Sturesson Linda, Groth Kristina
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Centre for Innovation, Karolinska University Hospital, Stockholm, Sweden.
J Med Internet Res. 2018 Jun 27;20(6):e221. doi: 10.2196/jmir.9866.
Video mediated meetings with patients were introduced in outpatient care at a hospital in Sweden. New behaviours and tasks emerged due to changes of roles, work processes and responsibilities. The study investigates effects of digital transformation, in this case how video visits in outpatient care change work processes and introduces new tasks, in order to further improve the concept of video visits.
Through real-time, social interactional features of preparing for and conducting video visits, the study examines clinicians' perceived limitations and disturbances, and how the conditions between patients and clinicians may change when using video visits instead of face-to-face meetings in outpatient care.
Qualitative methods have been used including 14 observations of video visits at two different clinics and 14 followup interviews with clinicians. Transcriptions of interviews and field notes were thematically analysed, discussed and synthesised into themes.
Disturbances and limitations related to the technology were related to time; a flexibility to schedule the meeting unbound of place, frustrations when the other part was late for the scheduled meeting, and that more experienced users of video visits usually waited longer before logging in. They were also related to sound; problems getting the sound to work satisfactory during the video visits, and problems with the image. Disturbances and limitations related to the surroundings were related to both the patient's and the clinician's environment; the principle of video technology in itself may affect the experience and the content of the consultation, and the surrounding chosen changes the conditions for and reduces the participants' field of view.
We could see 1) a transformation of roles and responsibilities when turning from face-to-face meetings to video visits, 2) that video visits add new circumstances, with a risk of introducing disturbances and limitations, that in turn affects the content of the meeting, 3) that avoiding negative disturbances during a video visit, requires a sensibility from the clinician's side as well as a trust in the patient's judgement, 4) that both expected and unexpected disturbances and limitations during a video visit affect the clinician's behaviour, feelings, the content of the meeting and how the clinician's relate to the different components of the concept, and 5) that there is a change of roles introduced when conducting video visits, eg, the clinician taking the first line support if both (s)he and the patient encounter problems with the technology.
瑞典一家医院在门诊护理中引入了与患者的视频会议。由于角色、工作流程和职责的变化，出现了新的行为和任务。本研究调查数字转型的影响，在这种情况下，门诊护理中的视频问诊如何改变工作流程并引入新任务，以进一步完善视频问诊的概念。
通过准备和进行视频问诊的实时社交互动特征，本研究考察临床医生感知到的限制和干扰，以及在门诊护理中使用视频问诊而非面对面会议时患者与临床医生之间的状况可能如何变化。
采用了定性方法，包括在两个不同诊所对视频问诊进行14次观察以及对临床医生进行14次随访访谈。对访谈记录和实地笔记进行主题分析、讨论并综合成主题。
与技术相关的干扰和限制与时间有关；有在不受地点限制的情况下安排会议的灵活性，当对方在预定会议迟到时会感到沮丧，以及视频问诊经验更丰富的用户通常在登录前等待更长时间。它们还与声音有关；在视频问诊期间使声音正常工作存在问题，以及图像问题。与周围环境相关的干扰和限制与患者和临床医生的环境都有关；视频技术本身的原理可能会影响问诊的体验和内容，并且所选择的周围环境会改变条件并缩小参与者的视野。
我们可以看到1）从面对面会议转向视频问诊时角色和职责的转变，2）视频问诊增加了新情况，存在引入干扰和限制的风险，这反过来会影响会议的内容，3）在视频问诊期间避免负面干扰需要临床医生的敏感性以及对患者判断的信任，4）视频问诊期间预期和意外的干扰和限制会影响临床医生的行为、感受、会议内容以及临床医生与该概念不同组成部分的关系，5）进行视频问诊时会引入角色变化，例如，如果临床医生和患者在技术方面都遇到问题，临床医生承担一线支持的角色。
