysis of Collaborative Working with Special Attention to Timing and Teleconferencing2006In: Computer Supported Cooperative Work (CSCW), ISSN 0925-9724 Print 1573-7551 Online, Vol. 15, no 5-6, p. 501-535Article in journal (Refereed)
    Abstract [en]

    In this paper we describe the process of a multi-disciplinary medical team meeting (MDTM), its functions and operation in colocated and teleconference discussions. Our goal is to identify the elements and mechanics of operation that enhance or threaten the dependability of the MDTM as a ‘‘system’’ and propose technologies and measures to make this system more reliable. In particular, we assess the effect of adding teleconferencing to the MDTM, and identify strengths and vulnerabilities introduced into the system by the addition of teleconferencing technology. We show that, with respect to the systemÕs external task environment, rhythms of execution of pre-meeting and post-meeting activities are critical for MDTM success and that the extension of the MDTM to wider geographic locations with teleconferencing might disrupt such rhythms thereby posing potential threats to dependability. On the other hand, an analysis of vocalisation patterns demonstrates that despite difficulties related to coordination and awareness in video-mediated communication (evidenced by increased time spent in case discussion, longer turns, decreased turn frequency and near lack of informal exchanges) the overall case discussion structure is unaffected by the addition of teleconferencing technology into proceedings. 

  • 33.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    On Record Keeping at Multidisciplinary Team Meetings2011In: Proceedings of CBMS 2011: The 24th International Symposium on Computer-Based Medical Systems, IEEE, 2011, p. 1-6Conference paper (Refereed)
    Abstract [en]

    This paper explores issues related to record keeping at multidisciplinary medical team (MDT) meetings. Based on questionnaire and interview data with MDT members of various specialities, roles and teams, the information priorities for inclusion in a MDT meeting are identified. The utility and need for records after the meeting is discussed, and methods for gathering the information considered. Concerns are expressed that real-time data gathering at the meeting takes more time and risks turning the meeting into a group form-filling exercise. The value of interactive discussion among multidisciplinary peers is restated. The difficulties identified are discussed in the context of design implications for record-keeping at meetings. The role of records as a co-ordinating mechanism for tasks conducted after the meeting is emphasised, The dichotomy of having a record of a i) detailed prescriptive treatment plan, or ii) detailed diagnostic information with little treatment plan articulated, is explained.

  • 34.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Probing the use and value of video for multi-disciplinary medical teams in teleconference2006In: Nineteenth IEEE International Symposium on Computer-Based Medical Systems: 22-23 June 2006. Salt Lake City, Utah / [ed] D.J. Lee, Brian Nutter, Sameer Antani, Sunanda Mitra, James Archibald, USA: IEEE, 2006, p. 518-523Conference paper (Refereed)
    Abstract [en]

    Face-to-face interactions, via teleconferencing link, are investigated for multidisciplinary medical team (MDT) meetings. Comparison is made between colocated MDT meetings and those held in teleconference. Attitudes towards video changed positively, over a period of 8 months, following participants' experience of teleconferencing. Analysis of display screen use reveals 60% of case discussion time was time spent in face-to-face view with remote sites, contrary to expressed views of its relative unimportance. The value of the video link in MDT meetings, held in teleconference, is found to have higher than expected value.

  • 35.
    Kane, Bridget
    et al.
    University of Dublin, Ireland.
    Luz, Saturnino
    University of Dublin, Ireland.
    ’Referring on’: Passing responsibility for patient care2007In: Workshop on ‘Handover': Collaboration for Continuity of Work’, ECSCW, 2007, Limerick: Association for Computing Machinery (ACM), 2007Conference paper (Refereed)
    Abstract [en]

    The issues identified here were identified in a process and task analysis of the work of a multidisciplinary medical team (MDT) and their meetings (MDTM). Structures are evolving and issues are emerging with respect to work processes. Problems are identified that are associated with the handling of ‘consultations’ and ‘referrals’ to members of the MDT and are summarised in Table I. There are lesser associated issues when ‘referring back’.

