Skills and Expertise
Jan 2003 - Dec 2011
University Hospital of North Norway
- Norwegian Centre for Integrated Care and Telemedicine
- Tromsø, Norway
Research Items (30)
- Jun 2019
iPads have become increasingly popular as tools for teaching in early education. With their multifaceted and interactive affordances as handheld and mobile devices, they have been ascribed great potential to change and expand on classroom practice. However, the iPad often becomes just another technology hype in education, and explanations often point to teachers’ and schools’ lack of technical know-how and ability to utilise the devices’ affordances. In this qualitative case study, we explore how teachers organise and practise iPads in two different classrooms. Classroom observations and interviews with the teachers were conducted to enrich our knowledge about the complexities of iPad use in teaching and to strengthen the knowledge of how different settings produce different iPad practices. Using an actor–network theory approach, the study suggests that iPads are not simply put into use, but enacted through fluid, heterogeneous assemblages of human and non-human actors in the classroom. The iPad’s affordances, such as mobility, are performed rather than inherent qualities of the devices themselves, and the classroom becomes a mishmash of fostering and hindering mobile practices.
- Aug 2018
Sociological interest in the digitization of health has predominantly been studied using qualitative approaches. Research in this field has grown steadily since the late 1990's but to date, no synthesis has been conducted to integrate this now rather comprehensive corpus of data. In this paper we present a meta-ethnography of 15 papers reporting qualitative studies of digitally mediated patient - professional interactions. By dissecting the detailed descriptions of digitized practices in this most basic relationship in health care, we explore how these studies can illuminate important aspects of social relations in contemporary society. Our interpretative synthesis enables us to reassert a sociological view that places changes in social structures and interaction at the core of questions about the digitization of health care. Our synthesis of this literature identifies four key concepts that point at structural processes of change. We argue that when patient-professional interactions are digitized, relations are respatialized, and there are reconnections of relational components. These lead to empirically specific reactions, which can be characterized as reconstitutions and renegotiations of social practices which in turn are related to the reconfiguration of basic social institutions. We propose a new direction for exploring the digitalization of health care to illuminate how digital health is related to contemporary social change.
Background: This paper explores Norwegian doctors' use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals' use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors' direct SCR experiences. Methods: We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach. Results: The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool's six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data. Conclusion: Therefore, we can assume that the popularity of the pharmaceutical summary among doctors is based on their preference to place their trust in - and therefore more often utilise - automatically updated information. In addition, the doctors' lack of trust in manually updated information might have severe implications for the future success of the SCR and for similar digital tools for sharing patient information.
Telementoring is a well-known practice in surgical training, and its impact is traditionally related to individual surgeons' performance and the quality of the procedure. The objective of this study was to explore telementoring in a wider organisational context. This paper reports on an ethnographic study carried out during 2014-2016 in Norway, combining observations, interviews, focus groups and field notes. We followed the surgical training of a specialist candidate at a medium-sized surgical ward. The training successfully took place through the use of telementoring, comprising updated standards for a surgical procedure that ensured minimum invasive surgery for a vulnerable patient group. We observed that telementoring was a necessary and important element in ongoing quality improvement processes at the ward, and its impact at the organisational level was important. In fact, a series of co-existing interwoven elements was necessary to normalise the new procedure in question. We conclude that the use of telementoring linking international expertise to local contexts is one of the factors that can facilitate and speed up quality improvement processes in small- to medium-sized surgical wards.
In Norway, a national digital tool for critical information sharing (CIS) was implemented in the period 2013–2017 for sharing critical patient information among and between primary and specialist healthcare professionals. The health authorities considered access to patient information across levels and institutions of care so important that it warranted an amendment. In September 2016, qualitative interviews were conducted with 12 project leaders (PL) responsible for the implementation of CIS and 25 doctors with access to CIS. The interviews were semi-structured, and they lasted 20–80 min each. They were recorded, then transcribed, and analyzed according to their content. The PL considered that they had succeeded with their implementation work, but practitioners seldom used the new technology for the purpose of providing critical information. CIS also gives access to prescribed medicaments, which is the most useful tool for them. As CIS is a national initiative, practitioners are implementing more long-term strategies. While PL consider their work to be finished after technology implementing and training, practitioners predict that CIS is one of several small steps toward a national journal for sharing even more patient information.
