Health, Technology & Organisation (HTO)

My name is Iosif Kakalelis and I’m towards the end of my master studies in computer science at Uppsala University. I have finished my four-year bachelor in my hometown Thessaloniki in Greece, where I studied Applied informatics at the University of Macedonia, a business school. My degree combines IT with business, marketing and economics. Here in Sweden, it is more flexible in terms of forming study plans. During my first year l, I experimented with different courses but in the end I realized that I was still more interested at working in real-life projects dealing with  needs of society. Hence, I chose to do my master-thesis at Uppsala University Hospital.

Nowadays, technology has been embraced by society in almost every applicable field. Healthcare is no exception. New, innovative technologies are gradually being introduced in different health facilities around the globe in order to make healthcare more effective, less costly and better monitored.

Uppsala University Hospital intends to introduce Closed Loop Medication [1] to its whole workflow. Pre-studies have already been carried out and certain funds are available for this ambitious project. This suggested solution concerns almost everyone involved in healthcare. Most often the end-users are nurses, who first check and then administer the prescribed medicine to patients. Other examples of people affected by this change are doctors who prescribe, pharmacists who control and verify the correct medicine doses but may also include storekeepers who inspect the availability of medical supplies. 

 The selected medication is prescribed on an unverified prescription order that is then transcribed. Transcribing includes performing multiple crosschecks of the prescription order to real-time patient information, healthcare industry practices, and medication information to generate a verified prescription order. After transcribing, the appropriate dispensing method is determined for the prescription order and dispensed. The dispensed medication is administered after confirmation by the administering clinician of the right patient, right medication, right dosage, right route, and right time. The whole process of medication use described above is monitored continuously in real-time. The monitored information is communicated to the prescribing, transcribing, dispensing and administering parts of the system. [1]

In other words, automation is part of the entire process, starting from the doctors who are prescribing medicine, pharmacists checking and verifying the prescribed medicine, nurses receiving medicine from vending machines and finally the patient being given prescribed meditation in a customized package for him. The reason for automating the process is ultimately to achieve improvement in the accuracy and speed of the medicine distribution chain. Although the hospital today is considered technologically advanced, they are currently using different software, which was developed and often owned by third parties, for each part of the chain. Furthermore, for some specific tasks there is not even an available software solution. The drawback of this approach is that, often, there is limited to no communication and connection between the different software.

Even worse, there is not efficient communication and real time information between the different departments of the same hospital, because, as mentioned above, different databases and software are used, sometimes even for the same functions. Therefore, it is not uncommon for nurses, for example, to manually search for the available medicine on shelves, or doctors to call other departments to ask if a specific medicine is available there. All those factors contribute to making the whole procedure more time consuming and lead to harsher working conditions for employees and generally lead to the diminishment of productivity. Clearly, there is a need for the right medication, in the right place, at the right time, with the least possible effort and risk. Effectiveness could be achieved with closed loop medication through a centralized, interconnected, and interoperable information system which embraces all the functionalities of the current solutions. This system should be closely aligned with the current routines and working habits of the staff. The fact that the end-users are usually nurses or doctors, whose time is always prioritized toward patients, should spend the minimum possible time learning and using a software for their daily tasks.

Implementing a closed-loop system, is a broad and ambitious vision that people at the hospital shares, which involves many different specialists and knowledge from different fields including logistics. The area of my study is going to be the pharmaceutical verification step in close-looped-medication. Here in Sweden, doctors prescribe medicine to patients, but before the latter receive them, the prescription has to be verified and approved by pharmacists for safety reasons. After a meeting I had at the hospital with Dr Anders Westermark and some other medical personnel, I was told that currently there is no software responsible for implementing and monitoring that process. However closed loop medication necessitates a verification solution to be implemented. Thus, this is the part I want to get involved with and below my plan is described.

First, I plan to understand, analyze the workflow of this step from the perspective of all professions involved (i.e. doctors, pharmaceutical employees). A verification system should check if prescribed medicines uphold some predefined standards and/or whether they take into account each patient’s special needs or peculiarities. In case discrepancies are found, relevant warning indicators and messages should be triggered.

