title: In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System.
abstract: BACKGROUND
  We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space.
  
  
  OBJECTIVE
  The objectives of this paper are to present the iterative design of the separate views for health care providers (HCPs) within each patient's secure space and examine patients', caregivers', and HCPs' perspectives on this separate view for HCP-only communication.
  
  
  METHODS
  The overall research program includes cycles of ethnography, prototyping, usability testing, and pilot testing. This paper describes the usability testing phase that directly informed development. A descriptive qualitative approach was used to analyze participant perspectives that emerged during usability testing.
  
  
  RESULTS
  During usability testing, we sampled 89 participants from three user groups: 23 patients, 19 caregivers, and 47 HCPs. Almost all perspectives from the three user groups supported the need for an HCP-only communication view. In an earlier prototype, the visual presentation caused confusion among HCPs when reading and composing messages about whether a message was visible to the patient. Usability testing guided us to design a more deliberate distinction between posting in the Patient and Team view and the Health Care Provider Only view at the time of composing a message, which once posted is distinguished by an icon.
  
  
  CONCLUSIONS
  The team made a decision to incorporate an HCP-only communication view based on findings during earlier phases of work. During usability testing we tested the separate communication views, and all groups supported this partition. We spent considerable effort designing the partition; however, preliminary findings from the next phase of evaluation, pilot testing, show that the Patient and Team communication is predominantly being used. This demonstrates the importance of a subsequent phase of the clinical trial of Loop to validate the concept and design.
authors.affiliation: Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Allison M
authors.identifier: http://orcid.org/0000-0001-5109-4121
authors.initials: AM
authors.lastname: Kurahashi
authors.forename: Peter B
authors.identifier: http://orcid.org/0000-0002-0016-8204
authors.initials: PB
authors.lastname: Weinstein
authors.forename: Trevor
authors.identifier: http://orcid.org/0000-0002-1050-3918
authors.initials: T
authors.lastname: Jamieson
authors.forename: Jennifer N
authors.identifier: http://orcid.org/0000-0002-9969-8052
authors.initials: JN
authors.lastname: Stinson
authors.forename: Joseph A
authors.identifier: http://orcid.org/0000-0002-3114-4440
authors.initials: JA
authors.lastname: Cafazzo
authors.forename: Bhadra
authors.identifier: http://orcid.org/0000-0001-7245-6769
authors.initials: B
authors.lastname: Lokuge
authors.forename: Plinio P
authors.identifier: http://orcid.org/0000-0001-9515-6478
authors.initials: PP
authors.lastname: Morita
authors.forename: Eyal
authors.identifier: http://orcid.org/0000-0003-0112-7188
authors.initials: E
authors.lastname: Cohen
authors.forename: Adam
authors.identifier: http://orcid.org/0000-0002-5090-8987
authors.initials: A
authors.lastname: Rapoport
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0002-3447-199X
authors.initials: A
authors.lastname: Bezjak
authors.forename: Amna
authors.identifier: http://orcid.org/0000-0001-8638-3943
authors.initials: A
authors.lastname: Husain
keywords: Internet communication technologies; Internet communication tools; chronic disease; collaborative care; communication; patient engagement; patient-centered care