Design as Bootstrapping

1

• Design as Bootstrapping
• On the evelution of ICT networks in health care

2
Introduction

• Keywords
• - Network growth
• - Critical mass
• - Bootstrapping
• - Telemedicine

3
Introduction

• Telemedicine is expected to enable huge
  improvments of health care services through
  radically new and improved ways of collaboratin
  and organizing within health care sector
• Lots of prototypes have been made and demostrated

4
Introduction

• Has been proved to be hard to bring the
  prototyped into regular use
• Dont seem to take-off

5
The logic of networks

• A crucial aspect of various large scale and
  networked technologies is that their value
  increases with the number of users
• As the number of users grow, the technology tends
  to get momentum and starts growing through a
  self-reinforcing prosess

6
Critical mass

• The challange is to get strarting building
  networks like this because no user wants to be
  the first one
• This lead to the consept critical mass

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Critical mass

• To get the critical mass its commen to use a
  strategy which identify and subsidize a number
  of users willing to adapt the technology
• This is not always as easy as it seems

8
Critical mass

• The critical mas model is simple
• Makes all elements equal
• But individual preferences vary
• Not static and given
• Dependent upon other peoples actions

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Critical mass

• So in small cases small changes in distribution
  of preferences can have tremendous effect on the
  outcome
• Implication of this model is the rather bying
  users until critical mass is reached, one have
  to identify the users being willing to adopt the
  technology first, then these willing to adpot the
  second etc.

10
Bootstrapping

• Definition to proote or develop by initiative
  and effort with no or little assistace
• Also described as the prosess of making a tool by
  the tool itself
• A design prosess taking its starting point the
  challange of enrolling the first users and then
  drawing upon the existing base of users and
  technology as a resource to extend the network

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Broadband networks in minimal invasive surgery

• A Intervential Centre was established in 1996 to
  do research and development on interventional
  radiology, image guided and minimal invasive
  procedures
• The hospital sat up an ISDN based
  vidioconferencing studio

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Broadband networks in minimal invasive surgery

• A starting point for the research was to focus
  on the feasibiliyt of the available ISDN
  technology for transmission of the procedures
  preformed locally.
• The quality was inadequate
• Other technological alternatives were explored.

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Broadband networks in minimal invasive surgery

• That resulted in a trial set-up of a broadband
  network between the Interventional Canter and
  Ullevål hospital for 14 days, where equipment and
  network access was provided by Telia
• The test were promising and the cooperation was
  continued and truned into a formal project

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Broadband networks in minimal invasive surgery

• Started with less complex and critical areas
• Then they expanded
• Avoid expensive solutions by expanding existing
  ones
• Experiment with the tecnology in areas where one
  can avoid interfering with exsisting practices
• Learn from simpler areas before moving into more
  comples ones
• Identify areas which are considerd important for
  users

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EDI infrastructures

• A private laboratory develop a simple
  technological solution enabling electronic
  transmission of reposrt from the lab to General
  Practitioners
• The solution was highly appreciated by the
  existing costomers, and it attracted lots of new
  ones

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EDI infrastructures

• Wanted to expand this to a wide range of areas
  inside health care.
• Would require a shared and open infrastructure
  for the hole health care sector
• Was decided that the messages should be exchanged
  using an underlying infrastricture based on X.400

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EDI infrastructures

• In practical terms no X.400 infrastructur was
  available
• Needed to build one
• No one would use the new system, everybody was
  waiting to see whether others really bougt X.400

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Telemedicine in ambulances

• In 1998 there was a process of rationalization
  and centralization the hospital into one
  organizartion
• Care units were reduced
• The time from door-to-needle-time became longer

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Telemedicine in ambulances

• Criticall in the care of myocardiak infraction
• Have to vertify the diagnosis before treatment
• MobiMed, a telemedicine system that facilitated
  transmission of text and ECGs from ambulances to
  a reciver(hospital)

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Telemedicine in ambulances

• Managed to get a try out of the system
• With a nurse available for emergency trips
• Was a big sucsess and the door-to-needle-time
  was reduces with 25-30 minutes
• The ambulace personnel was thougt how to use the
  equipment

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Telemedicine in ambulances

• The health authorities decided to support the
  purchase of the equipment to other ambulanses in
  other towns

22
Summary

• Highly motivated users have to be identified
• Less motivated users may be enrolled as
• The network grows and the use values increases
• The technology is imporved
• The sceptics become convinced about the positive
  contribution

23
Summary

• The cost of adpoting a technology depend on the
  adoptersknowlede about it. The more konwledge
  about the technology, the easier it is to adopt,
  since the user have some idea of what it may be
  used for

24
Summary

• Whether a user wants to adpot a technology or not
  also depends on
• Availability
• Simplicity
• Costs
• Flexibiliyt
• Future oriented