Abstract Virtual work introduces distinct challenges when compared to face-to-face or on-site work. Communication and collaboration are key factors in team development and in team performance. When teamwork is of a global nature, imposed because of a pandemic, then additional variables are introduced into the equation. The challenges that global virtual teams (GVTs) encounter when communicating and developing in the context of the Covid-19 pandemic impacts how work is structured and teams develop. This qualitative study was conducted just over 1 year after the start of the Covid-19 pandemic when working from home became mandatory and particular challenges for GVTs became apparent. Data are gathered through an online anonymous survey and followed by semi-structured video-mediated interviews with staff in a large multinational software development company. Findings show that GVTs encounter a number of distinct challenges than face-to-face teams. However, individuals are actively adapting to the situation in which they find themselves and are learning to deal with the challenges by being proactive. Even though the tools used previously may not be entirely suitable for virtual work, GVTs learn to change how tools are used to be more productive and collaborative. Challenges continue to exist in areas, such as knowledge gathering and knowledge sharing. Communication failures can lead to delays and confusion. The findings also indicate that even though GVTs are not communicating as much informally or socially with their colleagues because of remote working in the pandemic, being remote is not having a negative effect on the ability to get work done. Some aspects of team development can be negatively affected when working in GVTs. Impacts are identified relating to trust and relationship building, as well as being able to identify and resolve conflict. These results prompt further research opportunities as organizations and individuals continue to adapt and embrace global virtual teamwork.

Understanding demand on healthcare services is critical to inform resourcing decisions for service demands. We ask two questions: 1) Can out-patient (OPD) demand for the plastic and reconstructive services be forecast? 2) Can we predict theatre requirements in terms of volume, type or complexity? The use of Time Series Analysis (TSA), simulation modelling, data-driven methods including data mining are reviewed to address the questions. Starting with a knowledge-discovery in databases methodology, Autoregressive integrated moving average (ARIMA) TSA is applied to forecast OPD referral demand. Monte Carlo simulation (MCs) is used to forecast the theatre requirements in terms of type, complexity, volume, and duration. The ARIMA modelling forecasts 4,151 OPD referrals in the coming 12 months, which results in the requirement for 499 theatre sessions with intensive care facilities (total of 671 surgical intervention procedures); 301 minor theatre sessions (total of 1,836 procedures) and 206 theatre sessions (total of 761 procedures). Surgical intervention (procedure) types and theatre requirements form the research output that predicts an increase in theatre capacity is required to keep pace with demand in the short term. The insight provided into issues allows informed strategy development and decision-making. Our methodology can be easily adapted and applied to other surgical specialities with similar datasets.

The graphical and interactive design of a consent form helps individuals to keep control and pay attention to the information that they are disclosing. In the context of mobile apps we propose and test alternative interaction design solutions for selecting personal information on permission dialogues, namely using checkboxes, a drag-and-drop selection, and a swiping action. We test each proposed design and compare the results in terms of their usability and effectiveness in helping users to be more attentive and aware of their data flow, in other words, to provide their informed consent. This study demonstrates that checkboxes while speedy do not engage the user as much as drag-and-drop or swiping. User satisfaction is positively impacted by these newer ways of giving consent.

This paper presents an eHealth use case based on a privacy-preserving machine learning platform to detect arrhythmia developed by the PAPAYA project that can run in an untrusted domain. It discusses legal privacy and user requirements that we elicited for this use case from the GDPR and via stakeholder interviews. These include requirements for secure pseudonymisation schemes, for allowing also pseudonymous users to exercise their data subjects rights, for not making diagnostic decisions fully automatically and for assurance guarantees, conformance with specified standards and informing clinicians and patients about the privacy protection. The requirements are not only relevant for our use case but also for other use cases utilising privacy-preserving data analytics to classify medical data.

The development of medical applications and services is growing but is hampered by security and privacy concerns and a lack of trust by users. This interview study with 29 users of wearable devices reports perspectives on privacy concerns towards sharing of measured data in general, and measured stress data in the workplace. Participants consider stress data to be sensitive (73%), and report that privacy protection is a requirement for both the technology and the workplace. Sharing behavior is shown to be strongly coupled with clear purposes and incentives. Sharing measured fitness data is accepted (72%), and sharing stress measured data for the common good (48%), despite privacy concerns. Over half mistrust the technology not to leak data. Technology solutions should provide clear and sound purposes for storing, sharing, and processing measured data, as well as provide assurances from workplace and cloud.

