Tertiary-Level Telehealth: A Media Space Application

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.