Collaboration and CSCW Issues
in Radiographic Health Care
Hilda Tellioglu
Vienna University of Technology,
Department for CSCW
Argentinierstrasse 8, A-1040 Vienna,
Austria
Introduction
This paper looks at health care work
as a complex collaborative activity involving multiple actors using intermediaries
to enable the continuation of crucial actions necessary for patient treatment.
To carry out radiographic work the division of work usually follows a clear pattern
of distributed and shared responsibilities [2]. In a health care setting we also
have to consider the occurrence of ad-hoc distribution of tasks and responsibilities.
In case of an insufficiently created image the diagnosing radiologist may take
over the image production and perhaps the postprocessing of the image, or at least
s/he must support the corresponding radiographer by giving him/her instructions
to increase the quality of the image. By diagnosing a complex case a radiologist
may need the help of his/her colleagues who need not necessarily be in the same
room. Especially in case of ad-hoc work arrangements, the main question is how
to support the cooperative management of collaboration considering the overview
and awareness of actors' activities.
Material and Methods
In 1996 we (Peissl, Tellioglu, and Wild)
started working on a series of ethnographic studies - participatory observations
and semi-structured interviews - at the Danube Hospital in Vienna and Skejby University
Hospital in Denmark [3]. Additionally an international literature analysis and
interviews with experts from other hospitals like Lorenz Boehler Casualty Hospital
and County Hospital in Austria enriched the collection of information. Through
cooperation with Nina Lundberg a comparison could be made between work practices
in traditional and PACS based radiology departments in Austria, Sweden, and Denmark
[1, 2]. The following research results are created by applying CSCW (computer
supported cooperative work) concepts and findings to analyze computer-based collaboration
and cooperation issues within radiographic health care.
Results
Articulation of work activities and
decisions become a very important issue since organizational boundaries, especially
between the clinicians and radiologists, are increasing. It seems that receiving
the image additionally to the radiographic report changes the perception of clinicians
regarding radiological work, and increases the acceptance of radiologists as physicians
and as colleagues. The implicit information as an annotation or a sign onto the
image created by radiologists and readable by clinicians helps to communicate
the steps and points of importance during diagnosis work, and enables to create
a neutral platform for articulation work.
There are quite a lot of lists -
task or patient lists, room schedules, report lists - used to arrange the work
in radiology departments. Some of them are shared, i.e. are transparent and
available to all actors involved. They offer an overview of activities, time
schedules, responsibilities, and tasks at a given time, and makes actors to
be aware of what others are doing.
Additionally the shared information
space, created by PACS and RIS, hosts the cooperation and collaboration patterns
interchanged between all actors. Some systems are adapted to the needs of actors
using them in their daily work, others are inflexible avoiding sufficient access
to shared information (patient data, reports and images) allowing parallel work
processes. In some hospitals the strategy how to organize the cooperation between
actors constraints and restricts the access of some actors to the common data
even if the computer system used allows flexible configuration and setup.
Conclusion
There are some requirements to computer
systems supporting group work within hospital context. It is necessary to support
the flexible switching between overview and detailed representation of patient
data, between e.g. a general view of patient list (also of other actors) and old
reports, images or demographic data. I also suggest to enrich the common information
space within the hospital by making available information such as personal remarks
to diagnosed images or suggestions to treatment of patients, and enable a computer-based
mode of ad-hoc access in order to be able to act and react in emergent cases or
in case of uncertainties. These additional functionalities help to understand
others' actions and to articulate ones medical decisions.
References
1.- Lundberg, N., Tellioglu, H. Impacts
of the Re-Engineering Process on Radiological Work. A comparative study between
traditional/non PACS based and networked/PACS based radiology departments in Austria,
Sweden, and Denmark. Proceedings of the 15th International EuroPACS Meeting, September
25-27, 1997: 251-255.
2.- Lundberg, N., Tellioglu, H.
Understanding coordination work in health care. Submitted paper.
3.- Peissl W, Tellioglu H, Wild
C. Das digitale Krankenhaus. Eine Technikfolgen-Abschätzung moderner Telekommunikationstechnologien
im Krankenhaus am Beispiel des Donauspital/SMZO. Final Report of the Research
Projekt at Institute of Technology Assessment at the Austrian Academy of Sciences,
Vienna 1996
Corresponding Author:
Dr. Hilda Tellioglu
Vienna University of Technology
Department for CSCW
Argentinierstrasse 8
A-1040 Vienna, Austria
tel: +43.1.58801.4492
fax: +43.1.5042478
e-mail: hilda.tellioglu(at)tuwien.ac.at
Oral presentation
at EuroPACS'98, Barcelona, Spain