A visualization guided co-design technique for the implementation of health monitoring of newborn infants

Abstract

Neonatology, the medical subspecialty dedicated to newborn care, faces significant capacity challenges in Rotterdam. To address these issues, a research team from Erasmus Medical Center (EMC) in Rotterdam, in collaboration with the Amphia Hospital in Breda, launched the TeleNeo pilot project in January 2024. TeleNeo is a digital health service that enables audio-visual communication between healthcare professionals at EMC and Amphia, providing remote medical advice to prevent unnecessary patient transfers. The pilot marks the first use case in which TeleNeonatology is used in the Netherlands. This project is a collaboration between the TU Delft and EMC and aims to prepare for TeleNeo's implementation through an additional qualitative analysis.

The data collection of the project includes desk research on the TeleNeo pilot, a comprehensive literature review on digital health solutions, implementation settings, and service experiences. This research highlighted the common challenges faced when implementing digital health solutions, such as conflicting stakeholder values and the need for alignment with end-users and the broader healthcare system. An opportunity for design practice was identified through the use of visualizations as service prototypes by envisioning how solutions should ideally function and integrating them into existing healthcare systems.

In-depth stakeholder interviews and a Thematic Analysis on the obtained interview data revealed situation-specific barriers for implementing TeleNeo, including difficulties in planning and scheduling consultations, and unclear roles and responsibilities for healthcare professionals during the preparation, execution, and follow-up of consultations. Building upon the literature on existing visualization techniques and insights from expert interviews on visualization and co-design, the project's design phase emphasized the development of CoVisioning: a customized visualization guided co-design technique. This approach aimed to engage healthcare professionals in a collaborative session to address the situation-specific barriers through visual activities.

An iterative design process was adopted to incorporate feedback from designers and healthcare professionals, refining the visualization guided co-design technique. Utilizing the developed technique in a session with healthcare professionals from both hospitals, the project resulted in revised workflows for the NICU (EMC) and HC (Amphia) departments. These revised workflows integrated planned TeleNeo consultations, complemented with clearly defined roles for all involved.

CoVisioning proved instrumental in fostering a sense of ownership and collaboration among participants, leading to a more seamless integration of TeleNeo into routine healthcare activities and an initial step towards allocating TeleNeo responsibilities among involved healthcare professionals. Furthermore, the guidelines developed in this study for creating a similar visualization guided co-design technique can be applied to support the implementation of other digital health solutions dealing with scheduling and role allocation issues, promoting broader improvements in healthcare systems.