- Oct 2017
- IADIS International Conference e-Health 2017 (part of MCCSIS 2017)
T A national electronic information system for critical information sharing (CIS) was implemented in the period 2013-2017, and all general practitioners, doctors in emergency units, and doctors in emergency rooms were required to perform an e-learning course and pass an acceptance test in order to access the CIS. The acceptance test was seen as problematic as the users were challenged by the adjustments to the local information system, too time consuming, i.e. taking the test, picking up the PKI card, and logging on for use in critical situations. The use of CIS requires passing the test, which is determined by the national authority in Norway. The professionals feel controlled and ordered to take the test, and believe that the acceptance test is not needed in order to use the information system.
A Norwegian research group is adopting the Database of Individual Patient’s Experience of Illness (DIPEx) international methodology standards for collecting qualitative research into people’s health experiences and disseminating it on a web site. We are in the concept phase of developing the web site, and decided to build a topical ambiguous taxonomy together with a more clinically influenced taxonomy with top-level labels “Health and lifestyle” and “Illness” for the information architecture of the web site. In this paper, we report from usability testing of the top-level label of the topical taxonomy. We ran qualitative and quantitative A/B tests on wireframe concept sketches. The two top-level labels were a generic variant, “Topic”, tested against the control variant, “Everyday life”. Both qualitative and quantitative tests indicate better results for “Everyday life” as the top-level label for the topical ambiguous taxonomy of the web site. While not fully conclusive, the results provide reasonable confidence in the more descriptive label “Everyday life” at this early stage. It is preferable in that it both seems to create a more coherent set of expectations amongst the users, and more closely matches the content of the web site. The concept test is therefore deemed a useful first step in a rigorous testing program to ensure that the development process is informed by a patient-validated information architecture.
Web-based promotion of qualitative research has a potential to reform traditional scientific dissemination, as well as it challenges ethical norms of research participation and anonymity. In this poster, we discuss ethical considerations of web-based dissemination of qualitative research on patient narratives through video recordings. Including subjective un-anonymized patient stories in research dissemination to inform and support, might have benefits for the field of science, patients, health professionals and the general population. However, ethical norms and guidelines for anonymity needs to be considered with care when promoting patient voices on the Internet.
In northern Norway, laparoscopic surgeons under training use videoconferencing to access expert surgeons. Videoconferencing as a tool for collaboration and knowledge sharing overcomes the distance between expert mentors and mentees and might improve surgical training. Understanding of videoconferencing in surgical practice is limited, and the educational and clinical benefits of telementoring should be explored. Over a three-year period, from 2015 to 2017, we will undertake an qualitative, explorative study using video-recorded observations of interactions. Our objective is to examine collaboration in surgical training, seeking an in-depth understanding of the non-technical aspects or social processes of collaboration in surgical training. Here we discuss how video-recorded studies may contribute to the understanding of the interactions between mentors and mentees and how to use video for approaching this practice. We discuss the use of video-recorded observations and present a fixed and a flexible design for collecting video recordings. Experiences from 8 real-time cases and one simulation of collaboration using videoconferencing in the operating theatre reflect the optimality of the flexible design, which allows following the dynamic of the surgical team. The results reveal a number of resources that are important both for interactions during surgical (tele)mentoring and for the camera position.
- Jun 2015
- SHI 2015, Proceedings from The 13th Scandinavien Conference on Health Informatics
This paper is a study protocol. “Health talk Norway” is a one year project where we will pilot a new and increasingly popular international methodology for qualitative research on people’s health experiences; the DIPEx methodology, developed by the Health Experiences Research Group (HERG) at the University of Oxford. This study will explore if Norwegian research and dissemination on health experiences can be improved using the DIPEx methodology. At the core of the DIPEx methodology is a web site disseminating people’s accounts of their health experiences. DIPEx has been founded to promote the spread of well-researched data on personal experiences of illness and health for the benefit of patients, professionals (both clinical and academic), health services, health care providers and carers. The methodology has been developed in the UK and has so far been adapted to 9 other countries, in Europe, Australia, North America and Asia. Results from the pilot will be of importance for future development of a Norwegian health talk web site, and support research infrastructure for qualitative research on health experiences.