    An individual patient is assigned under the care of a single doctor and that doctor may consult with others or pass the care to another doctor (specialist). The consultation or trans- fer is usually initiated by letter (or phone call) between the referring doctor and the specialist they expect will be better able to look after that patient. Traditionally the specialist will ar- range to see the patient for assessment and will then make a decision on management.

    Structures are changing and the development of MDTs has had an impact on how pa- tients are being managed. Services are being delivered through specialist centres, dispersed geographically and linked via teleconferencing technology. In tandem with service restruc- turing, the level of MDT working in increasing with a resultant increase in the number of patients being managed through MDTMs. There is more shared, or collective, responsibility among MDT members (even though patients are technically assigned to one doctor).

    Some problem areas have been identified in the handover of patients within a single multidisciplinary team, between different teams and between different hospitals that need to be resolved for the system to be efficient. The question “So, who is looking after this patient?” may not be so easily answered and may become even more difficult to answer in the future if systems are not in place to explicitly designate tasks and responsibilities. 

  • 36.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Taking lessons from teleconference to improve same time, same place interaction2008In: Proceedings of the 21st IEEE International Symposium on Computer-Based Medical Systems CBMS 2008 / [ed] Seppo Puuronen, Mykola Pechenizkiy, Alexey Tsymbal, Dah-Jye Lee, IEEE, 2008, p. 494-499Conference paper (Refereed)
    Abstract [en]

    Performance on an information gathering task is shown to be superior in teleconference. Analysis of errors in an exercise revealed the data sources used in co-located and teleconference scenarios. The use of a visual display for text data, in addition to the audio source, is demonstrated in both co-located and teleconference discussions. Audio was used as a source of information more frequently in teleconference which resulted in an overall improvement in task performance.

    The lesson learned from the higher performance in teleconference, can be applied to improve performance at co-located meetings. Providing appropriate visual data together within audio enhanced spaces can be expected to improve the communication event and reduce medical errors. Results support proposals for the incorporation of physical spaces to improve communication in everyday work in co-operative workplaces, such as hospitals. 

  • 37.
    Kane, Bridget
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Luz, Saturnino
    Univ Edinburgh, Edinburgh, Midlothian, Scotland.
    Trust, Ethics and Access: Challenges in studying the work of Multidisciplinary Medical Teams2017In: 2017 IEEE 30Th International Symposium On Computer-Based Medical Systems (CBMS) / [ed] Bamidis, PD; Konstantinidis, ST; Rodrigues, PP, New York: IEEE, 2017, p. 527-528Chapter in book (Refereed)
    Abstract [en]

    This paper highlights the challenges for researchers when undertaking research on multidisciplinary medical teams (MDTs) in real-world healthcare settings, and suggests ways in which these challenges may be addressed.

  • 38.
    Kane, Bridget
    et al.
    Trinity College Dublin, Ireland.
    Luz, Saturnino
    Trinity College Dublin, Ireland.
    Jing, Su
    Trinity College Dublin, Ireland.
    Capturing multimodal interaction at medical meetings in a hospital setting: Opportunities and Challenges2010In: Workshop on Multimodal Corpora at LREC: Advances in Capturing, Coding and Analyzing Multimodality (MMC 2010) held in conjunction with 7th International Conference for Language Resources and Evaluation (LREC 2010), Malta, 2010, p. 140-145Conference paper (Refereed)
    Abstract [en]

    This paper highlights the issues involved in gathering a corpus of data on the multimodal interaction that occurs at a team meeting of medical specialists. Difficulties in capturing the data are described, and the ethical issues are emphasised. Methods to investigate the internal structure of meetings, at the level of discussion topic (patient case discussion) are summarised and the potential benefit that such meeting records promise are reviewed. The hospital setting where the corpora are proposed experience issues in common with any business venture, but in addition demonstrate additional sensitivities because of health service complexities and patient privacy issues.

