شناسایی مسائل پیش روی توسعه سیستم پایش از راه دور بیماران و ارائه راهکار از دیدگاه کاربران: کاربرد روش‌شناسی سیستم‌های نرم

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری مدیریت فناوری اطلاعات، دانشکده مدیریت و حسابداری، دانشگاه شهید بهشتی، تهران، ایران.

2 استادیار، گروه مدیریت صنعتی و فناوری اطلاعات، دانشکده مدیریت و حسابداری، دانشگاه شهید بهشتی، تهران، ایران.

3 استاد، گروه مدیریت صنعتی و فناوری اطلاعات، دانشکده مدیریت و حسابداری، دانشگاه شهید بهشتی، تهران، ایران.

چکیده

مقدمه و اهداف: به‌طورکلی سیستم‌های سلامت از راه دور و به‌تبع آن سیستم پایش از راه دور بیماران از زمان معرفی تاکنون همواره با مشکلاتی در خصوص پذیرش این سیستم‌ها از طرف کاربران مواجه بوده‌اند. تعدد و تعارض در دیدگاه‌ها، نیازمندی‌ها و نگرانی‌های کاربران نسبت به تغییر در نحوه ارائه خدمات سلامت، طراحی این سیستم‌ها را با وضعیتی پیچیده روبه‌رو می‌کند که می‌توان آن را به‌عنوان مسئله نرم تعریف کرد. در این شرایط طراحی این سیستم‌ها‌ نیازمند رویکردی برای درک مسائل و پیچیدگی‌ها و دستیابی به راه‌حلی مطلوب و ممکن با توجه به شرایط اجتماعی و فرهنگی محیط اجرا ‌است. هدف این پژوهش استفاده از چارچوب تغییریافته روش‌شناسی سیستم‌های نرم به‌عنوان یک روش ساختاریافته برای مقابله با مسائل نرم در مواجهه با پیچیدگی‌های طراحی و پیاده‌سازی سیستم‌ پایش از راه دور بیماران از دیدگاه عوامل انسانی ‌است.
 روش‌ها: در این پژوهش یک رویکرد ترکیبی شامل روش‌شناسی سیستم‌های نرم برای شناسایی مسائل، تعریف نیازمندی‌ها و اقدامات به همراه چارچوب NASSS به‌عنوان یک لنز نظری برای هدایت تفکر شرکت‌کنندگان معرفی شده است که از این‌ رویکرد در توسعه سیستم پایش از راه دور بیماران با تمرکز بر پذیرش سیستم استفاده شده است. در این مطالعه اقداماتی شامل انجام مصاحبه، ترسیم تصویر غنی، تحلیل محتوای دیدگاه‌ها و شناسایی مسائل در فاز یافتن و تعریف ریشه‌ای، تحلیل CATWOE و ارائه مدل‌های مفهومی در فاز مدل‌سازی انجام شد. در ادامه در فازهای مباحثه و تعریف بر اساس دو مدل مفهومی از دیدگاه پزشکان و بیماران، اقدامات مطلوب و ممکن تعریف شدند.
یافته‌ها: در پژوهش حاضر، مصاحبه‌هایی نیمه­ساختاریافته بر اساس حوزه‌های چارچوب NASSS با 15 نفر از پزشکان و 13 نفر از بیماران به‌صورت انفرادی و در گروه‌های دو و سه نفره به‌عنوان کاربر نهایی سیستم پایش از راه دور بیماران صورت گرفت. در ادامه نتایج مصاحبه‌ها تحلیل شد و دیدگاه‌های شرکت‌کنندگان در چهار مسئله نیازمندی‌های فرایند پایش از راه دور، اعتماد به سیستم، مقرون‌به‌صرفه­بودن آن و اجرای سیستم پایش از راه دور در ساختار و رویه‌های جاری بیمارستان دسته‌بندی شد؛ سپس در فاز مدل‌سازی برای درک بهتر مسائل از دیدگاه شرکت‌کنندگان در فرایند مصاحبه، تعاریف ریشه‌ای از طریق فرمول PQR ایجاد و با استفاده از تحلیل CATWOE غنی شده و مدل‌های مفهومی از مسائل بر اساس دیدگاه بیماران و پزشکان ارائه شد. در پایان پس از انجام فازهای مباحثه و تعریف، اقدامات مطلوب و ممکن برای توسعه سیستم پایش از راه دور بیماران به‌عنوان پاسخ به هر یک از نگرانی‌ها و نیازمندی‌های شرکت‌کنندگان در پژوهش، بر اساس ماهیت اقدامات در چهار بُعد ویژگی‌های موردانتظار از سیستم، فرایندهای اجرایی، قوانین و دستورالعمل‌های موردنیاز و همچنین سیاست‌گذاری‌های موردنیاز تعریف شد.
 نتیجه‌گیری: نتایج این پژوهش نشان داد که روش‌شناسی سیستم‌های نرم با درک دیدگاه‌های عوامل انسانی و شناسایی و مفهوم‌سازی مسائل و پیچیدگی‌های جنبه‌های مختلف سیستم‌ پایش از راه دور بیماران و تعریف اقدامات مرتبط موردتوافق می‌تواند به توسعه‌دهندگان سیستم، مجریان و سیاست‌گذاران نظام سلامت در شناخت نیازمندی‌ها و فرایندهای موردتوافق کاربران بالقوه سیستم‌ پیش از طراحی و پیاده‌سازی آن کمک شایانی کند و موجب کاهش مقاومت و افزایش پایبندی در کاربران شود.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Identifying the Problems Facing the Development of Patient Telemonitoring Systems and Providing Solutions from Users' Perspectives: Application of Soft Systems Methodology

