1 Arild FAXVAAG The Norwegian EHR research centre (NSEP), Institute of neuroscience, Faculty of medicine, NTNU, Trondheim, Norway Co-Operation Support.

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Arild FAXVAAGThe Norwegian EHR research centre (NSEP), Institute of neuroscience,

Faculty of medicine, NTNU,

Trondheim, Norway

Co-Operation Support Through Transparency (COSTT)

2Bilde hentet fra www.helsebygg.no

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Co-Operation Support Through Transparency (COSTT)

• domain: development and clinical testing of system for coordination of perioperative work  

• budget: 4-year, 3,3 MEUR researcher project funded by the Norwegian Research Council and the partners

• principal investigator: Pieter J Toussaint, IDI, NTNU• people: faculty from NTNU health informatics, two post docs, 4

PhD students, researchers from partners, programmers• partners: NTNU Health informatics, SINTEF, HEMIT, St.Olavs

hospital (Trondheim), SONITOR (Oslo), Aker University hospital (Oslo) and Cetrea (Danmark)

• project kick-off: sept 2008

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den medisinsk-teknologiske utvikling

• lidelse skaper behov for forskning• forskning skaper ny kunnskap• ny kunnskap gir ny teknologi

– som kan brukes til å kartlegge sykdom

– som kan brukes til å endre sykdomsprosesser

• ny teknologi skaper behov for nye, mer spesialiserte arbeidsmetoder• gammel teknologi overflødiggjøres sjelden fullstendig• nye arbeidsmetoder gir mer spesialiserte aktører• aktørene er (og forblir) ansvarlige for de handlinger de utfører

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Faxvaag, Samstad and Seim Manuscript in preparation

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the perioperative domain

By Mark Meyer

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basic assumptions (1)

• Traditional workflow systems– Require beforehand knowledge of:

• Actions to be performed• Order of actions• Actor(s) responsible for actions

– don’t do well in healthcare…

.. partly because

• Clinical processes are problem solving activities

• Existing systems don’t support training and research

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Chares P Friedman J Am Med Inform Assoc. 2009;16:169-170

Chares P Friedman J Am Med Inform Assoc. 2009;16:169-170

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basic assumptions (2)

• theoretical perspective from CSCW, and from Daniel Dennett:• Dennett: we try to understand the world around us by interpreting

other actor’s intentions– the intentional stance

• CSCW: people are good at coordinating their work • .. and will become even better at coordinating their work if they are

provided with information about what’s going on in adjacent places – awareness

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our approach:

• information about the patient trajectory — what actually happens with the patient — can enhance the actors’ ability to coordinate themselves

• information about the patient trajectory can be sampled automatically and made available to the actors in real-time

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Chares P Friedman J Am Med Inform Assoc. 2009;16:169-170

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we are developing a prototype that will

• retrieve representations of relevant digital and physical events, – examples:

• physical event: That a person enters, or leaves a room, that the anesthesia machine is turned on, that the diathermy knife kicks in

• digital events:– that a healthcare professional opens the medical record of patient x– that the operation room planning system signals that the operation should have

started

• infer which healthcare act might be unfolding– examples:

• patient + surgeon is present + the anesthesia machine is running = ongoing surgery• patient present + surgeon has left the room + nurse assistant present = patient about

to leave the operating theatre and on his way to the recovery room

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the prototype, contd.

• and visualize representations of the patient trajectory on wall mounted boards in operating rooms, coordination rooms, recovery and bed ward

• the prototype is being developed with techniques from participatory design, and successive iterations of the prototype will be tested in our usability lab

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