This paper examines user requirements for a new audiology information system for use in audiology departments by audiology staff. There is a lack of literature on requirements for an audiology information system. This ethnographic study describes the current audiology service and the equipment used in the diagnosis and treatment of hearing loss. Eliciting user requirements from all the users of a clinical information system provides the best possible outcomes for all user groups: clinical, administration and hearing aid technicians. The study includes a review of audiology internal policies and a survey of all potential end users of a new audiology information system in the Health Service Executive (HSE) community service. The findings identify the six most important user requirements in a new audiology information system. These priority requirements include the storage of all Noah files, multiple patient search options, have all test results stored in the patient's electronic record, be capable of generating IT-based reports and store the audiogram in the patient's electronic record (EHR). Other findings include the desire for a paperless system and for the integration of all audiology equipment and existing IT databases, with up-to-date? information system involving automated processes.

A survey of health information seeking behaviour among young adults, 18-29 years old, reports that as well as searching for information for their own use, searching for information to help family and friends is also practised?. Overall, the top 5 categories of information searched are 'Personal Health', 'Symptoms', 'Healthy Diet', 'Mental Health' and 'Treatment'. For the Top 5 Information searches for Self, 'Disease Prevention' is in 5th place and displaces 'Mental Health'. Respondents mostly report a high regard for the information they retrieve in their searches. The use of support groups for themselves is reported, as well an altruistic motivation to support others. While the motivation for many searches is to avoid attending a health professional, approximately one-third search after their visit. Of the respondents who are Swedish residents, 42% are unaware of the availability of their Journalen, online health record in Sweden, and of those 56.7% who know of it, 18% have never accessed it.

This paper highlights the challenges for researchers when undertaking research on multidisciplinary medical teams (MDTs) in real-world healthcare settings, and suggests ways in which these challenges may be addressed.

The quality and impact of application system messages (ASMs) is an important yet neglected area of human computer interaction (HCI) in healthcare. Complex, technical, uninformative ASMs contribute towards user frustration, lack of acceptance, may lead to interruptions in healthcare workflow, and impact patient safety. ASMs refer to messages displayed within a software application and includes error messages, alerts, reminders and exception technical error messages. We report on a usability evaluation and users' attitudes to system messages in order to inform recommendations for ASM design. A descriptive two part study incorporates a questionnaire and a system usability evaluation of 23 error messages, sourced from four healthcare software applications. The majority of participants (56%) indicate that constructive advice within ASMs is insufficient and 48% experience an interruption to workflow as a consequence of the delivery and display of ASMs. Messages evaluated are explicit (95%) and visible (90%) while consistency (68%) and politeness (48%) could be improved. The ASMs encountered lack constructive advice (32%), are imprecise (23%) and do not attempt to reduce workload. All respondents agree that there is a need for system consistency and 92% have preference for consistency of ASM presentation. We conclude that the elimination of inappropriate interruptions to users will improve healthcare efficiency, and reduce risks to patient safety. A healthcare application that relays constructive advice, is consistent in the implementation of ASMs and is considerate of workflow should ensure a more positive user experience, and improve technology acceptance among healthcare professionals.

A discharge summary (DS) is the main mode of communication between secondary / tertiary care and primary / community care. Low quality DS can lead to poor communication, and break the continuity of care in the community. The development of a Minimum Dataset (MDS) for postnatal discharge summaries (PDS) using a mixed methodology with sequential explanatory design is reported. A MDS development process is used to harmonise datasets in a newly developed PDS. Informed by literature, an analysis of the PDS collected from 15 maternity hospitals in Ireland, together with input from 50 submissions from public health nurses (PHNs), general practitioners (GPs), obstetricians, and midwives, identify the required datasets for the PDS. Dataset definitions are identified using national and international data dictionaries. SNOMED-CT standard is used for terminology. As well as supporting mother and baby care, the developed PDS has the potential to support strategic planning by providing information on maternity health indicators, maternity care outcome measures, national and perinatal mortality and morbidity statistics and national and international data comparisons.

Nursing shift handover is a vital part of clinical care where relevant patient information needs to be communicated accurately and precisely, to ensure continuity of care and patient safety. Poor communication and lack of structured format are contributing factors in adverse incidents where patient care is put at risk. This ethnographic study reports on a computerised structured format for nursing shift handover using the ISBAR3 communication tool. 20 shift handovers pre-and post-implementations of ISBAR3 tool were observed. The time taken for handover has substantial reduced from an average of 31 minutes to 27 minutes (1.7 minutes to 1.5 minutes per patient), i.e. 4 minutes in each handover. Use of an electronic structured format replaced the traditional way of handover to a systematic, precise, accurate, relevant mode of updated communication in a very short period of time. Successful implementation of the ISBAR3 handover tool with e-technology in gynaecology supports the roll-out of this mode of communication to other nursing and maternity services in the hospital. As well as saving time, implementation of the ISBAR3 handover tool enhances communication, and reduces the risks to patient safety.