This paper describes a work in progress, a project studying collaboration among laparoscopic surgeons who are instructed during their education. Access to expert surgeons is a problem at many hospitals. Implementing videoconferencing (VC) as a tool for instruction (telestration) and knowledge-sharing overcomes the distance between mentors and mentees, and has the potential to improve surgical training. Understanding of VC is limited in surgical practice, and the educational and clinical benefits of telementoring should be explored. This project will meet this demand by seeking in-depth understanding of the non-technical aspects or social processes of collaboration in surgical training. Over a three-year period, from 2015 to 2017, this project will examine collaboration in surgical training (CoaST). A hospital in northern Norway at which surgeons collaborate in surgical training to complete their surgical education in general surgery will be investigated. This paper discusses how we will collect the data. When they start to use VC for mentoring in distance surgical training, this will be included. An explorative study will be carried out using video-recorded observations of interactions. The paper is relevant for the conference focusing on the topic of distributed surgery and collaboration between professionals creating new telemedicine practices. This paper outlines the objectives of the study and the qualitative design; the study will explore non-technical aspects or social processes of collaboration in surgical training. The paper concludes by presenting a design for collecting video recordings to explore surgical training.
The use of synchronous and asynchronous telemedicine technology for medical probl]em solving is often treated as a question of functionality. The objective of this paper is to explore how the use of synchronous videoconference (VC) and asynchronous discussion forums for medical problem solving in Norway contributes to sharing knowledge in order to solve medical problems. A secondary use of qualitative data is analyzed in order to explore interactions over a period of time. The results illustrate, by in-depth analysis of interactions, the importance of the interface between questions and answers, when seeking to expand knowledge and learning. Hence, synchronous and asynchronous collaboration represent different opportunities for expanding knowledge. Even though they both can facilitate regularly use, and continuing problem solving, synchronous collaboration is an engagement for here and now problem solving, which affect the regularity and the types of medical problems discussed. The paper is relevant for the topic of the conference, discussing social relations and processes in telemedicine practice. When considering implementing technology for knowledge sharing, it's a need to keep in mind that the practice affects the learning opportunities, and the knowledge shared.
How videoconferences (VCs) as a tool for real-time collaborative medical diagnosis are organised affects the content of collaborative work. The objective of this paper is to outline how the organisation of VCs for pre-planned and acute situations affects content in collaboration. Forty-seven VCs were observed and videotaped, and twenty semi-structured interviews were conducted in two studies, representing three contexts, reflecting pre-planned and acute medical problem solving. Regularly pre-planned meetings differ from others, creating a practice that includes consultations about general medical problems, the opportunity to discuss specialised problems, and information sharing between levels of care. Regularity and thus knowledge of each other and of the patient support the sharing of information about patients previously discussed. Acute use of VC is organised as a restricted service, offered during a specific timeslot during the day. The consultation is specialised (i.e., stroke), in which professional(s) with specific specialised knowledge meet. Non-planned, 24/7 acute use of VC is still left to be explored in its context. What is known is that acute knowledge is knowledge in the moment, requiring unplanned access to VC as a tool for sharing knowledge resources twenty-four hours a day. These factors should be considered when VC is implemented for collaborative medical diagnosis. The paper is relevant as it is concerned with tools to enhance collaboration online, i.e., VC, and how VC improves the value of distributed knowledge among virtual teams.
- Sep 2013
Interdisciplinary professional education (IPE) contributes to the formation of effective collaboration in the field of practice. Education needs to be organised so that health science students can learn with, from, and about each other. This article explores how web-based collaboration contributes to this, by describing how it promotes reflection and professional understanding among health science students. Our data analysis is based on focus group interviews and online student discussions. The findings show that the flexibility of digital network, which represents both collaboration triggered by videos and online communication, is important for the students: they develop their argumentation together in reflective tranquillity. It is important to practise reflection since a choice of actions is an integral part of healthcare work, work which depends upon judgement exercised by the individual healthcare worker. The digital network allows students from different health science programmes to draw on each other’s knowledge and expertise. The findings are relevant for the development of reflection and professional understanding among health science students, as they show how students discuss and seek solutions to complex challenges in the practice.
Increased patient involvement is a goal in contemporary health care, and of importance to the development of patient oriented ICT. In this paper we discuss how the design of patient-user interfaces can affect patient involvement. Our discussion is based on 12 semi-structured interviews with patient users of a web-based solution for patient - doctor communication piloted in Norway. We argue ICT solutions offering a choice of user interfaces on the patient side are preferable to ensure individual accommodation and a high degree of patient involvement. When introducing web-based tools for patient - health professional communication a free-text option should be provided to the patient users.