  • 39.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Meaney, James
    St. James’s Hospital, Dublin, Ireland.
    Perception of Movement and Orientation in Digital Medical Imaging2009In: Proceedings of I-HCI 2009, Dublin: Trinity College Dublin , 2009, p. 111-114Conference paper (Refereed)
    Abstract [en]

    This paper presents preliminary results on an investigation into a visual illusion observed in health care. The illusion is demonstrated in radiological imaging and may have impli- cations for patient safety. A URL to a video of a Positron Emission Tomography (PET) scan image was circulated and participants reported the type of movement they observed in the video. There is a wide variation with respect to the observations reported, which appears to be independent of gender or age differences. The clinical significance of this finding is discussed and plans for further investigation of the phenomenon are outlined.

  • 40.
    Kane, Bridget
    et al.
    Trinity College Dublin, Ireland.
    Luz, Saturnino
    Trinity College Dublin, Ireland.
    Menezes, Gerard
    Trinity College Dublin, Ireland.
    Hollywood, Donal P.
    Trinity College Dublin, Ireland.
    Enabling Change in Healthcare Structures through Teleconferencing2005In: 18th IEEE Symposium on Computer-Based Medical Systems (CBMS'05), IEEE, 2005, p. 76-81Conference paper (Refereed)
    Abstract [en]

    Developments in teleconferencing capabilities have made changes in work practices possible and are facilitating working partnerships between institutions. This study of a teleconferencing initiative examines how the work of a multi-disciplinary team (MDT) is affected by extending the meeting to remote locations. Challenges are highlighted, particularly in relation to the management of information flows, development of norms (meeting protocols) and record keeping. 

  • 41.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College & Trinity Centre for Health Sciences, St. James's Hospital.
    Luz, Saturnino
    Trinity College, Dublin.
    O’Briain, D. Sean
    St. James's Hospital, Dublin.
    McDermott, Ronan
    St. James's Hospital, Dublin.
    Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments2007In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 5, no 15Article in journal (Refereed)
    Abstract [en]

    Background: The development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.

    Methods: For one month, all work related to clinical meetings between pathology and radiology with clinical staff was documented and later analysed.

    Results: The number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging) can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted.

    Conclusion: Difficulties are being experienced by pathology and radiology departments participating fully in several multidisciplinary teams. Time spent at meetings, and in preparation for MDTMs is significant. Issues of timing and the coordination of materials to be reviewed are sometimes irreconcilable. The exchange of patient materials with outside institutions is a cause for concern when full data are not made available in a timely fashion. The process of preparation for meetings is having a positive influence on quality, but more resources are needed in pathology and radiology to realise the full benefits of multidisciplinary team working. 

  • 42.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Luz, Saturnino
    Thomas, Steve
    Including Cost Analysis in a Framework for Evaluating Technology Use at Multidisciplinary Team Meetings in Healthcare2014Conference paper (Refereed)
    Abstract [en]

    Evaluation of work healthcare practices is problematic, and assessment of technology use in a particular work practice is often undertaken without fully taking account of the economic costs involved, including those of related work practices.  

    We propose a model of evaluation of the use of information communication technology (ICT) that takes account of the organizational, social functions and the patient services that are served in the process.  We focus this study on multidisciplinary team meetings (MDTMs) as a technology in patient care.  Multidisciplinary team (MDT) work and MDTMs are recommended for the management complex patients, and cancer patients in particular, by respected agencies.  We also demonstrate the introduction of videoconferencing into the MDTM setting and the additional factors, including economic aspects, that need to be taken into account in the evaluation of its use.

    Methodology: Data were gathered in a long-term ethnographic study with MDTs in a large tertiary referral teaching hospital.

