Papers by Gunnar Hartvigsen
JMIR Medical Informatics, 2017
Background: Telemedicine services have been successfully used in areas where there are adequate i... more Background: Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. Objective: The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. Methods: A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. Results: The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated another 219 papers, leaving 203 relevant papers. After a full-text assessment, 36 articles were left, which were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. Despite the increasing number of fishermen and other seafarers, Arctic and maritime working conditions are mainly characterized by an absence of access to health care facilities. The condition is further aggravated for fishermen and seafarers who are working in the Arctic regions. In spite of the existing barriers and challenges, some telemedicine services have recently been successfully delivered in these areas. These services include teleconsultation (9/37, 24%), teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%), telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37, 27%). However, the use of telemedicine in relation to search and rescue (SAR) services is not yet fully exploited. Therefore, we foresee that these implemented and evaluated telemedicine services will serve as underlying models for the successful implementation of future search and rescue (SAR) services.
Yearbook of Medical Informatics, 2016
SummaryObjectives: Assess unforeseen consequences of Telehealth and suggest solutionsMethods: An ... more SummaryObjectives: Assess unforeseen consequences of Telehealth and suggest solutionsMethods: An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature.Results and Conclusion: A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken.
North Norway has been a world-leading area in the use of telemedicine services. Since the first t... more North Norway has been a world-leading area in the use of telemedicine services. Since the first telemedicine services were established in the late 1980ies, telemedicine and e-health services have been established in many areas of specialist health care. The goal has been to provide specialist health care to people living in rural and very remote areas. Success factors for this development are summarized in ten lessons learned: (1) Strong governmental involvement through National plans; (2) Access to a secure communication infrastructure; (3) Mandatory use of standards; (4) Implementation of Electronic Health Record (EHR); (5) Laws adapted to the modern way of working; (6) Reimbursement must be in place for telemedicine services; (7) Videoconference is often the best solution; (8) Management and support is essential; (9) KISS -Keep it simple, stupid; and, (10) Electronic messages for high volumes.
For individuals with diabetes to live a healthy life, they must balance carbohydrate intake, insu... more For individuals with diabetes to live a healthy life, they must balance carbohydrate intake, insulin injections, physical activity, and monitoring of blood glucose levels. For adolescents with diabetes, this can be challenging – measuring blood glucose and injecting insulin often feels awkward, especially in public areas. In the long run, the result of not managing the factors affecting their diabetes can cause serious consequences. In order to motivate this particular group with diabetes to maintain recommended levels of blood glucose, serious games can be used. The Diabetes Automata project is a part of the research being done on serious games for diabetes at the Norwegian Centre for Integrated Care and Telemedicine. In the project, we have developed a prototype version of a software engine on which diabetes-related serious games, simulators and other tools for diabetes management on various platforms can be based. The Diabetes Automata calculates blood glucose levels based upon r...
The publishers will keep this document online on the Internet -or its possible replacementfrom th... more The publishers will keep this document online on the Internet -or its possible replacementfrom the date of publication barring exceptional circumstances. The online availability of the document implies permanent permission for anyone to read, to download, or to print out single copies for his/her own use and to use it unchanged for noncommercial research and educational purposes. Subsequent transfers of copyright cannot revoke this permission. All other uses of the document are conditional upon the consent of the copyright owner. The publisher has taken technical and administrative measures to assure authenticity, security and accessibility. According to intellectual property law, the author has the right to be mentioned when his/her work is accessed as described above and to be protected against infringement.
Health information technology is often presented as a solution to increase the efficiency and cos... more Health information technology is often presented as a solution to increase the efficiency and cost-effectiveness of health care providers. However, health IT is still far from meeting the stakeholders’ expectations. The aim of this paper is to discuss the role of research, in particular of research institutions, in the field of health IT. The differences in the roles of health IT research institutions and health IT companies is discussed according to a framework on the determinants of successful health IT implementations. It is argued that it is necessary to understand that health IT research institutions and health IT companies are two different players with different focus. As health IT companies have their focus on the product, the production of new knowledge should be the main focus of health IT research. In this sense, the two should not be evaluated in the
The cancellation of elective surgeries wastes valuable hospital resources. Our site of research h... more The cancellation of elective surgeries wastes valuable hospital resources. Our site of research has identified inadequate planning due to lack of information as a main cause for cancellations. It is anticipated that the pre-operative planning process may be improved if adequate patient information is gathered at an earlier stage, before the patient is admitted at the hospital. The aim of our research is to determine how an electronic personal health assessment questionnaire interface to the patient should be designed. Participants were asked to complete the electronic personal health assessment questionnaire in the two versions of the interface. The results indicate that, contrarily to literature, in a pre-operative setting, patients prefer to be presented various questions at a time when completing personal health assessment questionnaires. Keywords-cancellations; surgery department; electronic communication; electronic health record; patient interfaces.
