Augmented notebooks for pervasive learning in medical practice.

Medical e-learning can benefit from the new technologies, and pervasive learning resources and tools worth to be introduced in the medical context. Micro-learning seems to be an interesting way for pervasive learning. But it is still difficult to propose pedagogical resources that are built by learners, from meaningful experiments. We conducted an analysis of the exchanges performed by Health care professionals in the hospital in order to understand where and when educational exchanges appear. We analyzed the type of documents exchanged. The residents' paper notebooks caught our attention first because it answers some clinician-needs and second because the computerization of such a notebook could add a collaborative dimension to the pedagogical resources. We propose a model of an augmented resident's notebook and we briefly describe an implementation using Content Management System and WIKI, before setting the discussion and the conclusion sections.

Characterizing consumer health terminology in the breast cancer field.

Despite the large availability of medical information on the Internet, health consumers still encounter problems to find, interpret and understand this information. These problems are mainly due to their lack in medical knowledge and the difference between their language and the language of health professionals. In order to propose information retrieval services more adapted to health consumers language and knowledge, we have developed techniques to collect, identify and analyze the terms and the expressions used by lay persons to talk about breast cancer. The study of health consumers' language is a relatively recent research field. Many studies have been conducted to analyze and characterize the vocabulary used by health consumers to talk about medical subjects in English. We have conducted the same study for the French language in the breast cancer field. We have gathered a corpus of texts to identify terms and expressions used by health consumers who talk about breast cancer in French. The terms have been organized in a concept-based terminology. This terminology has been analyzed on several levels: concept level, term level, term-concept level and finally relation level.

Group Decision Support System applied to the medical pluri-disciplinary decision group: usability and efficacy.

OBJECTIVES: This paper aims to study whether the application of a Group Decision Support System to medical collective decision committees is possible and to determine which GDSS specifications are convenient. BACKGROUND: We introduce the common knowledge about GDSS and define the process of the collective medical decision. METHODS: An experimental GDSS has been tested in an actual medical collective decision committee. A usability analysis has been performed to precise usability and acceptability of the system and to highlight pro and cons of the various functionalities of the GDSS. RESULTS: Information sharing was conveniently supported by the GDSS. All the documents were available for the support of the discussion. But, the introduction of a GDSS in the decision committee added new constraints such as the necessity of an excellent preparation phase. Limits of the system have been revealed: lack of feedback on decision actors, lack of support to obtain the consensus and lack of memorisation. According to these results, we have proposed new GDSS features to improve the decision. DISCUSSION-CONCLUSION: Using a GDSS supporting the medical collective decision is realistic and may support the process of the consensual decision.

Informal notes to support the asynchronous collaborative activities.

BACKGROUND: Health care professionals' collaboration is highly important for the medical practice. Efficient exchange of information improves good cooperation, but remains complex, due to the diversity of the medical activities. Currently, the health record is mainly used to manage structured medical information. On the one hand, such structure supports treatment that requires the documented information. On the other hand, however, the structure also imposes constraints on narrative and conversational practices of health care professionals. They use other collaboration means through phone, mail, annotations and free texts for informal strategies of communication. We focussed on informal written documents. Two different studies provided us some materials: home care charts in the context of home care and annotations in the context of the hospital health records. PURPOSES: We wanted to design a model of the Communication Notes to computerize the written notes so as to improve the communication and the coordination of the practitioners. METHODS: We compared the results of the two studies about the various writing strategies used by the health care professionals to keep traces of their exchanges and of their acts. The first study deals with the information mentioned by the nurses in a chart during home care situations. We analysed the distribution of cooperation activities in action and in planning. The second study deals with the annotations which are written by all the practitioners to complete the documents of the health record in a paediatric ward. We analysed how annotations take part in their collaborations. RESULTS: We found some invariable items in these two situations and we proposed a model for these Communication Notes which can be used to describe and to index them according to different points of view. Some indications on the way such descriptions are used in current computerized systems are also reported. The originality of this model comes from the way it takes into account a collaborative perspective which is not often used in the electronic medical settings. CONCLUSIONS: With our model of Communication Notes, we now dispose of a promising setting for managing all the informal and unforeseeable information produced by the health care professionals during care.