MDTMs are now a feature of routine hospital work and provide a valuable learning opportunity for education and practice development. The popularity of the forum as a patient management mechanism has had a negative counter effect on the educational function of the forum. Behavioural interventions and technical supports are identified based on long term ethnographic studies to restore the educational benefits of the forum. The potential for re-developing the MDTM into a rich educational resource that will assist in clinical education, professional development, provide an evidence base for guideline development by integrating clinical outcome feedback into the meeting record is proposed.

How can information communication technology be better applied to make our health-care systems more effective, dependable and safer for patients, and deliver economic efficiency? Economists challen...

This paper reviews the practices of multidisciplinary teamwork (MDT) for cancer care in three large teaching hospitals in separate jurisdictions. Ethnographic observations provide the main source of data, which are verified though interviews, and in some cases by surveys and analysis of video recordings. We demonstrate how MDT practices develop among different groups, and in different jurisdictions. Common practices are identified and differences explained. Work practice analysis is an integral part of our research, and this study provides insights into medical teamwork and decision-making.

Designing technology for use in healthcare, and its evaluation in the healthcare setting, deserves special attention because of the nature of the special context of use. Biological hazards and the risk of infection, issues of privacy and security, system response times, as well as human factors and patient safety are identified as areas deserving of special attention. We give examples and quote from clinician interviews for illustration, and we argue that increased focus from the HCI community on these areas will bring tangible benefits of health information systems to healthcare staff, and ultimately improve patient services.

The potential of Electronic Health Records (EHRs) is widely recognised, however studies assessing dermatology end-users expectations and perceived benefits are lacking. We report on a survey of 142 physicians working in Dermatology in Ireland. Eight question stems assess experience with EHRs and expectations of an ideal system for use in Dermatology. 61 (43%) physicians responded, of which 27 (44%) describe their experience with EHRs. 6 (33%) of 18 suggest components of an ideal dermatology EHR (ease of data inputting, integration with laboratory systems and radiology, integration with administrative systems, photography, drawing tools and standardised nomenclature) rate between very important and vital. The usefulness of an ideal dermatology EHR rates between very and extremely useful across all categories proposed, with safety, building a National network and demonstrating the work performed by a department rating highest. This survey highlights the core needs of dermatology end-users, whose integral involvement is essential to ensure successful EHR implementation.

Identifying an appropriate method to evaluate the use of technology during patient case discussions at multidisciplinary medical team (MDT) meetings, is problematic. A number of approaches conducted over an extended period of study are described and the lessons learned are explained. A framework is proposed to serve as a basis for evaluation of technology use in these complex collaborative work settings that incorporates hospital, technology and people perspectives.

Increasing dependability in collaboration work among health professionals will directly improve patient outcomes, and reduce healthcare costs. Our research examines the development of a shared visual display to facilitate data entry and validation of an electronic record during multidisciplinary team meeting discussion, where specialists discuss patient symptoms, test results, and image findings. The problem of generating an electronic record for patient files that will serve as a record of collaboration, communication and a guide for later tasks is addressed through use of the shared visual display. Shortcomings in user-informed designed, structured data-entry screens became evident when in actual use. Time constraints prompt the synopsis of discussion in acronyms, free text, abbreviations, and the use of inferences. We demonstrate how common ground, team cohesiveness and the use of a shared visual display can improve dependability, but these factors can also provide a false sense of security and increase vulnerability in the patient management system.

Argumentation theory (AT) has been gaining momentum in the health care arena thanks to its intuitive and modular way of aggregating clinical evidence and taking rational decisions. The basic principles of argumentation theory are described and demonstrated in the breast cancer recurrence problem. It is shown how to represent available clinical evidence in arguments, how to define defeat relations among them and how to create a formal argumentation framework. Argumentation semantics are then applied over the built-framework to compute arguments justification status. It is demonstrated how this process can enhance the clinician decision-making process. A encouraging predictive capacity is compared against the accuracy rate of well-established machine learning techniques confirming the potential of argumentation theory in health care.

Emphasis on usability for all users at the design stage of an Electronic Patient Record (EPR) is directly relative to successful implementation. This article outlines the values of considering the heterogeneity of users in EPR systems. We review the literature available on the design of EPR systems with a focus on its usability principles. A case study of how an outpatient EPR system was successfully implemented in the Epilepsy Unit of Beaumont Hospital, Dublin, with due importance to usability testing for a multidisciplinary team is explored.

This paper explores issues related to record keeping at multidisciplinary medical team (MDT) meetings. Based on questionnaire and interview data with MDT members of various specialities, roles and teams, the information priorities for inclusion in a MDT meeting are identified. The utility and need for records after the meeting is discussed, and methods for gathering the information considered. Concerns are expressed that real-time data gathering at the meeting takes more time and risks turning the meeting into a group form-filling exercise. The value of interactive discussion among multidisciplinary peers is restated. The difficulties identified are discussed in the context of design implications for record-keeping at meetings. The role of records as a co-ordinating mechanism for tasks conducted after the meeting is emphasised, The dichotomy of having a record of a i) detailed prescriptive treatment plan, or ii) detailed diagnostic information with little treatment plan articulated, is explained.

