Challenges and Opportunities for Collaboration Technologies for Chronic Care Management

In this paper, we explain how our research on applications for chronic care domain problems has uncovered challenges and opportunities in the design and development of collaborative applications. Specifically, we discuss projects focused on care of the elderly, children with special needs, and individuals with diabetes. Background and Motivation Growing awareness of the changing world demographic and increasing proportion of older population is leading to a blossom of computing applications that support healthcare. These applications span a spectrum from the more traditional support of medical professionals in acute care centers, such as hospitals, to the growing attention to supporting individuals suffering from long-term chronic ailments at their homes. Acute healthcare centers have long become an important area of study from the perspective of cooperation and inspired in-depth investigations in the field of Computer Supported Cooperative Work [27]. On the other hand, the appreciation of the chronic care environments as an inherently collaborative activity, while growing, is still nascent [8, 13, 25]. Over the past several years, each of us has engaged in research agendas focused on elder care, care for children with specials needs, or support of individuals with diabetes respectively. This work has covered a large spectrum of human-computer interaction research, from exploratory, ethnographic work to deployment and evaluation of full systems. These research projects were not initially motivated by the ideas about collaborative work. However, through the investigations, each set of researchers independently reached the same conclusion: chronic care is an inherently collaborative effort and applications that support it need to reflect its intricate cooperative nature. Both individuals providing care and those receiving it face significant challenges in coordinating care, sharing information, and communicating within a sometimes very large network of caregivers. Furthermore, although these caregivers usually each share a common goal of providing the best care possible, they often have other different and sometimes conflicting goals and priorities. Our research in the design of applications for a variety of chronic care environments has uncovered both challenges and opportunities for collaborative applications for chronic care management. We focused these projects on supporting familial caregivers of the elderly and aging in place, professional and informal caregivers of children with autism, and professional and self-care for patients with diabetes. Through this examination of chronic care, we have formulated two research questions: How do the underlying technologies of existing chronic care applications need to change to support usage by a group of people? How do the practices, approaches, and theories in CSCW need to be adjusted to transition from work practices into such areas as home technologies and, specifically, chronic care at home? In this paper, we describe the conditions on which we have focused to provide the reader with sufficient background in the domain problems. We also describe the similarities of the chronic care management problem across these conditions. We then describe the networks of caregivers, including the patient or student in the center, for each of these conditions again with an eye towards the commonalities that can provide some indication of parallel system needs. We then recount the technologies developed by us and by others for addressing some of the problems within these domains. Finally, we conclude with a discussion of the design considerations for technologies to support chronic care and how the group of caregivers supporting these students and patients directly and particularly influences these considerations.