Studies in health technology and informatics, 2015
We present a novel approach to the design of video conferencing (VC) systems, taking advantage of... more We present a novel approach to the design of video conferencing (VC) systems, taking advantage of recent technological achievements in web-based implementation. Delivering VC functionality as a service over the Internet opens new grounds for easier integration, support, and application in many scenarios, since hardware-agnostic ad-hoc VC connections are a feature of the proposed architecture. Validity is demonstrated through latency measures in surgical telementoring service and comparing them to reported thresholds.
The Scandinavian Conference on Health Informtics 2016 is organized together with the national hea... more The Scandinavian Conference on Health Informtics 2016 is organized together with the national health informatics organisations in Denmark, Norway, and Sweden and this year also the Vitalis conferen ...
Studies in health technology and informatics
Despite a growing number of clinical-intervention studies of mobile applications for diabetes sel... more Despite a growing number of clinical-intervention studies of mobile applications for diabetes self-management, details of participants' engagement with the intervention tools and of usability and feasibility issues are seldom reported. The Few Touch application is a mobile-phone-based self-management system for people with Type 2 diabetes mellitus (T2DM) developed by involving patient-users in design processes from an early phase to a long-term trial. An improved version was tested in a five-month trial by 11 individuals either with T2DM or at high risk of T2DM. Results showed clearer correlations between usage and perceived usefulness among these individuals compared with those involved in the design process. However, feedback on usability issues was mostly consistent between the two trials. This study therefore confirmed: 1) the value of including patient-users not only in design-concept development but also in a long-term trial to identify as many factors critical to usabilit...
Health Information Technology is recognized as a solution to manage health care and improve the q... more Health Information Technology is recognized as a solution to manage health care and improve the quality of care. However, literature reports on unsuccessful implementation projects, challenges and unforeseen consequences of IT in health care. In order to define health IT system requirements, a methodology to comprehensively model health care processes is described. It is concluded that the design of health IT systems should not be done by software engineers or technical personnel in an isolated manner. It is argued for the necessity to engage with the health care sector as an empirical field, and the need for interdisciplinary teams, to tackle the idiosyncrasies of health care processes. The suggested methodology is a useful approach for supporting the definition of the IT requirements, aiming a successful implementation.
Surgery cancellations are undesirable in hospital settings. In order to reduce elective surgery c... more Surgery cancellations are undesirable in hospital settings. In order to reduce elective surgery cancellations at the University Hospital of North Norway, the eTeam-Surgery project studied the pre-operative planning to determine if part of the planning process could be moved from the hospital to the patient at home – through electronic collaboration. This paper discusses the actual readiness for electronic communication between patients and hospitals. In order to approach the readiness for electronic communication, the method section is divided in two parts. The first part consists of a documentary study of the most recent health reform in Norway, focusing on the readiness for using IT within the health care sector. In the second part, an in-depth empirical study of the pre-operative planning process at the hospital, is described. The results are reported in three analytical categories, according to the findings: a) Norwegian health policy; b) Health care workers at the hospital; c) ...
Journal of Telemedicine and Telecare, 2015
Introduction Using graphical annotations in surgical telementoring promises vast improvements in ... more Introduction Using graphical annotations in surgical telementoring promises vast improvements in both clinical and educational outcomes. However, these assumptions do not consider the potential patient safety risks resulting from this feature. Major differences in regulations regarding the implementation of telestration encourage an assessment of the utility of this feature on the outcomes of telementoring sessions. Methods Eight students participated in a randomized controlled trial, comparing verbal with annotation-supplemented telementoring via video conferencing. A remote mentor guided the participants through four localization exercises, identifying the features in a still laparoscopic surgery scene using a laparoscopic simulator. Clinical and educational outcomes were assessed; the time consumption and quality of mentoring were determined. Results The study revealed no significant difference in localizing the intervention between the studied methods, while educational outcomes...