In this paper, we explore the use of videoconferences (VCs) in medical practice, and discuss how characteristics of the context affect the use of VCs. Forty-seven VCs were observed and videotaped, and 41 semi-structured interviews were conducted. Our findings suggest the use of VCs for acute collaborative work differs from the non-acute use of VCs. Non-acute use facilitates collaboration throughout the entire patient trajectory, while acute use facilitates medical problem solving in the moment. Strict specialization and division of labor reduce the cases to discuss and the discussion of complex treatment trajectories. Acute collaborative work is past and present work, while non-acute collaboration reflects past, present, and future treatment, that is, an overall trajectory.
- Feb 2013
- eTELEMED 2013, The Fifth International Conference on eHealth, Telemedicine, and Social Medicine
This article explores the ways in which collaboration between professionals using videoconferencing affects the e-health delivered to patients. In Norway, general practitioners (GPs) and specialists routinely hold videoconferences. Observations of 42 VC meetings, each lasting from 5 to 40 min, were analysed in terms of the interactions. In addition, five semi-structured, face-to-face interviews were conducted, each lasting from 20 to 70 minutes. Statements were selected to illustrate the content of the interactions and how collaborative work affects the delivery of healthcare. Successful collaborative work provides practitioners with a new way of thinking: exchanging information and knowledge between levels of care in order to provide the best treatment for patients locally. The regularity makes the collaborative work a two-way achievement. GPs receive decision support and second opinions, and specialists receive information and opportunities to follow up. How the professionals manage their work (i.e., collaborating) may benefit their patients. The regular use of videoconferencing will furnish professionals with enhanced resources for the meeting of patients’ demands in the future. Regularly informing one another and exchanging knowledge, benefits the professionals by providing increased certainty with regard to their medical decisions, and it benefits the patients because they will feel satisfied with the competence of the specialists where they live.
In Norway, it is a national goal to provide more patients with thrombolytic treatment. A referring hospital and a specialist hospital have implemented videoconferencing (VC) equipment to share knowledge and discuss stroke patients, regarding thrombolytic treatment. VC has only been used four times within the 19 months that the service has been available. The objective in this article is to increase the understanding of the contradiction between the need for knowledge-sharing through VC technology, as well as the reasons for low frequency of use when discussing stroke patients. Semi-structured interviews were conducted with 13 professionals. The results illustrate how the technology per se is not the reason for the low frequency use. Health care is shaped by behavior, traditional rules, standards and division of labor. By using cultural historical activity theory (CHAT) as a framework, we illustrate the importance of understanding the historic way of performing an activity to be able to expand the treatment activity in the future.
Purpose – Videoconferencing between general practitioners and hospitals has been developed to provide higher quality health care services in Norway by promoting interaction between levels of care. This article aims to explore the use of videoconferencing for information exchange and consultation throughout the patient trajectory and to investigate how collaboration affects learning and the patient's treatment. Design/methodology/approach – The approach was interaction analysis supplemented by interviews. Medical discussions concerning the patient were observed for 15 days, creating a trajectory of seven videoconferences. Interviews were conducted to examine the collaboration. Findings – General practitioners and specialists use a different repertoire of knowledge and experiences to report and consult throughout the course of treatment. Over time, new medical problems arose, and the treatment had to be adjusted. The activity remained continuous and contributed to an integrated knowledge and information exchange. Collaboration using videoconferencing across levels of care created opportunities for workplace learning in health services and can lead to continuity, improved coordination, and a higher quality of care. Originality/value – In contrast to other studies, which state effects, the need for continuity and cooperation in health care, and the ways in which individual differences make it difficult to achieve seamless health care services, this study offers insight into how continuity and cooperation can be achieved. It includes both observations of interactions and interviews of the participants, providing analysis of collaborative work in situ. This provides insight into the content of the interaction over time as a resource for understanding the outcome of the use of technology and improving health care.