    MDTMs are complex collaborative work settings, with several highly specialised roles interacting and sharing information in text, images and speech.  Pathologists present pathological results (including tissue images); radiologists review relevant radiology images, and clinicians present their findings.  Radiation and medical oncologists, discuss treatment options with surgeons and other specialists.  Each role can elaborate on their findings, ask and answer questions from colleagues, and refine or revise their assessment.  ICT is used to assist in this complex task, particularly in demonstrating images, accessing electronic patient information, and building collaborative electronic records.  Video-technology is often applied to extend the MDTM over several hospitals, to facilitate patient assessment and management in remote locations.  Typically an MDTM is held weekly for approximately 1.5hours.  Up to 30 people are in attendance that include consultant specialists, senior registrars, house officers, nurses, as well as allied health professionals (dieticians, physiotherapists and speech therapists).  In Sweden, referring doctors are also in attendance, although sometimes their attendance is facilitated by videoconference, like in Ireland.  It has been reported that some MDTs, particularly for Head and Neck MDTs, that patients also attend while their case is being discussed.  Our studies identify significant resources consumed in preparation for MDTMs in Radiology and Pathology Departments.  Our studies calculate that 2hours of preparation are required for radiologists per hour of MDTM; in pathology 2.4 hours are spent in preparation for an hours meeting.  For a typical tertiary referral teaching hospital there is approximately 83.5 MDTM hours per month with an additional 324.4 hours of consultant time (pathologist / radiologist) spent in preparation for meetings.  One hour of MDTMs costs 35-40 hours (i.e. one hour per attendee + 4.5hours preparation); resources per MDT is equivalent to WTE 1.5.

    When calculating staff costs, account must also be taken that for some MDTMs, staff participant is voluntary, and outside their contracted hours.  This voluntary participation for some MDT members is rooted in the team history and should be acknowledged in any evaluation.

    Full economic assessment of MDTMs that takes account of patient benefits is needed.  This paper provides the framework and first steps.

  • 43.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland; Norway.
    Luz, Saturnino
    Trinity College, Ireland.
    Toussaint, Pieter
    NTNU, Norway.
    Developing a Framework for Evaluation of Technology Use at Multidisciplinary Meetings in Healthcare2013In: Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems (CBMS) / [ed] Rodrigues, PP; Pechenizkiy, M; Gama, J; Correia, RC; Liu, J; Traina, A; Lucas, P; Soda, P, IEEE conference proceedings, 2013, p. 355-360Conference paper (Refereed)
    Abstract [en]

    Identifying an appropriate method to evaluate the use of technology during patient case discussions at multidis- ciplinary medical team (MDT) meetings, is problematic. A number of approaches conducted over an extended pe- riod of study are described and the lessons learned are explained. A framework is proposed to serve as a basis for evaluation of technology use in these complex collab- orative work settings that incorporates hospital, technology and people perspectives.

  • 44.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Meaney, James
    St. James’s Hospital, Ireland.
    Luz, Saturnino
    Trinity College Dublin, Ireland.
    Sharing Patient Radiological Imaging Studies and Pathological Samples2011In: Conference on Information and Knowledge Management (CIKM) 2011, ACM , 2011Conference paper (Refereed)
    Abstract [en]

    This paper discusses the problems experienced in sharing radiological images and pathological samples between hos- pitals. Despite the introduction of DICOM standards for medical imaging, difference are reported in the adoption of this standard by different vendors. Furthermore the stan- dard is under constant review and is being continually up- dated. These updates mean that imaging conducted un- der the newer standards are often not readable in older sys- tems. Transmission of images, while theoretically possible, is not practically implemented because of shortcomings in networks, deterioration of resolution on transmitted images and issues of maintaining text or voice based records with an associated image. There are also many obstacles to sharing because of differences in local imaging protocols. While digital imaging is not in widespread use for pathology samples, local processing protocols and techniques regularly prove ob- stacles to sharing patient pathological data. Co-ordination of both radiology and pathology samples is the most impor- tant challenge to sharing this information among hospitals and institutions. This paper describes work in progress to make a comprehensive list of obstacles to sharing radiolog- ical image sets and pathological material between referring doctors and specialists. Issues of standards, protocols, pro- cedures and techniques in pathology and radiology are explained.

    ors.

