To OZCHI ’12 with a Telehealth Stethoscope paper

For the last few years I’ve been working as a Research Associate on an ARC Linkage Grant, “Remote patient assessment using digital stethoscope for telehealth systems in Australia“. The grant has ended and now we’re really going to start ramping up our publications of things we learned. We’ve already got a few papers out of the early stages and now it’s time for the next tranche.

In the first part of the project, my colleagues and I were investigating how doctors use ordinary stethoscopes. Some of what we found out went into the design of a prototype digital stethoscope.

Doctors with patient, 1999, Seattle Municipal Archives

Doctors with patient, 1999, Seattle Municipal Archives

In this part of the project we took the prototype digital stethoscope into hospitals where pairs of doctors and nurses used it in a simulated “telehealth” scenario. The doctor-and-nurse pairs had to collaborate to listen to a volunteer’s chest.

We didn’t use it in real clinical situations because (1) we weren’t testing for clinical efficacy, we were trying to find out how the doctors and nurses would  work collaboratively and (2) there are obvious ethical issues with using a prototype device on real patients.

We simulated the telehealth conditions by putting the nurse and patient at one end of a table and the doctor at the other end. Only the nurse could touch the patient and only the nurse had control of the stethoscope. The doctor and nurse could hear the patient’s chest sounds through the stethoscope. We simulated the telehealth situation rather than using the telehealth infrastructure because renting time on the telehealth system is expensive and it’s always being used for clinical reasons.

Turns out, using a stethoscope collaboratively is pretty different from using a normal stethoscope. One of the biggest challenges is for the doctor to ask the nurse for a stethoscope placement, rather than just putting the stethoscope on the patient. And for the nurse, the challenge is in understanding the doctor’s request. Because doctors and nurses think about and use stethoscopes differently, they use different words when they talk about using a stethoscope.

In our research doctors and nurses were able to very quickly overcome their communication obstacles by figuring out a shared vocabulary for talking about stethoscope positioning. Once they had a shared vocabulary, they were quickly able to gain enough experience using the telehealth stethoscope to use it with very few errors.

The first published outcome from this part of the project was accepted this week as a long paper for OZCHI which will be held in Melbourne in November. Here’s the abstract:

We investigated the collaboration of ten doctor-nurse pairs with a prototype digital telehealth stethoscope. Ten pairs of doctors and nurses listened to a patient’s chest with a prototype digital telehealth stethoscope. Doctors could see and hear the patient but could not touch them or the stethoscope. The nurse in each pair controlled the stethoscope. For ethical reasons, an experimenter stood in for a patient. Each of the ten interactions was video recorded and analysed to understand the interaction and collaboration between the doctor and nurse. The video recordings were coded and transformed into maps of interaction that were analysed for patterns of activity. The analysis showed that as doctors and nurses became more experienced at using the telehealth stethoscope their collaboration was more effective. The main measure of effectiveness was the number of corrections in stethoscope placement required by the doctor. In early collaborations, the doctors gave many corrections. After several trials, each doctor and nurse had reduced corrections and all pairs reduced their corrections. The significance of this research is the identification of the qualitites of effective collaboration in the use of the telehealth stethoscope and telehealth systems more generally.

The full paper, with more details and graphs and charts that show how the doctors and nurses got better at using the telehealth stethoscope will be available after the conference in late November.

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