Category Archives: software development

Seminar on Digital Work Environment with Examples from Health Care and DOME

Last week Gerolf Nauwerck and I did a presentation about Digital Work Environment at the Swedish Ergonomic Society’s yearly meeting. This blog post will shortly describe this presentation. It was the first time that Gerolf and I presented together, but despite limited time for preparing it went really well much thanks to Gerolf and an enthusiastic audience.

Gerolf started off the presentation by discussing the term Digital Work Environment that is used by for example Digitaliseringskommissionen, Prevent and Vision. For example Digitaliseringskommisionen defines it as:

 “The work environment in the digital economy”.

There is no scientific definition of the word, and in research other terms are used such as work engagement and healthy work.

Twenty years ago there were numerous different professions that worked with different tools, but working life has changed and today most work is done using a computer or an iPad, or other ICT technology, see image below:

arbete-fo%cc%88ra%cc%88ndring

When looking at the digital work environment there are numerous alarm reports from health care such as Isabella Scandurras “Disturbing or Facilitating“. Most health care professionals use around 25 different computer systems in their work, and these are often not connected or made to work well together even though they spend much of their time working through these systems. Physicians spend around 50% of their time working with the computer, and around 50% doing other things such as meeting patients. There are numerous media articles about the problems with ICT in health care, see the picture of the blog post. The problems are alarming, and health care professionals are as a consequence not always positive to changes related to IT.

One example of digitalisation in health care is medical records online for patients. Most physicians and nurses are very worried of the effects of this system. Mostly they are worried about the effects on the patient, but they are also worried about the effects on their work environment through the following changes:

  • Changes in well established work routines
  • Time pressure
  • Less time for preparation
  • Increased risk of misjudgements

Health care is not the only area where the digital work environment is problematic. Unionen (one of the largest Swedish unions) distribute a yearly or biannual survey to their members to investigate the digital work environment. The sub-titles of their reports called “The digital work environment of white-collar workers” tell us about the results from the survey:

2008: Why doesn’t it get better?

2010: A system error?

2011: Always online – never relaxed

2012: One step forward and two steps back

2014: No lightning ahead

In the seminar we continued with discussing what is known about software development and success factors, and we presented the results from the CHAOS report and research reports that show that one of the most important things when developing good IT for work is user involvement. But I guess that you already knew that 🙂

 

What is DOME? Some Words about the Background and the Consortium from My Perspective.

I have collaborated with the county council in Uppsala since 2003 as a part of the project course IT in Society. In this course I collaborate with my husband Mats Daniels who does research on learning environments for developing professional competencies related to IT systems development. The course is based on the teaching strategy of Open Ended Group Projects. Through this course we worked on the topic “Medical Records Online for Patients” a couple of three times between 2003 and 2011. The students did thorough research as a part of their course, and they also wrote one of the white papers that the county council sent to Brussels to get funding for the SUSTAINS project.

Around 2012/ 2012 the large EU project named SUSTAINS started and was coordinated by the county council in Uppsala. Mats Daniels and I were contacted by the project managers Benny Eklund and Leif Lyttkens (with whom we collaborated in the IT in Society course) who asked if we wanted to start a research project and do research on the implementation and consequences of putting medical records online in Uppsala county.

The SUSTAINS project had a meeting in Uppsala around new years eve in 2011/2012 and my husband and I set up a brief document describing the major ideas behind a research project and you still find these ideas in DOME today. These idead were presented at the meeting to see if there were other researchers interested:

  • Three work packages:
    • 1) patients & relatives
    • 2) health care professionals
    • 3) systems development and implementation
  • Multidisciplinary research
  • Studies on the effects of the implementation from different perspectives using both qualitative and quantitative research methods.

My main research areas are IT and work, and how we develop and implement IT for work. However, in DOME I have not only done this but also research looking at the implementation from the patient perspective.

After this initial meeting we organised a few start up meetings in Uppsala for researchers that would be interested in this work. We got help from the EU coordinators at the university to find people, and somehow the words spread and we became a group of around ten people very quickly. I had never met most of these researchers, but we had very open and creative discussions.

