Volume 12, Number 7 November 19, 2004

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Computer scientist builds on health-care background

By David Hutton

David Pinelle

David Pinelle

Home-care practitioners, whether nurses, therapists, or home health aides, work together to progress patients from illness to wellness. However, because of the independent nature of their work, communication between practitioners caring for the same patient is often difficult and sparse, consisting, most often, of occasional chance encounters. Information on the progress individual workers are making is, therefore, rarely shared.

David Pinelle, a former occupational therapist turned computer scientist, and Texan turned Canadian, moved to Saskatoon in 1999 and targeted this perceived problem, seeking a computer-based solution for home care in the Saskatoon Health Region in his PhD work at the U of S.

Once here, Pinelle began working under the supervision of Carl Gutwin, a specialist in human/computer interaction and computer-supported co-operative work – fields with definite sociological underpinnings and applications that would allow Pinelle to build on his sundry background and apply his knowledge of computers to the health-care domain that he had become so familiar with in the United States.

“When I came to the U of S, I didn’t want to abandon my experience in health care altogether, so I began looking at health-care problems that could potentially be solved using computer technologies. One of the problems that I had previously experienced when working in home care was that the same patient could be treated by several different practitioners that would rarely see each other face-to-face,” explains Pinelle.

“It can be difficult to co-ordinate treatments with the other practitioners. When you have limited information about others, it is possible to duplicate the service someone else is giving or even to provide a service that is contra-indicated. Since communication is limited, it isn’t always clear that there is a concern that needs to be addressed unless the patient or their family members happen to tell you.”

Initially, Pinelle surveyed home care work practices in the Saskatoon area, which gave him a better conception of what would be required for the research. Later, the project received funding through a Canadian Institutes of Health Research operating grant, which enabled hardware to be purchased to investigate design issues.

Pinelle then “crawled away for a year” and went to work on a laptop-based system which used wireless modems and a cellular network to enable field workers to easily share information and maintain an electronic record of their work in a shared repository.

“Let’s say a nurse creates a progress note,” relates Pinelle, “then the therapists can read that note right away. With the system you have improved awareness so that you can co-ordinate your work a little more closely. There was also a big emphasis on improved communication.”

Pinelle says the goal was not a pervasive culture change within home care, but simply to give home-care practitioners the ability to correspond when they felt it necessary.

“There are some benefits to not being in constant communication. For example, if a worker wants to revise their schedule, they don’t have to check with others first – they have a lot of flexibility in managing their day, which is important since their work day is often unpredictable. Because of this, the system design doesn’t force people to communicate, but it makes it more convenient.”

The clinical information system Pinelle developed went through two trials in the Saskatoon Health Region. The first laptop–based trial had six participants from five home care disciplines and lasted 2½ months. The second trial was larger – it had 10 participants, used laptops and Audiovox Thera handhelds, had implementation help from Pinelle’s colleague Jeff Dyck, and lasted three months.

Although both trials kept a cell-phone-carrying Pinelle busy, as he was often answering questions into the night, the work paid off: the trials were well received.

“We saw a lot of communication. The logs showed that the practitioners used the electronic record a lot, logging in to the system to read other people’s clinical documents so they could keep current on what others were doing.

“Several of the participants described instances where they changed their activities based on information in the system, so there is some evidence of improved co-ordination in the treatment team.”

Pinelle, now living in Montreal, hopes that the work will help contribute to more widespread application of such clinical information systems in the future.

For more information, contact communications.office@usask.ca

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