A pilot study is reported to identify an improved method of evaluating digital user interfaces in health care. Experience and developments from the aviation industry and the NASA-TLX mental workload assessment tools are applied in conjunction with Nielsen heuristics for evaluating an Electronic Health Record System in an Irish hospital. The NASA-TLX performs subjective workload assessments on operators working with various human-computer systems. Results suggest that depending on the cognitive workload and the working context of users, the usability will differ for the same digital interface. We conclude that incorporating the NASA-TLX with Nielsen's heuristics offers a more reliable method in design and evaluation of digital user interfaces in clinical environments, since the healthcare work context is taken into account. Improved interfaces can be expected to reduce medical errors and improve patient care.

This paper profiles multidisciplinary team activity (MDT) in a typical teaching hospital setting and reports on a survey conducted among the teams to establish the information needs and constraints which affect their interaction. Support for pre-meeting work and post-meeting responsibilities is considered important in enabling the interaction at team meetings to be effective. Acoustics in the meeting room have higher priority over visual displays, although both `hearing the discussion' and `seeing images and colleagues' is important at meetings. Issues of time include scheduling and timing and are difficult to manage, particularly when individual roles belong to several MDTs and span more than one hospital. The potential is identified for automatic processing of some decisions by simple algorithm, which potentially will allow for more time at meetings to discuss complex patient cases in more detail.

Discussion on patient data, among hospital staff, plays an increasingly important role in inter-specialist communication. Effectiveness of a discussion depends, among other factors, on how well its participants perceive, assimilate and interpret information exchanged during a discussion. This paper reports a field study conducted to assess information assimilation among medical observer participants during PCDs in a hospital. Medically trained observer participants undertook a questionnaire at multi-disciplinary medical team meetings (MDTMs) in teleconference and co-located settings. Results show that participants are more likely to offer opinions in teleconference while their expectations on the long-term effects of treatment are more realistic in co-located PCDs than in teleconference PCDs. Surprisingly, the presentation of clinical findings, radiology and pathology is perceived to be clearer in teleconference, and respondents believe that they follow the discussion, know the patient management plan and understand the basis for decisions, better in teleconference than in co-located PCDs. While a higher educational value is attributed to teleconference PCDs, evidence suggests a trend to have more errors in teleconference, less critical evaluation and no expression of disagreement with patient management decisions made in teleconference.

This paper investigates the use of amount and structure of talk as a basis for automatic classification of patient case discussions in multidisciplinary medical team meetings recorded in a real-world setting. We model patient case discussions as vocalisation graphs, building on research from the fields of interaction analysis and social psychology. These graphs are "content free" in that they only encode patterns of vocalisation and silence. The fact that it does not rely on automatic transcription makes the technique presented in this paper an attractive complement to more sophisticated speech processing methods as a means of indexing medical team meetings. We show that despite the simplicity of the underlying representation mechanism, accurate classification performance (F-scores: F_1 = 0.98, for medical patient case discussions, and F_1 = 0.97, for surgical case discussions) can be achieved with a simple k-nearest neighbour classifier when vocalisations are represented at the level of individual speakers. Possible applications of the method in health informatics for storage and retrieval of multimedia medical meeting records are discussed.

Performance on an information gathering task is shown to be superior in teleconference. Analysis of errors in an exercise revealed the data sources used in co-located and teleconference scenarios. The use of a visual display for text data, in addition to the audio source, is demonstrated in both co-located and teleconference discussions. Audio was used as a source of information more frequently in teleconference which resulted in an overall improvement in task performance. The lesson learned from the higher performance in teleconference, can be applied to improve performance at co-located meetings. Providing appropriate visual data together within audio enhanced spaces can be expected to improve the communication event and reduce medical errors. Results support proposals for the incorporation of physical spaces to improve communication in everyday work in co-operative workplaces, such as hospitals.

Face-to-face interactions, via teleconferencing link, are investigated for multidisciplinary medical team (MDT) meetings. Comparison is made between colocated MDT meetings and those held in teleconference. Attitudes towards video changed positively, over a period of 8 months, following participants' experience of teleconferencing. Analysis of display screen use reveals 60% of case discussion time was time spent in face-to-face view with remote sites, contrary to expressed views of its relative unimportance. The value of the video link in MDT meetings, held in teleconference, is found to have higher than expected value

Developments in teleconferencing capabilities have made changes in work practices possible and are facilitating working partnerships between institutions. This study of a teleconferencing initiative examines how the work of a multi-disciplinary team (MDT) is affected by extending the meeting to remote locations. Challenges are highlighted, particularly in relation to the management of information flows, development of norms (meeting protocols) and record keeping.