During the first years the DOME project had funding from VINNOVA, and the last few years it has changed into a research consortium that consists of  researchers with funding from different sources. This fall we have funding from AFA through the EPSA project, Forte through the DISA project as well as strategic research funding through Örebro University and Uppsala University. This spring there will also be some funding from NordForsk through a new centre for gender research, and from Forte through the PACESS project.

The number of active researchers in DOME has varied over the years, but we are around 12-15 people that participate in meetings and do studies on medical records online. We come from six different universities, and we meet using Skype every three weeks and have a conference every semester at one of the universities. The next DOME conference is organised in Skövde in March 2017. DOME has a small group of leaders, and I am the coordinator of the consortium.

DOME is an open consortium and the only criteria for joining us is that you want to do research in the area of medical records online for patients, and that you spend time with us in DOME.  You can come from any area of research, and any university. 🙂

Working with Usability in Scrum Projects – what Usability Activities are Used in Practice?

A few years ago Yuan Jia worked with Marta Larusdottir and me as a master student doing her master thesis study in our research project on Agile development and UCD.

There was lack of studies describing to what extent different user centred methods were used in Scrum projects, so this became the topic of Yuan Jia’s master thesis, and which resulted in a conference paper. I remember that we had a very good collaboration with Yuan Jia, who now is a PhD student in the US.

When designing the study we quickly ran into problems with the number of respondents to our web based questionnaire. We did not have the mail contact information to people in organisation working with Scrum and user centred design. First we distributed the survey through the Uppsala Tax Office and LokaIdelen which is a website offering information to companies in Sweden. I also remember Yuan Jia’s long lists of company names and phone numbers as she systematically contacted company after company. Tedious work, but to be honest research work can be very much administration from time to time. In the end we had around 50 people who answered the survey 🙂

The survey has some interesting results, se Figure below. The most commonly used usability technique in Scrum projects is workshops, followed by lo-fi prototyping, interviews and meetings with users, all used by more than half of the participants.

One can note that all these usability techniques are informal, meaning that these techniques can be used quickly without much preparation. Formal usability evaluation with users is a highly ranked technique by the participants but not commonly used by them.

 

the-usage-of-usability-techniques

 

We presented the paper at the Human Centred Software Engineering Conference (HCSE) in 2012.

You find the paper here.

 

The Future of Health Care: Student eHealth Project Kick off with the County Council in Uppsala

Now we have had a kick off day for this year’s project course in the IT in Society Class at Uppsala University. This is a collaborative class with students from thee different universities: Uppsala University, Gannon University and Rose-Hulman Institute of Technology.  Their project course is based on a student-centric learning philosophy, and open ended group work. Previous years the students have worked on various topics that are related to eHealth systems. 

We are constantly working on improving the course and the learning experience, and we have published some papers on the collaboration in the area of Computer Science Education.
This year 20 Uppsala University students will collaborate with 12 Americans on the topic:

Health systems in the future and possibilities with digitalization- Integrating systems

During the kick off day, there were a large number of people presenting their perspective of this years’ project. Annemieke Åhlenius who is the head of IT at the hospital was first and presented the Uppsala County Council’s . Some of the challenges that Annemieke and the county council face are in relation to:

  • co-ordination and interoperability
  • usable to whom?
  • integrity
  • prioritisation

This was an interesting presentation with some of the ideas similar as in this YouTube film, ending with “We need your help!” and some topics that the County Council would like the students to work on are:

  • Best in breed or best in sweet? (Standard systems or uniquely designed software)
  • For whom are we documenting in the Electronic Medical Records (EMR)?
  • How to archive one EMR instead of several professional-based ERM:s in one system?

Åke Nilsson who is a senior advisor at the County Council, was the second presenter, and he presented the national services that we have in Sweden. The most striking part of his presentation was the dependency map that he showed that clearly illustrated the complexities of eHealth. He also mentioned “the double work” that is a result of all these dependencies. People add the same information in many different systems.