نویسندگان [English]

  • Omid Shafaghsorkh 1
  • Ashkan Ayough 2
  • Akbar Alem Tabriz 3
1 Ph.D Candidate, Department of Industrial Management and Information Technology, Faculty of Management & Accounting, Shahid Beheshti University, Tehran, Iran.
2 Assistant Professor, Department of Industrial Management and Information Technology, Faculty of Management & Accounting, Shahid Beheshti University, Tehran, Iran.
3 Professor, Department of Industrial Management and Information Technology, Faculty of Management & Accounting, Shahid Beheshti University, Tehran, Iran.
چکیده [English]

Introduction: Telehealth systems, including patient telemonitoring systems, have consistently faced challenges in user adoption since their introduction. The diversity and conflicts in users' views, needs, and concerns about changes in health service delivery create a complex situation, which can be defined as a "soft problem." Designing these systems requires an approach to understand the issues and complexities and achieve feasible solutions considering the social and cultural conditions of the implementation environment. This research aims to use the modified soft systems methodology framework as a structured method to tackle these soft problems in the design and implementation of patient telemonitoring systems from the perspective of human factors.
Methods: This research employs a hybrid approach, incorporating soft systems methodology to identify problems, define requirements, and determine actions, alongside the NASSS framework as a theoretical lens to guide participants' views. This approach was used to develop the patient telemonitoring system with a focus on system adoption. The study involved conducting interviews, drawing rich pictures, analyzing users' views, identifying problems during the finding phase, and performing root definition, CATWOE analysis, and presenting conceptual models in the modeling phase. During the discussion and definition phases, based on conceptual models from physicians' and patients' perspectives, desirable and feasible actions were defined.
Results and discussion: Semi-structured interviews were conducted with 15 physicians and 13 patients, individually and in groups of two and three, as end-users of the patient telemonitoring system. The interview results were analyzed, and participants' views were categorized into four issues: telemonitoring process requirements, trust in the system, cost-effectiveness, and the implementation of the telemonitoring system within the current hospital structure and procedures. In the modeling phase, root definitions were created using the PQR formula and enriched with CATWOE analysis. Conceptual models of the problems were then presented based on patients' and physicians' perspectives. Finally, after the discussion and definition phases, desirable and feasible actions for developing the patient telemonitoring system were defined in four dimensions: expected system features, executive processes, required rules and instructions, and necessary policies.
Conclusions: The results show that soft systems methodology, by understanding human factors' perspectives and identifying and conceptualizing the problems and complexities of various aspects of the patient telemonitoring system, can significantly aid system developers, implementers, and health system policymakers. It helps them understand the requirements and agreed processes of potential users before design and implementation, reducing resistance and increasing user adherence.