Second, I will try proposing solution ideas about this verification system answering questions about how it will look like, and how that would effectively fit inside the workflow, based on feedback I will receive from all the involved actors. This thesis motivates me to study papers regarding eHealth and automation in order to discover how knowledge of the others could give nice ideas for my project.  Since the topics is about improving healthcare, potentially I could also make a small literature research about AI and automation in health. The optimal solution would include a verification system that self learns and improves.

 It is also important to study the outcome this automation will have to the people. Role of technology is to serve people’s needs and not vice-versa. They should have control and opinion in the whole process and not kept outside the loop, like simple spectators. Therefore, it is my plans to study about potential problems that automation could bring. My final suggestions should take into consideration people’s considerations and concerns.

References

Henderson, D., Richard, L., Marklewicz, E., Tobin,C. (2003). CLOSED LOOP MEDICATION AND METHOD.

Organizations, Artifacts and Practices (OAP) yearly workshops remind of the fact that work in organizations happens in certain physical spaces, need certain time and is performed with the help of artifacts – even in the digital age. The theme for this year’s conference was ”Rematerializing organizations in the digital age” An overarching theme in the sessions I attended was places where we work – working from home or working in open space offices, especially hot-desking, i.e. not having a designated desk.

Timon Beyes’s opening keynote on ”The work of disconnection” discussed the increasing trend of learning to disconnect from the digital world – for example digital detoxes. His descriptions of how digital media has invaded our ways of thinking even when we try to disconnect was quite thought-provoking. The occasional giggle in the audience indicated that we to a certain extent recognised ourselves in the descriptions.

In the final panel the three days’ presentations on locations and open office spaces were summed up, and, generally, open offices were criticised on basis of many surveys and interview studies, some of them done in universities. The lack of privacy was acutely felt. In the overall effort of creating open offices, even people with functions the really demand private spaces (counselling, for example) found it difficult to assert their needs, as in Bernadette Nooij’s study. Identity crises – “who am I without my books”, as a university staff asked. And, actually, some people felt more lonely, when chatting at the door of a colleague was no longer possible. As Marie Hasbi has found out, there can be gender issues – not only had female workers problems in finding a space for their handbags (the lockers relatively far away, and nowhere to lock away the handbag when moving from the desk), the acts to re-territorialise desks could have gender aspects, as well as being exposed to all colleagues all the time. And the negatives seemed to persist.

Increased working from home often goes hand-in hand with hot-desking (so the number of desks can be kept lower than the number of employees). Melanie Goisauf had studied a well functioning public bureaucracy, where working from home was introduced and found out that control of the employees by the managers increased when the team control, built on common ethos and responsibility and supported by daily interaction diminished. Instead of “us” having responsibility towards the public, single employees shifted their responsibility towards the management, and the team spirit deteriorated as competition regarding individual performance increased. As managerial control based on performance measures increased, tacit knowledge disappeared from managers’ view.

Joshua Firth’s study from New Zealand at an ICT development company, developing tools for healthcare goes in line with the HTO results: Practitioners/healthcare workers find it difficult to really get a voice in development processes, even if they would be formally enlisted, and this trend seems to get stronger the longer the process goes on. Firth talked of building in neotaylorism in the healthcare software, and just like Taylorism in its time, it profoundly changes work practices, disempowers the (healthcare) workers and centralises managerial power.

Also Joao Cunha’s study on how people enlist other people’s help when they have to use online communication is interesting in healthcare, where more and more communication is supposed to use electronic forms instead of personal interaction. Cunha found that when people just have to send a message to a great unknown, and, thus positional power or personal relationships cannot ensure that their request will be heard, they invent different strategies in trying to ensure that the request is dealt with swiftly.

The workshop made great efforts for breaking up traditional academic lecturing styles with a number of panels and question-answer sessions. In this context Vrije Universiteit Amsterdam had an artefact I haven’t encountered before: A conference microphone shaped like a soft cube (see image). Instead of people running around with microphones, the “dice” was thrown around in the lecture hall. Fun – but also demanding that the person who had something to say had a fair ball sense to be able to catch and throw precisely enough. Still another academic ability coming on?