Gustaf Hedström works with computer based decision support and Birgitta Wallgren who nowadays works with IT,  also did a very motivating presentation for the students. Gustaf presented how the work as a health care professional has changed, and the history of Electronic Medical Records (EMR).

Birgitta Wallgren describes that health care professionals want to work with patients, and they do not want to do the documentation. She presents the problem of documentation during surgery where one person documents what happens. Today they have many systems where they need to document, and there is very little integration between the systems.

Gustaf Hedström continued by describing the complexity of being a health care professional and being up to date, and that 1.244.252 papers were published in the Life Science area. Today it takes about 17 years for research in these papers to be implemented in the health care systems, according to Gustaf Hedström. And this is of course too long!

He also continued describing the health care system in the US, and had a fantastic quote from a physician that he had met:

There is no way I can summarize the health care system in the US, it is chaos

I am really looking forward to this years’ project, and for sure will blog about it some more.

The New Ladok System will Reshape the IT Landscape at Swedish Universities

The magazine Ergo had an article on our work with the establishment of a new study administrative system at Uppsala University. The Health Technology and Organisations research group collaborate with the university administration and we have further developed our vision seminar method in this project which has resulted in a submitted application by Thomas Lind and will soon be the core of his PhD thesis work. We have also launched a usability coaching program, since our experiences are very positive when it comes to the effects of such a program.

My research group has a long tradition of doing action research, and we collaborate closely with different organisations. Action research has one goal to improve society in one way or the other, and one goal to spread knowledge about the change. Previously we have had projects together with the county council of Uppsala and a large number of government organisations such as CSN, Skatteverket, Försäkringskassan and Migrationsverket.

The New Ladok is the ICT system which is the heart of university study administration. And replacing it is like a difficult piece of heart surgery that requires skilled professionals and careful planning. The system will be introduced at 39 universities in Sweden. At Uppsala University the system will be introduced in 2018, and it will affect about 45 000 people in the roles of course administrator, teachers, director of studies, program managers, counselors, all our students and graduate students.

During the fall we will do a study where we investigate the existing digital work environment of study administrators. The study is run by Gerolf Nauwerck, and as a part of it we will look at and compare the existing methods for organisations to incorporate work with digital work environment in their routines.

We will also do a pilot at the Department of Information Technology regarding development of processes and procedures for study administration. These will work together with the common goal which has been developed in the vision seminars. The idea is that the department of information technology’s pilot work will serve as a support for other departments in the transition to the New Ladok system.
You find the Ergo article here

On the Future of Software Engineering by Ivar Jacobson

I listened to a very interesting key note by Ivar Jacobson on the future of software engineering. Many of the things he said were spot on true, and some were a bit provocative and I disagree, but the talk was still very interesting.

Ivar Jacobson starts his key note with a historical overview of the history of software engineering, and the presentation included reflections on organisational learning and good practices. According to Jacobson there has been a few different paths in software engineering, but very little learning from past experiences. Software developers are not trained in learning from the past, and to rework and improve. They are trained in doing new things. I think he has a point here, and this is a wider phenomena than something unique for software engineering:

“Every new path starts by throwing away what you had and starting all over with new vocabulary, “new” practices, new gurus”

When talking about Agile, Ivar Jacobson claims that it is definitely a good practice. He claims that if you are a methodologist you need to be out of marketing, otherwise you are out of the game, and Agile has succeeded here. The method also needs to be accepted and appreciated by the software developers, and there is where Agile is successful. However, he also claims that many of the good practices and things we learned about software development was thrown over board when moving to agile:

“I am a firm believer in Agile, but lots were lost when we moved to Agile.”

One cornerstone of learning in an organisation, according to Jacobson, is the common ground and a common vocabulary. And we need methodologies, processes and a common vocabulary to coordinate the work with ITC in organizations. Work that includes several thousand people cannot be only creative design.

We also need to know more about how software developers learn, and how the marketing of new methods work. I really agree with this, and studies of learning in relation to software engineering is really a part of my interest. Ivar Jacobson continues by  saing that people learn through using, and working with methods, and he is reflecting on the use of books as a source of learning:

“People buy the books, but they don’t read them. How do we know what they know?”