کلیدواژه‌ها [English]

  • Telehealth Systems
  • Patient Telemonitoring System
  • Soft Systems Methodology
  • System Design
  • System Adoption

مراجع

  1. Al Sabbagh, B. (2019). Cybersecurity incident response: a socio-technical approach: Department of Computer and Systems Sciences, Stockholm University.
  2. Allam O, Gray A, McIntosh S, Morrey D. (2004). A systems approach to a deeper understanding of a cancer care domain. Health informatics journal, 10(3), 205-20.
  3. Al-Samarraie, H., Ghazal, S., Alzahrani, A.I., Moody, L. (2020). Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations. International journal of medical informatics, 141, 104232.
  4. Amalberti, R., Vincent, C., Nicklin, W., Braithwaite, J. (2019). Coping with more people with more illness. Part 1: the nature of the challenge and the implications for safety and quality. International Journal for Quality in Health Care, 31(2), 154-8.
  5. Aminoff, H., Meijer, S. (2021). Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting. JMIR Perioperative Medicine, 4(2), e26580.
  6. Anckar, B., Walden, P. (2001). Introducing web technology in a small peripheral hospitality organization. International journal of contemporary hospitality management, 13(5), 241-250.
  7. Armenakis AA, Harris SG, Mossholder KW. (1993). Creating readiness for organizational change. Human relations, 46(6), 681-703.
  8. Augustsson H, Churruca K, Braithwaite J. (2019). Re-energising the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice. BMC health services research, 19(1), 1-11.
  9. Bali, S. (2018). Barriers to development of telemedicine in developing countries. Telehealth: IntechOpen.
  10. Braithwaite, J., Churruca, K., Long, J.C., Ellis, L.A., & Herkes, J. (2018). When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC medicine, 16(1), 1-14.
  11. Brewster, L., Mountain, G., Wessels, B., Kelly, C., Hawley, M. (2014). Factors affecting front line staff acceptance of telehealth technologies: A mixed‐method systematic review. Journal of advanced nursing, 70(1), 21-33.
  12. Chambers, D.A., Glasgow, R.E., Stange, K.C. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation science, 8(1), 1-11.
  13. Checkland, P., Poulter, J. (2020). Soft systems methodology. Systems approaches to making change: A practical guide: Springer. 201-53.
  14. Checkland, P., Winter, M. (2006). Process and content: two ways of using SSM. Journal of the Operational Research Society, 57(12), 1435-41.
  15. Checkland, P. (2000). Soft systems methodology: a thirty year retrospective. Systems research and behavioral science, 17(S1), S11-S58.
  16. Clemensen, J., Rothmann, M.J., Smith, A.C., Caffery, L.J., Danbjorg, D.B. (2017). Participatory design methods in telemedicine research. Journal of telemedicine and telecare, 23(9), 780-5.
  17. Cowan, K.E., McKean, A.J., Gentry, M.T., Hilty, D.M., editors. (2019). Barriers to use of telepsychiatry: clinicians as gatekeepers. Mayo Clinic Proceedings. Elsevier.
  18. Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A., & Lowery, J.C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science, 4(1), 1-15.
  19. De Marchi, F., Contaldi, E., Magistrelli, L., Cantello, R., Comi, C., Mazzini, L. (2021). Telehealth in neurodegenerative diseases: opportunities and challenges for patients and physicians. Brain Sciences. 11(2), 237.
  20. De Savigny, D., Adam, T. (2009). Systems thinking for health systems strengthening: World Health Organization.
  21. de Souza, C.H.A., Morbeck, R.A., Steinman, M., Hors, C.P., Bracco, M.M., Kozasa, E.H., et al. (2017). Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemedicine and e-Health, 23(6), 527-32.
  22. Dodoo, J.E., Al-Samarraie, H., Alzahrani, A.I. (2021). Telemedicine use in Sub-Saharan Africa: Barriers and policy recommendations for Covid-19 and beyond. International Journal of Medical Informatics, 151, 104467.
