Evaluating practice-centered awareness in cross-boundary telehealth decision support systems

Building systems to enable knowledge sharing and decision support among clinicians across organizational and geographical boundaries is a complex but important task that lies at the core of the idea of telehealth. Practice-centered awareness has the potential to enhance the usability of cross-boundary clinical decision support systems by providing a shared context of work for decision support across organizational and geographical boundaries based on awareness of a clinician's work contexts and practice-related work activities, including local workarounds, non-explicit rules, improvisation strategies, institutional agenda and patients' needs. We present a multi-method evaluation of the practice-centered awareness features of CaDHealth. CaDHealth is a clinical decision support system that enables clinicians to construct awareness of one another's work activities and contexts across geographical and organizational boundaries based on three categories of work practice - ontological, stereotyped and situated work practices. Evaluation results indicate that incorporating practice-centered awareness features in telehealth systems results in better work coordination across organizational and geographical boundaries, leads to more effective cross-boundary clinical decision support, and enhances the perceived usefulness and adoption of telehealth and e-health applications.