An analysis of the dynamics of multidisciplinary medical team meetings and the use of communication technology

Sammanfattning: Multidisciplinary medical team meetings (MDTM)s are collaborative fora where healthcare spe- cialists come together to discuss patient cases, establish a definitive diagnosis and determine the best treatment strategy for the patient. The practice of MDTMs is growing in importance as regulatory agencies advocate their adoption into routine practice.This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or me- chanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective. The work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion.In this longitudinal study, the development of a multidisciplinary medical team was followed through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM.System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result.Cases discussed in teleconference are less satisfactory from the users’ perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions compared to co-located meetings. Case controlled study reveals a doubling effect observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (arte- facts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted. Visual needs are identified for both sides of the teleconference interface at MDTMs. Providingmore control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make com- munication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment.The internal temporal structure identified in patient case discussions (PCD)s prompts the in- vestigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of commu- nication within the health service.