International Journal of Medical Informatics, 2015
Journal of telemedicine and telecare, 2008
We conducted a qualitative study of the system for contagious disease surveillance in Norway. Sem... more We conducted a qualitative study of the system for contagious disease surveillance in Norway. Semi-structured interviews were held with five general practitioners (GPs), including one person responsible for informing GPs in their region about potentially serious disease outbreaks. The interviews suggested that the existing system had several limitations, making it of little relevance to local epidemics or daily medical practice. Specifically, it was difficult and time-consuming for physicians to locate relevant information, and there was a substantial delay between reported diagnoses and eventual feedback about outbreaks. This resulted in information that was too old to be of value. The interviews also investigated design matters related to future realtime disease surveillance systems. The GPs expressed interest in a distributed system for realtime extraction and presentation of data from electronic record systems. They required that any such system be customizable to the specific n...
Surgical innovation, 2013
Surgical telementoring has been reported for decades. However, there exists limited evidence of c... more Surgical telementoring has been reported for decades. However, there exists limited evidence of clinical outcome and educational benefits. To perform a comprehensive review of surgical telementoring surveys published in the past 2 decades. Of 624 primary identified articles, 34 articles were reviewed. A total of 433 surgical procedures were performed by 180 surgeons. Most common telementored procedures were laparoscopic cholecystectomy (57 cases, 13%), endovascular treatment of aortic aneurysm (48 cases, 11%), laparoscopic colectomy (32 cases, 7%), and nefrectomies (41 cases, 9%). In all, 167 (38%) cases had a laparoscopic approach, and 8 cases (5%) were converted to open surgery. Overall, 20 complications (5%) were reported (liver bleeding, trocar port bleeding, bile collection, postoperative ileus, wound infection, serosa tears, iliac artery rupture, conversion open surgery). Eight surveys (23%) have structured assessment of educational outcomes. Telementoring was combined with si...
In autumn 2005, the University of Tromsø started a 2-year master of science in telemedicine and e... more In autumn 2005, the University of Tromsø started a 2-year master of science in telemedicine and e-health. Students can choose between technology and health, and the program starts each fall. The program is developed and run in close collaboration between the University of Tromsø and the Norwegian Centre for Integrated Care and Telemedicine (NST). The idea behind the development and implementation of telemedicine is to move information instead of patients and reduce the growing burden on health care. Master's degree in Telemedicine and e-health provides a thorough introduction to medical technology, how health care is organized and how best to introduce telemedicine to provide better services to patients. The teaching language is English. Teaching is a mixture of lectures and group work. All students write a final thesis.
This paper presents a study addressing the usability issues of relatively small touchscreen devic... more This paper presents a study addressing the usability issues of relatively small touchscreen devices used as endpoints for telementoring. The trial is motivated by the need for systematic knowledge and user experiences on the use of mobile devices for remote supervision of surgeons. Having a stationary computer equipped with relatively large screen and using mouse as an input device in mind, we challenge mobile touchscreen gadgets in order to find out if the same (or sufficient) qualities of mentoring from the mentor's perspective are maintained. The presented study protocol exploits crossover randomized controlled trail design addressing the usability of mobile touchscreen devices for controlling a moving scene (video) and freehand sketching.
The publishers will keep this document online on the Internet -or its possible replacement -from ... more The publishers will keep this document online on the Internet -or its possible replacement -from the date of publication barring exceptional circumstances. The online availability of the document implies permanent permission for anyone to read, to download, or to print out single copies for his/her own use and to use it unchanged for non-commercial research and educational purposes. Subsequent transfers of copyright cannot revoke this permission. All other uses of the document are conditional upon the consent of the copyright owner. The publisher has taken technical and administrative measures to assure authenticity, security and accessibility. According to intellectual property law, the author has the right to be mentioned when his/her work is accessed as described above and to be protected against infringement.
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Papers by Gunnar Hartvigsen