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.

This project focuses on developing a functional wearable prototype that can monitor changes in breathing behaviour by integrating textile sensors. The project was initiated by Mediventic, a healthcare industry start-up aiming to simplify the diagnoses and treatment of Chronic Hyperventilation Syndrome (CHVS) by creating affordable home-use smart clothing embedded with sensors that objectively record a patient’s biomedical data. Medical literature highlights the challenges of accurately diagnosing medical conditions in the healthcare industry, particularly CHVS, which is prone to errors due to the unusual range of complaints and symptoms. Medical professionals underline the need for wearable instruments to detect tell-tale signs and provide preventative treatment. On the other hand, current applications of smart textile wearables often lack focus on a specific problem.

To better comprehend the problem and solution space, fundamental medical themes and the current status of wearable technology are reviewed. Important annotations about CHVS are concluded, emphasizing the close link between psychological and physiological elements that drive the self-perpetuating cycle of chronic hyperventilation and the development of symptoms. To assist the patient in gaining respiratory control, the use of wearable technology to support treatment processes is investigated. In particular, ‘smart textiles’ resemble an attractive medium for the integration of sensors and electronics. Respiratory movements can be captured at various points on the upper body utilizing strain sensors embedded in the textile medium. This allows a wearable to preserve valuable qualities for
user experience typical for textiles such as comfort, flexibility, and aesthetics.

During prototype development, performance, manufacturability, and usability requirements are translated into tangible prototypes, such as the fabrication of working knitted strain sensors for tracking breathing behaviour. Different versions are fabricated through iterative steps and intermittently tested for performance and usability. Throughout development, the steps for fabricating and integrating components as a ‘textile system’ are made insightful. Through user testing, the final prototype is used to evaluate sensor performance and as well assess for comfort and usability. Participants are instructed to wear the prototype in several active positions and perform breathing tests.

Conclusively, the results and development process are contemplated concerning the project’s design requirements and initial aim. Although the data’s usefulness must be evaluated by medical professionals, the results suggest that utilizing knitted sensors for measuring breathing behaviour is successful enough for real-time data collecting, even with basic prototyping components. Information regarding breathing rate and depth of respiration can be interpreted at different locations on the body. Also, the prototype design appeals to the imagination during user tests. Users associate the prototype with regular clothing and results indicate that the wearable-textile form factor allows for unintrusive monitoring of breathing behaviour. However, developments must be made to improve the reliability of the construction and durability of the sensors. Depending on the definition of signal detail, signal amplification and noise suppression might elevate the quality of information to the next
level.

Even though many technologies are developed with the goal to support the healthcare sector in face of the ever-growing demands, many of them will never be implemented in hospitals. They fail either during the implementation process or when scaling up, what leads to unused opportunities, wasted time, effort, money and frustration on the side of all stakeholders. Using the implementation of a large language model during consultations at the Reinier de Graaf hospital as a case study, their current implementation process was evaluated. Through qualitative interviews and co-creation workshops many barriers in the collaboration between the organizational employees and key users on the side of the hospital, and the technology companies on the other hand were found.

This thesis explores how key users can be facilitated to turn the identified barriers into opportunities for successful implementation. A service for the organizational employees and technology companies was created, consisting of a book and poster that guide them through the most important milestones in their collaboration with key users: From forming the implementation team and finding the right key users, setting them up for the adaptation phase, preparing the department for the upcoming change and the go-live of the new technology all the way to sustaining and consistently monitoring its use.

This service was iteratively designed and evaluated with stakeholders of the context and design experts to provide a guided and empowering implementation experience. It also gives specific recommendations for the implementation of Autoscriber into the Reinier de Graaf and provides a foundation for future research into the practical aspects of how to effectively involve key users, a topic that is still explored very little by literature.