  23. Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. New England Journal of Medicine, 375(2), 154-161
  24. Fagherazzi G, Goetzinger C, Rashid MA, Aguayo GA, Huiart L. (2020). Digital health strategies to fight COVID-19 worldwide: challenges, recommendations, and a call for papers. Journal of Medical Internet Research, 22(6), e19284.
  25. Frehse AE. (2021). Overview and History of Telehealth. Telemedicine, Springer, 3-14.
  26. Gajarawala SN, Pelkowski JN. (2021). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218-21.
  27. Garne Holm, K; Brødsgaard, A; Zachariassen, G; Smith, A.C., Clemensen, J. (2017). Participatory design methods for the development of a clinical telehealth service for neonatal homecare. SAGE open medicine, 5, 2050312117731252.
  28. Greenhalgh T, Maylor H, Shaw S, Wherton J, Papoutsi C, Betton V, et al. (2020). The NASSS-CAT tools for understanding, guiding, monitoring, and researching technology implementation projects in health and social care: protocol for an evaluation study in real-world settings. JMIR research protocols, 9(5), e16861.
  29. Greenhalgh T, Papoutsi C. (2018). Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC medicine, 16, 1-6.
  30. Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., Kyriakidou, O. (2004). Diffusion of innovations in service organizations: systematic review and recommendations. The milbank quarterly, 82(4), 581-629.
  31. Greenhalgh, T., Shaw, S., Wherton, J., Hughes, G., Lynch, J., Hinder, S, et al. (2016). SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context. BMJ open., 6(2), e010208.
  32. Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., Hinder, S., et al. (2017). Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of medical Internet research, 19(11), e8775.
  33. Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., Hinder, S., et al. (2018). Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework. BMC medicine, 16(1), 1-15.
  34. Hanafizadeh, P., Mehrabioun, M. (2018). Application of SSM in tackling problematical situations from academicians’ viewpoints. Systemic Practice and Action Research, 31(2), 179-220.
  35. Hosseinzadeh, M., Mehregan, M.R., Amiri, M. Designing a Framework to Assist Multi-Methodology in Operations Research using General Morphological Analysis. The Journal of Industrial Management Perspective, 3(3), 63-87. (In Persian)
  36. James, H., Papoutsi, C., Wherton, J., Greenhalgh, T., & Shaw, S. E. (2021). Spread, scale-up, and sustainability of video consulting in health care: systematic review and synthesis guided by the NASSS framework. Journal of medical Internet research, 23(1), e23775.
  37. Jang-Jaccard, J., Nepal, S., Alem, L., Li, J. (2014). Barriers for delivering telehealth in rural Australia: a review based on Australian trials and studies. Telemedicine and e-Health, 20(5), 496-504.
  38. Jin, K.G. (2000). Power-based arbitrary decisional actions in the resolution of MIS project issues: A project manager's action research perspective. Systemic Practice and Action Research, 13(3), 345-90.
  39. Kaplan, B. (2020). Revisiting health information technology ethical, legal, and social issues and evaluation: telehealth/telemedicine and COVID-19. International journal of medical informatics, 143, 104239.
  40. Kushniruk, A., Nøhr, C. (2016). Participatory design, user involvement and health IT evaluation. Stud Health Technol Inform, 222, 139-51.
  41. Lin, C-CC., Dievler, A., Robbins, C., Sripipatana, A., Quinn, M., Nair, S. (2018). Telehealth in health centers: key adoption factors, barriers, and opportunities. Health Affairs, 37(12), 1967-74.
  42. Lopez, A.M., Lam, K., & Thota, R. (2021). Barriers and facilitators to telemedicine: can you hear me now? American Society of Clinical Oncology Educational Book, 41, 25-36.
  43. Luna, D., Almerares, A., Mayan, J.C., de Quirós, F.G.B., Otero, C. (2014). Health informatics in developing countries: going beyond pilot practices to sustainable implementations: a review of the current challenges. Healthcare informatics research, 20(1), 3-10.
