Designing for Collaborative Reflection

Gabriela Marcu, Anind Dey, Sara Kiesler
2014 Proceedings of the 8th International Conference on Pervasive Computing Technologies for Healthcare  
A rise in chronic conditions has put a strain on our healthcare system. Treatment for chronic conditions spans time, agencies, and providers, making coordination a complex problem. Information systems such as electronic health records should be helping with the challenge of coordination, but research shows that often they do not. This thesis aims to alleviate this problem by examining the design of health information technology with an emphasis on social and organizational processes. The focus
more » ... f this thesis is on the implications of continuous care over time: the shift from a single provider to team-based services, the emergence of patients and families as primary caregivers in the home, and the diffusion of data-driven decision making. I investigated these trends to understand the role of data in coordinating long-term care, and inform the design of information systems. I studied behavioral and mental health services for children, which are coordinated across clinical, home, and special education settings. I found coordination that was unstructured, unpredictable, and adaptive. I developed a conceptual framework, collaborative reflection, to describe my observations and distinguish my findings from the processes of time-critical and protocol-based care. I also found ways in which coordination was not data-driven, due to a lack of support and tools. Collaborative reflection thus illustrates how long-term coordination works when it is data-driven, informing a discussion of what is needed for coordination to be data-driven. Based on the process of collaborative reflection, and using participatory design, I developed Lilypad-a tablet-based information system for data-driven coordination. I conducted a five-month deployment study of Lilypad in the field, to examine its social impact. This study validated designing for collaborative reflection to improve the use of data in coordination. The contributions of this thesis are: a description of unstructured and informal workflow that drives long-term coordination in health services; the theoretical construct of collaborative reflection to inform the design of systems that improve coordination; a field deployment validation, demonstrating how designing for collaborative reflection improves coordination and avoids common unintended consequences of health information technology. In this work I have been aided, influenced, and accompanied by many wonderful people. Above all, I thank them for helping me to do what I love and love what I do. Having come to the end of this process, I maintain that I do not know what the downsides are to being co-advised. My advisors deserve much credit for this. Anind Dey provided unwavering support and mentorship through the hardest parts and lowest points in this process. I aspire to do for my future students what you have done for me. Some of my greatest moments of triumph during this process were a hard-earned stamp of approval from Sara Kiesler. Your kindness and supportive guidance enabled me to work as hard as I did for them. My committee shared in my passion for this work, and pushed me to honor the vision I had for it. Jill Lehman helped me learn to be thoughtful and conscientious in my research, so I can realize my dream of creating technology that will truly have a positive impact on the world. Mary Czerwinski jumped into this with enthusiasm and encouragement, and provided positivity during a process that is all about critique. Madhu Reddy wasted no time putting his mark on this work with lasting influence, believing in me from the moment we met, and being a wonderful mentor during the critical juncture that is transitioning out of being a PhD student. This work was accomplished by an impeccable team, which enabled me to reach much further with this dissertation than I could have imagined. To my team: thank you for being in the thick of it with me. Your dedication, talents, and moral support made me fearless. Working with all of you was a highlight of this entire experience:
doi:10.4108/icst.pervasivehealth.2014.254987 dblp:conf/ph/MarcuDK14 fatcat:clvghnkk5reudf4iud5mkif5hy