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PhD half-time seminar

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Presentation for my PhD half-time seminar. Description of the research project, the setting, conducted activities, main results so far, and plans for the future.

Presentation for my PhD half-time seminar. Description of the research project, the setting, conducted activities, main results so far, and plans for the future.

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PhD half-time seminar PhD half-time seminar Presentation Transcript

  • Collaborative Case-based Presentation Situational Awareness of Patient Information during Medical Multi-disciplinary Team Meetings PhD half-time seminar Oscar Frykholm, frykholm@kth.se http://hci.csc.kth.se/personView.jsp?userName=frykholm Department of Human-Computer Interaction Royal Institute of Technology Stockholm, Sweden
  • One research project Funk-IS: Functionality enhancing technologies for built-in systems with application within advanced medical processes September 2008 – December 2011, funkis.csc.kth.se Tracks Project members ”Database of experiences”, 8 researchers and PhD visualization of patient students from human- information. computer interaction, The Royal Institute of Technology Haptics and 3D graphics for radiologist/surgeon 7 surgeons MD PhD from communication. GastroCentre Surgery, Karolinska University Hospital Methodology used in the project.
  • The setting: GastroCentre Surgery 25 medical specialists in esophagus, liver, pancreas. Patients are referred to Gastro from the Stockholm region, i.e. they work together with seven other hospitals. Yearly: 1900 referrals, 1200 on to decision meeting, 370 on to surgery. Central processes Clinical Care Pathway: a structured process Team-based care: not one specialist per patient Multi-disciplinary team meetings (MDTM): consensus decisions
  • Clinical care pathway, information flow at Gastro Coordination Decision Treatment Post-op Referral Presenter aggregates Patient information is Re-view of patient relevant information. accessed individually information and Coordinator makes by surgeons in order feedback on first assessment of Presentation of to: treatment. patient information examinations and patient information: - plan and perform Coordinator surgery conference: surgeon - decision and radiologist check meeting - write post-surgical if available notes. - pre-operative information is planning sufficient.
  • Decision meeting
  • Decision meeting - structured process Medical specialists: Surgeon, Radiologist, Oncologist, Hepatologist, Pathologist Presenter Radiologist All medical specialists Chair Roles Ref. physician, oncologist Pathologist Presenter Brief presentation: Thorough presentations Discussion on all patient Decision: Presented - Patient status of conducted info: - diagnosis examinations: - symptoms, diagnosis informa- - The organ - treatment, - treatment, continued - radiology tion - Subjective symptoms decision procedures - pathology - Past, ongoing and new diagnostic procedures - Clinical assessment and clinical question for the decision meeting Meeting progression
  • Why a “database of experiences”? Notes from MDTMs include decision, not: motivation, discussions, alternative diagnosis, discarded suggestions on treatment, similar cases et.c. Information is collected during several months/years. -> Decisions made in the MDTMs depend on who is present and what they remember. The surgeons stated in the beginning of the project that they want to know what has been done before, they want senior surgeons to share their clinical gaze. We hypothesize that access to similar cases is one way. -> In the end, this will lead to a better basis for decision on diagnosis and treatment.
  • Research questions and directions How can discussions during multi-disciplinary medical team meetings be captured, in order to describe the patients? How can medical specialists collaboratively work with patient information, in order to find similar cases? Case-based presentation (information visualization) Interaction design (CSCW)
  • Demo sessions of technology Workshops Prototyping Cooperative / participatory design with the surgeons
  • Conducted activities Project meetings Field studies Demo sessions Observations of MDTMs Workshops, interviews Studies of (simulated) MDTMs Prototyping sessions
  • Result 1: Structured patient information Based on National quality register of pancreatic tumours, which is used today. Engström and Groth, Understanding needs and requirements in applications for identifying clinically relevant similarities between patients with liver related diseases. In Proceedings of HealthInf, Porto, Portugal, January 2009. Relevant patient information (pancreas) at Gastro.
  • Top-level nodes • Patient status Coordination • The organ • The patient’s subjective symptoms • Conducted, ongoing and planned diagnostic procedures • Clinical assessment and clinical question for the decision meeting Decision • Conducted examinations • Concluding diagnosis and decision on continued procedures • Surgery Tre Post-op • Anatomical pathology, after surgery (4-6 weeks) • Post- operative follow-up (9-12 months)
  • Example: Node 1, Patient status Referring physician Current diseases Factors influencing Name / Clinic / Hospital Comorbidity, per organ examinations system: Example: Kidney failure / Cardiovascular Contrast medium allergy / About the patient Heart failure / Angina / Claustrophobia, psychological Age / Sex / Endemic area / limitations / Implanted Dysrhythmia / Infarct Performance status metallic objects Pulmonary Life style KOL Drug or alcohol problems / Smoker Excretion (kidney) Motivation to treatment Kidney failure Liver Cirrhosis Previous decision meeting when patient "Psychological" was discussed Anxiety / Psychosis / Dementia Decision / Date / Follow-up Metabolic on decision Diabetes / Weight loss
  • Result 2: concept of a Clinical Journal Workspace on top of all their systems. Tag the most important pieces of information for future use. Visualisation of patient Multi-disciplinary decision making information Shared display Display presented information Support for all disciplines and sites Better overview Collaborative tools: annotation, pointing, Focused discussions presence Find and review similar cases and studies Based on the list structured patient Interactive and multi-touch information Shared large display Text and images linked Personal hand-held devices Collaborative planning of work processes
  • Clinical Journal – first prototype
  • Timeline of patients and activities The care-planning unit and out-patient clinic can see an overview of all ongoing patients, based on where they are in the patient care pathway and what activities have been conducted. Overview of relevant patient information One-screen overview to display relevant information during case discussions. Summarized patient information allows physicians to focus on the most important information. The source material can still be accessed when needed.
  • Evaluation with senior surgeons Sketches produced in cooperation with one of the surgeons. Evaluated with him and four other surgeons. Improvements and new requirements.
  • Next 1-2 years Continued high-level prototyping of Clinical Journal Evaluate in decision and pre-op meetings Focus on MDTM situational awareness Fine-tune case-based presentation How to find similar cases? Find suitable interaction techniques Personal vs shared focus?
  • PhD half-time seminar Oscar Frykholm, frykholm@kth.se http://hci.csc.kth.se/personView.jsp?userName=frykholm Department of Human-Computer Interaction Royal Institute of Technology Stockholm, Sweden