  44. Mathew, J., J. Lail, A. C. Chang & Jefferies, J. L. (2018). Outpatient monitoring and self-care. Heart Failure in the Child and Young Adult, Elsevier: 755-772.
  45. Mehregan, R., Akhavan Anvari, M., Raissifa, K. (2015). Desining and Mapping Soft Operations Research as a New Science Area. The Journal of Industrial Management Perspective, 4(4), 9-29. (In Persian)
  46. Mirijamdotter A, Somerville MM. (2009). Collaborative design: An SSM-enabled organizational learning approach. International Journal of Information Technologies and Systems Approach (IJITSA), 2(1), 48-69.
  47. Nielsen, P.A. (2020). Problematizing in IS design research. International Conference on Design Science Research in Information Systems and Technology. Springer. 15th International Conference on Design Science Research in Information Systems and Technology. (pp. 259-271).
  48. Papoutsi, C., A’Court, C., Wherton, J., Shaw, S., & Greenhalgh, T. (2020). Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework. Trials, 21, 1-15.
  49. Paula Silva, A.Cd, & Loureiro, G. (2013). Soft Systems Methodology for Hard Systems Engineering: The Case of Information Systems Development at LIT/INPE/BRAZIL. Concurrent Engineering Approaches for Sustainable Product Development in a Multi-Disciplinary Environment: Springer, 1081-92.
  50. Sagaro, G.G., Battineni, G., & Amenta, F. (2020). Barriers to sustainable telemedicine implementation in Ethiopia: A systematic review. Telemedicine Reports, 1(1), 8-15.
  51. Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K., & Brooks, M. (2018). Evaluating barriers to adopting telemedicine worldwide: a systematic review. Journal of telemedicine and telecare, 24(1), 4-12.
  52. Shafaghsorkh, O., Ayough, A. (2022). Application of soft operations research methods in healthcare: A systematic review. Journal of Industrial Engineering and Management Studies, 9(1), 136-47.
  53. Sharma, R., Zhang, C., Wingreen, S.C., Kshetri, N., & Zahid, A. (2020). Design of blockchain-based precision health-care using soft systems methodology. Industrial Management & Data Systems, 120(3), 608-632
  54. Solimini, R., Busardò, F.P., Gibelli, F., Sirignano, A., & Ricci, G. (2021). Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. Medicina, 57(12), 1314.
  55. Sundell, K., Beelmann, A., Hasson, H., & von Thiele Schwarz, U. (2016). Novel programs, international adoptions, or contextual adaptations? Meta-analytical results from German and Swedish intervention research. Journal of Clinical Child & Adolescent Psychology, 45(6),784-96.
  56. Taylor, M., Baskett, M., Hughes, G., & Wade, S. (2007). Using soft systems methodology for computer game design. Systems Research and Behavioral Science: The Official Journal of the International Federation for Systems Research, 24(3), 359-68.
  57. Thuan, N.H., Drechsler, A., & Antunes, P. (2019). Construction of design science research questions. Communications of the Association for Information Systems, 44(1), 20.
  58. Van Velthoven, M.H., Cordon, C. (2019). Sustainable adoption of digital health innovations: perspectives from a stakeholder workshop. Journal of medical Internet research, 21(3), e11922.
  59. Wang CJ, Liu TT, Car J, Zuckerman B. (2020). Design, adoption, implementation, scalability, and sustainability of Telehealth programs. Pediatric Clinics. 67(4):675-82.
  60. Weidner, K., Lowman, J., Fleischer, A., Kosik, K., Goodbread, P., Chen, B. & Kavuluru, R. (2021). Twitter, telepractice, and the COVID-19 pandemic: a social media content analysis. American Journal of Speech-Language Pathology, 30(6), 2561-2571.
  61. Wosik, J., Fudim, M., Cameron, B., Gellad, Z.F., Cho, A., Phinney, D., et al. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957-62.

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