- Jul 2011
This study explores how teams create opportunities for learning through medical talk in video conferences (VCs). The empirical context is 47 real-time VCs carried out between general practitioners (GPs) and specialists to examine collaborative work through medical talk. Sixteen of the observations were consultations wherein knowledge was shared with the purpose of solving a specific medical problem. Eight interviews were done face-to-face with a focus on the content of the talk, with the purpose of examining the findings of the observations. Analysis of information and knowledge sharing in medical talk through discussing a patient's medical record shows that collaborative work creates opportunities for learning. The participants describe, inform, recommend, explain and confirm in a two-way process. Individuals' different experience-based knowledge and scientific knowledge closes the knowledge gapsbetween GP and specialist. Contradictions between the individual's thinking and the knowledge collectively shared furthers the activity. Regular VCs offer the opportunity to be part of a distributed team that expands the opportunity provided by irregular phone calls, deviates from the expected course of traditional procedures for doing medical work and creates a space for learning. The VC facilitates collaboration and collective reflection as a distributed health care team.
- Apr 2011
In this article, I explore what happens when general practitioners (GPs) and specialists meet using videoconferencing to collaborate on a patient's treatment. By using videoconferencing, GPs and specialists are offered opportunities to share and produce knowledge. The data corpus was 42 videotaped videoconferences. The treatment of one specific patient was selected.This patient was discussed over a period of 9 days, which constituted five videoconferences. I describe how GPs and specialists discuss treatment strategies and exemplify how knowledge sharing creates opportunities for learning in boundary zones across activity systems as a part of daily practice.The talk about the treatment occurs by information exchange and by consultation. Information exchange without any dilemmas presented might support decisions already made. Consultations wherein dilemmas are presented and solved by bridging knowledge gaps between the general practitioner and the specialist create opportunities for learning.
- Jan 2010
Teleconsultations provide new opportunities for learning in medical settings. This study explores the conditions under which learning among physicians takes place. The empirical context is 47 real-time video conferences carried out to examine collaborative work and the medical talk involved. Sixteen of the observations were consultations wherein general practitioners (GPs) and specialists shared knowledge with the purpose of solving a medical problem related to a patient under treatment. In this exploratory study, the learning opportunities are seen as what medical practitioners with different types of expertise achieve through interaction while working with patients over periods of time. The analysis of medical talk in consultations shows that collaborative work among GPs and specialists creates a shared understanding of the patient's clinical history and treatment trajectory. As knowledge is demanded and attributed and gaps of knowledge become shared, consultations create a work tool that expands the medical work and talk. Collaborative work in and between different levels of the health care service expands knowledge, creates opportunities for learning in everyday settings, and improves the quality of knowledge distribution in the health care system.
- Feb 2008
Over a period of five months we observed teleconsultations between general practitioners (GPs) in community care and specialists in hospitals in two Norwegian health regions (A and B). In total, 47 teleconsultations between GPs and specialists were recorded. In region A, teleconsultations were organized when needed to discuss specific medical problems. In region B, teleconsultations took place during the specialists' daily morning meeting. The teleconsultations lasted for 5-40 min. There were three categories of talk. In the first two there was information exchange for patient updates and practical organization of the service. The third category, consultation, was the communicative process in which the GP and the specialist engaged in collaborative work, primarily discussing medical problems related to decision-making in patient care. Regular use of teleconsultation opens access to different repertoires of knowledge and experience, and brings knowledge to the point of patient care and medical decision-making.
- Feb 2005
A Web-based collaboration tool was developed for ophthalmologists, called Øyenet. A feasibility study was performed in 2000. The system was ready to use in 2001, but the usage of the system was disappointing, compared to the enthusiasm expressed in the feasibility study. In order to identify facilitators and barriers for usage of the system, we performed a qualitative study. Nineteen ophthalmologists from different parts of Norway, who had been using the system but to a varying degree, were interviewed. The study revealed that a single common solution is not appropriate for the ophthalmology community as a whole. It also revealed that colleagues from abroad should be allowed to use the system, in order for it to act as a tool for collaboration and seeking advice in complex medical problem solving.
- Feb 2003
Telemedicine is not simply a technology - it also involves processes. The use of telemedicine is influenced by many factors. Our intention was to examine what conditions promote the use of telemedicine between general practitioners (GPs) and hospitals. Qualitative interviews were undertaken with 16 GPs in northern Norway. The extent to which GPs were using the services was limited, although some used them fairly frequently. The most widely used service was teledermatology. The GPs saw advantages of the services in general and saw clear benefits for their patients. The services were considered to be time-consuming, and the lack of adequate government remuneration for the time involved in teleconsultations was seen as a barrier to their use. The GPs focused on their own ability to handle new technology and expressed a need to practise more.