  • 45.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Morrough, Mary
    St. James’s Hospital, Dublin.
    Al Chalabi, Hassan
    St. James’s Hospital, Dublin.
    O’Keeffe, Sylvia
    St. James’s Hospital, Dublin.
    Dunne, Barbara
    St. James’s Hospital, Dublin.
    Kennedy, M. John
    St. James’s Hospital, Dublin.
    Hollywood, Donal
    St. James’s Hospital, Dublin.
    Boyle, Terry
    St. James’s Hospital, Dublin.
    Connolly, Elizabeth
    St. James’s Hospital, Dublin.
    McDermott, Ronan
    St. James’s Hospital, Dublin.
    O’Byrne, Ken
    St. James’s Hospital, Dublin.
    Lynam, Finian
    St. James’s Hospital, Dublin.
    Luz, Saturnino
    University of Dublin, Trinity College, Ireland.
    Multidisciplinary Team (MDT) experience in the incorporation of PACS and real-time electronic record-keeping at meetings2011In: Health Informatics Society of Ireland (HISI), ICS HISI , 2011Conference paper (Refereed)
    Abstract [en]

    In tandem with the introduction of PACS and the adoption of an EPR system at St. James’s hospital, there has been a 237% increase in the number of patients being managed through Breast MDT meetings between 2005 and 2010.

    Methodology: This study forms part of a long-term ethnographic study at St. James's Hospital. Data are gathered at MDT meetings.

    Due to increased numbers of women attending breast triple assessment clinics, and awareness of breast complaints, coupled with new protocols and amended local hospital policies, new strategies were required to be implemented to cope effectively with the increased demand. Strategies include grouping and prioritizing of cases, increased formalisation, and the incorporation of real-time electronic record-keeping at meetings (as opposed to note-taking).

    The Electronic Patient Record (EPR) system allows access to all laboratory test results and the final written pathology report if required during discussion. PACS implementation facilitates direct access to digital radiological imaging such as Mammograms, Breast Ultrasound, Breast MRI, Body CT and Bone Scans. The increase in the number of patient presenting to the breast care services has resulted in more selective use of illustrating images. It is no longer practical to conduct a routine review of all images as may have happened in the past.

    In 2010 a ‘computer-on-wheels’, connected to the hospital wired-network, was introduced to enable real-time data entry of the decisions of the MDT. The lead clinician, at the end of the meeting, validates entries and the report from the MDT discussion is then available in the individual patient record.

  • 46.
    Kane, Bridget
    et al.
    University of Dublin, Trinity College, Ireland.
    Toussaint, Pieter J.
    NTNU, Trondheim, Norway.
    Luz, Saturnino
    Trinity College, Dublin, Ireland.
    Shared Decision Making Needs a Communication Record2013In: CSCW '13 Proceedings of the 2013 conference on Computer supported cooperative work, Association for Computing Machinery (ACM), 2013, p. 79-90Conference paper (Refereed)
    Abstract [en]

    Increasing dependability in collaboration work among health professionals will directly improve patient outcomes, and re- duce healthcare costs. Our research examines the develop- ment of a shared visual display to facilitate data entry and val- idation of an electronic record during multidisciplinary team meeting discussion, where specialists discuss patient symp- toms, test results, and image findings. The problem of gen- erating an electronic record for patient files that will serve as a record of collaboration, communication and a guide for later tasks is addressed through use of the shared visual display. Shortcomings in user-informed designed, structured data-entry screens became evident when in actual use. Time constraints prompt the synopsis of discussion in acronyms, free text, abbreviations, and the use of inferences. We demon- strate how common ground, team cohesiveness and the use of a shared visual display can improve dependability, but these factors can also provide a false sense of security and increase vulnerability in the patient management system.

