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Blixt L.1, Nyheim Solbrække K.1, Schrøder Bjorbækmo W.1
1University of Oslo / Institute of Health and Society, Department for Health Sciences, Oslo, Norway
Background: eHealth is currently the subject of intense research and commercial development. The implicit assumptions driving this development are that digital solutions will provide for evidence based practice, and better use of the resources. Applications (apps) for smart phones and tablets are in abundance in the health segment, most of them are free to install and available to download as potential tools within clinical practice. However, although multiple functionalities and user friendly interface are persuasive features, little research has been conducted to map the interaction between patient, clinician and digital device within the clinical encounter.
Purpose: To investigate how physiotherapists and their patients engage in, relate to and implement a digital device with an app for assessing basic patient information as well as a range of functions designed to document treatment course. The main objective is to help the therapist be more systematic, and improve patient journals. Better understanding of this implementation process, could inform developers and vendors who aim to develop useful electronic clinical tools.
Methods: In Norway, the research program FYSIOPRIM (physiotherapy in primary health care) is using and developing an app containing standardized patient reported measures and clinical tests. Data in the project presented her are generated through close observation, and interviews with five physiotherapists and four patients. Two observations are videotaped and eight interviews are audiotaped, and transcribed using Hyper TRANSCRIBE©. Analyses have been conducted using Hyper RESEARCH©. The first author transcribed the material and developed the analyses drawing on hermeneutic phenomenological method. The co-authors contributed to the refinement of the analyses and final discussion.
Results: The physiotherapists in this study maintain a cautious attitude when introducing their patients to the various elements of the app. They demonstrate a strong attentiveness to a conceived fragile relation to the patient, constantly negotiating the timing of presenting the device. It seems that 1)asking for permission, 2)preparing the patient and 3)making the proper introduction, are vital steps, and the therapists achieve this in various ways, depending on how they perceive the risks and opportunities within the clinical encounter.
Conclusion(s): In their clinical practice the therapists seem to acknowledge the many potentials of the electronic solution, and are attracted to several of the built-in elements. When sensing risk of alienating or over-loading the patient, they still refrain from using the app. This sensitivity, however, inspire creative use of the various elements, incorporating questionnaires and tests according to the therapists personal, habitual practice. Obviously, this implementation mode collides with current understandings of evidence based practice. Nevertheless, it guides the therapists endeavor to live up to an abstract standard of conduct for health workers.
Implications: In developing apps or similar computer software that are meant to aid the clinician, it seems that designing for personalized, tailored practice, rather than standardization, is a crucial feature.
Funding acknowledgements: The Norwegian Fund for Post-Graduate Training in Physiotherapy through the FYSIOPRIM project.
Topic: Professional issues
Ethics approval: This study was advised by the Norwegian Data Protection Official for Research (Norwegian Centre for Research Data), project number 47353.
All authors, affiliations and abstracts have been published as submitted.
