Sundhedsinformatik: En undersøgelse af sundhedsprofessionelles forventninger til - og anvendelse af applikationen ReMind i ambulant behandling i psykiatrien: præ- og post- implementering

Healthcare informatics: Exploring expectations and use of the application ReMind in psychiatric outpatient care: pre- and post- implementation

Jessen, Tanja Prlac

2. årgang

Master i Sundhedsinformatik (Efter- og videreuddannelse)

2015

2015-06-10

80

Baggrund: Region Midtjyllands psykiatri prioriterer sundhedsteknologi, især videokonsultationer, for at gøre behandling mere fleksibel, målrettet og omkostningseffektiv. Appen ReMind er udviklet til at understøtte videokontakt mellem patienter og behandlere og er besluttet implementeret i flere ambulante enheder. Forskning viser dog, at nye teknologier kan være svære at få i brug, bl.a. fordi sundhedsprofessionelle ikke altid accepterer dem. Denne undersøgelse ser på, hvilke forventninger sundhedsprofessionelle har til ReMind, og hvilke erfaringer de gør sig, når teknologien introduceres i klinisk psykiatrisk praksis. Metode: Vi indsamlede sundhedsprofessionelles perspektiver gennem 10 semistrukturerede kvalitative interview: fem før og fem efter, at implementeringen gik i gang. Materialet blev fortolket hermeneutisk (en fortolkende tilgang til at forstå mening i data). Som analytiske briller brugte vi socio-teknisk systemteori (der ser på samspillet mellem mennesker, arbejdsprocesser og teknologi), det Udvidede Teknologibegreb og indsigter fra Technucation-projektet inden for STS (Science, Technology and Society), som undersøger teknologi i en samfundsmæssig kontekst. Fund: Fire hovedtemaer fremkom: forventninger, oplevelser, anvendelse og barrierer. Forventningerne var, at ReMind kan 1) mindske betydningen af geografiske afstande, 2) øge patientinddragelse og empowerment (støtte patienters egenomsorg og handlekraft) og 3) give mere fleksibilitet i samarbejdet. Oplevelserne omfattede 1) manglende fortrolighed med systemet, 2) behov for at ændre praksis og 3) en vurdering af, at ReMind ikke passer til alle patienter. Det var ikke muligt at beskrive brugen med patienter i dybden, da fire deltagere endnu ikke havde brugt ReMind, og den femte kun kort havde anvendt beskedfunktionen med én patient. Anvendelse blev desuden præget af 1) sammenligning med andre platforme og 2) et ønske om, at teknologien skaber tydelig værdi fra dag ét. De største barrierer var 1) tidspres i hverdagen, 2) begrænset ledelsesinvolvering og manglende fælles retning for implementering og 3) behov for lokal it-support. Konklusion: Sundhedsprofessionelle ser primært ReMind som værdifuld for patienterne, særligt fordi den kan styrke patientinddragelse. De har sværere ved at pege på gevinster for dem selv som behandlere. Manglende tid er den største barriere og peger på, at ReMind endnu ikke opleves som en integreret del af kerneopgaven. For nogle er selve vejen ind i organisationen uklar. Medarbejdere, der tidligere har haft gode erfaringer (fx iPad-projektet) og været med i udvikling, har lettere ved at se formålet. Manglende integration til eksisterende systemer udfordrer arbejdsgange og patientsikkerhed. Der er behov for fremtidig forskning i patientperspektivet for at afklare, hvilke funktioner en app som ReMind bør have for bedst at styrke patienternes egenomsorg (empowerment).

Background: The Central Denmark Region’s psychiatry plan prioritizes health technology, especially video consultations, to make treatment more flexible, targeted, and cost-effective. The ReMind app was developed to support video contact between patients and clinicians and is being rolled out in several outpatient units. Research shows, however, that getting new technologies into everyday practice is difficult, partly because health professionals do not always accept them. This study examines what health professionals expect from ReMind and what they experience when the technology is introduced into clinical psychiatric practice. Methods: We gathered professionals’ perspectives through 10 semi-structured qualitative interviews: five before and five after implementation began. The material was interpreted using a hermeneutic approach (an interpretive way of understanding meaning in data). As analytical lenses, we used socio-technical systems theory (which looks at how people, workflows, and technology interact), the Extended Concept of Technology, and insights from the Technucation project within STS (Science, Technology and Society), which studies technology in its societal context. Findings: Four main themes emerged: expectations, experiences, use, and barriers. Expectations were that ReMind can 1) reduce the impact of geographic distance, 2) increase patient involvement and empowerment (supporting patients’ self-care and agency), and 3) provide more flexibility in collaboration. Experiences included 1) lack of familiarity with the system, 2) the need to change practice, and 3) the view that ReMind does not fit all patients. It was not possible to describe use with patients in depth, as four participants had not yet used ReMind and the fifth had only briefly used the messaging function with one patient. Use was also shaped by 1) comparisons with other platforms and 2) a desire for the technology to deliver clear value from day one. The main barriers were 1) everyday time pressure, 2) limited managerial involvement and a lack of a shared implementation vision, and 3) the need for local IT support. Conclusion: Health professionals mainly see ReMind as valuable for patients, particularly for strengthening patient involvement. They find it harder to name benefits for themselves as clinicians. Lack of time is the biggest barrier and suggests that ReMind is not yet perceived as part of the core treatment task. For some, the route by which the technology enters the organization is unclear. Staff with positive prior experience (e.g., the iPad project) and involvement in development more readily see the purpose. Missing integration with existing systems hampers workflows and patient safety. Future research should include the patient perspective to clarify which features an app like ReMind needs to best support patients’ self-care (empowerment).

[Dette resumé er genereret ved hjælp af AI]

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