Finally Ivar Jacobson presents the concepts of Essence, which is built on previous methods and ideas. According to Jacobson Essence is:

Essence – a standard that defines the smallest set of concepts that are common to all software projects – helps embed agile professional practices and governance across an organization for sustainable, scalable and responsive solution delivery.

The future of software engineering is human centred, of course, but there is still some way to go before we are there . According to Ivar Jacobson the way forward is to create a learning organisation, that includes a kernel of common concepts and knowledge. I agree with him completely, and the problem is how to create this situation. Perhaps action research and practice oriented research is the answer to this question?

 

The Volkswagen Scandal: Values and Software Development

In 2015 it was revealed that Volkswagen had deliberately cheated with environmental tests, and that their engines did not fulfil the requirement of pollution. This was indeed a big scandal! But one can wonder how it could happen that such a well reputed company makes such bad and unethical decisions? The presentation that I listened to at the Human Centred Software Engineering conference did not give an answer to this question, but instead talked about what we should do in software development to ensure that these things do not happen. The paper is called: “Do you own a Volkswagen? Values as Non-Functional Requirements”

Friedman’s ideas of Value sensitive design has been around since the 1990’s, and the idea behind it is really good. We should be aware of our values and incorporate them in systems development. Cockton has also made some contributions in the field of value, but he looks more at the value perceived by customers than the value of the systems developers. I also worked some with values as my first area of research, and did my licentiate degree on Values and Perspectives Affecting IT Systems Development and Usability work. My focus was on what values are at the core of the decisions made in companies when it comes to software development. Not surprising money, time and automation were values that collided with the values of user-centred design.

One can wonder why this way of thinking is not present in software development processes such as agile development? It feels like the value sensitive design and the ideas behind that are completely off, even though agile generally has a very strong focus on working teams, humans, communication and leadership – not to mention speed. 

Perhaps it would be easier to discuss values in software development today than ten years ago due to the discussion about sustainability? Perhaps things have matured and we have another way of thinking than before? Hmmm. Or perhaps not?

Robots Instead of Health Care Professionals??

I listened to the introductory key note from the conference Human Centred Software Engineering by the very inspiring Danica Kragic on social robotics.

Clearly robots such as avatars of humans will influence work very much in the future. One of the areas of application is health care. Danica Kragic mentioned health care services such as Cognitive Behavioural Therapy, and research has indicated that this might be a possible future avenue. Physicians would collaborate with robots in their work, and part of the work would be replaced by robots such as some part of the therapy.

Hmm. One can wonder what the reactions from physicians would be if we start doing research on replacing them with robots or machines? And how would the patients react to robots? Perhaps not as negative as one could think?

One can also wonder how the professional competence of health care professionals can be transfered to robots?  Is this possible?

BTW: If you haven’t listened to Danica Kragic’s Sommar, I highly recommend it (in Swedish only, though) 😀

“How do we design Work 4.0? “

 

Technology change human work, changes responsibilities, change decision making and we are losing knowledge and competencies, according to a paper by Holger Fischer and Björn Senft presented at the Human Centred Software Engineering Conference. Their research is then on how organisations should work to ensure that the systems build to support this work are usable, and conform with standards. Unfortunately the paper does not present the silver bullet to how this should be done ;-).

This research is indeed very relevant for my research group as it is a complex issue to design ICT that works well. Hmm. But after a few years in the area of ICT and work, we are getting a bit disillusioned about the state of the art when it comes to ICT at work. Or as one of my colleagues in the group joked :

“I do research on how to introduce new ICT systems for work in organisations without breaking the organisation down “

 

Visit to the Visualization Studio at KTH

The conference reception for Human Centred Software Engineering yesterday was at the KTH Visualization studio.

We got the possibility to try different Virtual Reality Games. Of course I tried all available devices!

planetarium

The visit also included a 3D planetarium demonstration with an extremely interesting presentation of the possibilities of technology.

Very cool indeed!!

If you ever get the chance – go there and try it! 🙂