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Tertiary-Level Telehealth: A Media Space Application

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Abstract

A media space provides the communications channels to support the interactions between people at different locations using video and audio links and shared access to data. This paper looks at a telehealth implementation of outpatient consultations for tertiary-level paediatric surgical patients, consultations which exercise a high degree of interpersonal and data-sharing communication between the participants. Framing the telehealth situation as a media space invites the designer of the telehealth system to access a large body of prior work which identifies and discusses many of the issues that will arise in this complex multi-participant telehealth context. This paper presents, as a case study, a two-year project that developed and deployed a whole-of-room telehealth system in partnership with surgeons from The Royal Children’s Hospital (RCH), Melbourne, Australia. Based on observations at the hospital and discussions with the surgeons, a descriptive model of the proposed telehealth consultation (and of its deployment in a clinical trial) was developed. This descriptive model became the vehicle for gathering requirements and for design and evaluation of the telehealth system. The evaluation contained four major components: two human factors studies, an observational study of training and process change for the clinicians and a clinical trial of the resulting system. The case study demonstrates the flow of design decisions from concept to deployment. It highlights the gaps that appeared in the descriptive model when the transition was made from the laboratory to deployment in the hospital. The conclusion is that, at this relatively unexplored level of telehealth, there are likely to be gaps in such a descriptive model that are not uncovered by laboratory experiments or by analytic evaluation but emerge only during a clinical trial with actual patients, clinicians and patient data.

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Acknowledgements

The studies for this paper were done while the author was an employee of the CSIRO ICT Centre in Canberra, Australia. This work was supported by the Australian Government through the Advanced Networks Program (ANP) of the Department of Communications, Information Technology and the Arts (DoCITA). The author acknowledges his former colleagues at CSIRO, Matthew Hutchins, Jocelyn Smith, Chris Gunn, Doug Palmer, Ken Taylor, Jane Li and Susan Hansen, and the staff at the Royal Children’s Hospital (RCH) in Melbourne, Australia.

The laboratory experiments were approved by the CSIRO Human Ethics Research Committee (HREC) and the clinical trial was approved by the Royal Children’s Hospital HREC. The author acknowledges the participants who took part in the laboratory experiments and the hospital trial and the staff of RCH who prepared for and conducted the clinical trial.

The author was enrolled as a doctoral student in the School of Computer Science at the Australian National University (ANU) and this work forms part of his doctoral thesis. He acknowledges his supervisors Professor Tom Gedeon and Associate Professor Henry Gardner, at ANU, and Dr Cécile Paris, at the CSIRO ICT Centre.

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  1. School of Computer Science, Australian National University, Acton, 0200, Australia

    Duncan Roderick Stevenson

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Correspondence to Duncan Roderick Stevenson.

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Stevenson, D.R. Tertiary-Level Telehealth: A Media Space Application. Comput Supported Coop Work 20, 61–92 (2011). https://doi.org/10.1007/s10606-010-9125-8

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