Context awareness in health care: a review.

BACKGROUND: Health care systems will integrate new computing paradigms in the coming years. Context-awareness computing is a research field which often refers to health care as an interesting and rich area of application. AIM: Through a survey of the research literature, we intended to derive an objective view of the actual dynamism of context awareness in health care, and to identify strengths and weaknesses in this field. METHODS: After discussing definitions of context, we proposed a simple framework to analyse and characterize the use of context through three main axes. We then focused on context-awareness computing and reported on the main teams working in this area. We described some of the context-awareness projects in health care. A deeper analysis of the hospital-based projects demonstrated the gap between recommendations expressed for modelling context awareness and the actual use in a prototype. Finally, we identified pitfalls encountered in this area of research. RESULTS: A number of opportunities remain for this evolving field of research. We found relatively few groups with such a specific focus. As yet there is no consensus as to the most appropriate models or attributes to include in context awareness. We conclude that a greater understanding of which aspects of context are important in a health care setting is required; the inherent sociotechnical nature of context-aware applications in health care; and the need to draw on a number of disciplines to conduct this research.

A study of the communication notes for two asynchronous collaborative activities.

INTRODUCTION: To build relevant tools for Health Care Professionals, we must study and understand their practices. This paper discusses the way they leave traces in the Patient Record to help asynchronous collaboration, elaborating new documents or adding annotations. METHODS: We compared the results of two studies about the various writing strategies used by the Health Care Professionals to capture knowledge in the Patient Records. The first study deals with the information written by the nurses in a textbook during homecare situations. The second one deals with the annotations left by all the practitioners to complete the documents of the patient record in a hospital ward. RESULTS: We have found some invariants in these two situations. An interpretation model based on four levels: Communication Context, Communication Object, Value of Communication and Value of Cooperation, is proposed in order to describe and to index the characteristics of the Communication Notes.

A distributed coordination platform for home care: analysis, framework and prototype.

Good cooperation between health care (HC) professionals, patient, and family is indispensable during homecare as mentioned in reports and analyses from different countries. In a French National project named coordination for the quality of care (COQUAS), we aimed to address the problem of improving such cooperation with current tools and techniques. We hypothesized that, as in some other domains, a better integration of use and users in informatics systems could improve the usefulness of the cooperative tool. The first part of this paper is devoted to the cognitive analysis of the homecare process and highlights the requirements which should be met according to this analysis. We describe some specific features of asynchronous cooperation and some communication issues in the cooperation of HC workers. We then detail the analysis of the homecare process: methodology, description of the processes, cognitive activity analyses, and of the requirements which flow from this analysis. The second part of this paper proposes a framework and then describes a modular system prototype, designed to take into account these requirements, including aspects of both cooperation and interoperability. It uses a meta-description of actions and information derived from a cognitive study to build dynamically the interface settings; it respects the current trend in distributed architecture and uses XML communication of messages, manages complex coordination with a workflow and allows mobile work. The last part of the paper presents the evaluation which has been done with the implemented prototype, with actual homecare users.

Homecare: the need for cooperative information systems.

Assuming responsibility of patients at home (Homecare) is organized around a complex cooperation of partners: health care actors, relatives and helpers, all of whom intervene in the patient's home and who spark off the setting up of cooperative information systems. We present our work relating to such systems within the context of home care. Such activity is based on the collaboration of multiple mobile actors, obtaining information in a multimodal fashion, while taking the job profiles and professional grades of the users into account. Information is obtained from heterogeneous systems. The quality of management of the activity of the various health care actors and of the feedback on information handled at the time of the homecare process will determine how easy it may be to set up homecare as well as the quality of care. In this paper we outline the main stages of our work: grasping the context of homecare and studying co-operative activity from a fundamental point of view but also as applied to homecare. We describe the system proposed for accessing distributed information and for organizing the supervision of the 2 fundamental processes: (1) the LOGISTICAL process (to manage the organization), (2) and the CARE Process (to follow-up the medical or nursing status of the patient), and then we enhance the contribution of mobile technologies in this context.