  • 47.
    Kane, Bridget
    et al.
    NTNU Trondheim, Norway.
    Toussaint, Pieter J.
    NTNU Trondheim, Norway.
    O’Byrne, Ken
    Trinity College Dublin, Ireland.
    Informality and Teamwork2013In: Workshop on Informality in Medical Work, at CSCW, 2013Conference paper (Refereed)
    Abstract [en]

    This discussion paper considers examples of informal communication among multidisciplinary medical teams in the context of their weekly meeting. Informal exchanges are frequent, particularly at the beginnings and endings of meetings, are often private (1-2-1). This opportunity for synchronous face-to-face informal exchange is highly valued and reported to be a strong motivator for attendance at MDT meetings. The exchanges are both task and non-task related and tend to be conversational. We suggest that the informal communication we observe plays an important role in helping team cohesiveness

  • 48.
    Lindegren, Daniel
    et al.
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Information Systems and Project Management. Karlstad Univ, Informat Syst, Karlstad, Sweden..
    Karegar, Farzaneh
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Mathematics and Computer Science (from 2013). Karlstad Univ, Comp Sci, Karlstad, Sweden..
    Kane, Bridget
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Karlstad Univ, Informat Syst, Karlstad, Sweden..
    Pettersson, John Sören
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Information Systems and Project Management. Karlstad Univ, Informat Syst, Karlstad, Sweden..
    An evaluation of three designs to engage users when providing their consent on smartphones2019In: Behavior and Information Technology, ISSN 0144-929X, E-ISSN 1362-3001Article in journal (Refereed)
    Abstract [en]

    The graphical and interactive design of a consent form helps individuals to keep control and pay attention to the information that they are disclosing. In the context of mobile apps we propose and test alternative interaction design solutions for selecting personal information on permission dialogues, namely using checkboxes, a drag-and-drop selection, and a swiping action. We test each proposed design and compare the results in terms of their usability and effectiveness in helping users to be more attentive and aware of their data flow, in other words, to provide their informed consent. This study demonstrates that checkboxes while speedy do not engage the user as much as drag-and-drop or swiping. User satisfaction is positively impacted by these newer ways of giving consent.

  • 49.
    Longo, Luca
    et al.
    Trinity College Dublin, Ireland.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Hederman, Lucy
    Trinity College Dublin, Ireland.
    Argumentation Theory in Health Care2012In: 2012 25th IEEE International Symposium on Computer-Based Medical Systems (CBMS) / [ed] P. Soda, F. Tortorella, New York, NY, USA: IEEE, 2012, p. 1-6Conference paper (Refereed)
    Abstract [en]

    Argumentation theory (AT) has been gaining momentum in the health care arena thanks to its intuitive and modular way of aggregating clinical evidence and taking rational decisions. The basic principles of argumentation theory are described and demonstrated in the breast cancer recurrence problem. It is shown how to represent available clinical evidence in arguments, how to define defeat relations among them and how to create a formal argumentation framework. Argumentation semantics are then applied over the built framework to compute arguments justification status. It is demonstrated how this process can enhance the clinician decision-making process. A encouraging predictive capacity is compared against the accuracy rate of well-established machine learning techniques confirming the potential of argumentation theory in health care. 

  • 50.
    Luz, Saturnino
    et al.
    University of Dublin, Trinity College, Ireland.
    Kane, Bridget
    University of Dublin, Trinity College, Ireland.
    Classification of Patient Case Discussions Through Analysis of Vocalisation Graphs2009In: Proceedings of the 2009 International Conference on Multimodal Interfaces, Association for Computing Machinery (ACM), 2009, p. 107-114Conference paper (Refereed)
12 1 - 50 of 61
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