| 1. |
- Cajander, Åsa, Professor, 1971-, et al.
(författare)
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What brings women into ehealth? : Women's career trajectories in digital transformations in health care
- 2020
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Ingår i: Proceedings of the 12th International Conference on e-Health.
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Konferensbidrag (refereegranskat)abstract
- Digital transformation of health care services is addressed world-wide in order to more efficiently meet the patients’ information and health care needs. However, little is known about the people working with this transformation, where two traditionally gendered fields meet; health care and IT. While work with digitalization generally is dominated by men, digitalization of health care services involves a large number of women. This case study explores the career trajectories of women working with the digital transformation of eHealth services. Who are the women in this eHealth project, and how did they come to working with this digital transformation? The analysis shows different types of trajectories that brought the women into eHealth transformations: The first illustrating women who were pushed into working with eHealth by their job descriptions, the second showing women using eHealth as an escape route from something else, and the last trajectory showing how women stumbled across eHealth and decided to stay on. This has implications for the educational system, and points to the need for being able to study computer science later in life. It also calls for a better understanding of what drives women in transformation processes.
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| 2. |
- Grünloh, Christiane, et al.
(författare)
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"The Record is Our Work Tool!"-Physicians' Framing of a Patient Portal in Sweden
- 2016
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Ingår i: Journal of Medical Internet Research. - Toronto : JMIR Publications Inc.. - 1438-8871. ; 18:6, s. 470-483
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uppsala County in Sweden launched an e-health patient portal named Journalen in 2012, which allows patients to access their medical records over the Internet. However, the launch of Journalen was critically debated in the media. The professionals were strongly skeptical and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians in order to understand their framing of the patient portal in relation to their work environment.Objective: The study uses the concept of Technological Frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment.Methods: 12 semi-structured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed.Results: The thematic analysis revealed four main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within healthcare only. Considering effects on work environment the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially that patients might read their test results prior to the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians, and increase or create a feeling of mistrust from patients. Regarding benefits for the patients most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided.Conclusions: Supported by the study we conclude: 1) The transfer of a paper-based healthcare process where patients read on paper, into a digital process challenges current work practices and has consequences for the work environment. Mostly this is explained by the changing positions between the physicians and the patient: the latter can drive the process, which reduces the physicians’ ability to guide the patient. 2) The physicians’ experiences were expressed as worries: patients would not understand the content of the record and become unnecessary anxious from misunderstandings. The concerns are to some extent based on a generalized view of patients, which might disregard those, who already actively participate in healthcare. This study hence reveals a need to provide physicians with information about the values for patients from using patient portals. 3) A change of work practices may be beneficial to increase patient participation, but such changes should preferably be designed and discussed with physicians. However, the strong resistance from the physicians made this challenging when launching Journalen.
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| 3. |
- Grünloh, Christiane, 1980-, et al.
(författare)
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"why do they need to check me?" patient participation through ehealth and the doctor-patient relationship : Qualitative study
- 2018
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Ingår i: Journal of Medical Internet Research. - : J M I R Publications, Inc.. - 1438-8871. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients. Objective: This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians' constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement. Methods: A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed. Results: Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient's role, lack of skills (technical or regarding medical jargon), motives to read, and patients' characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care. Conclusions: Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of "power" in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of "monitoring the doctor" but to make sense of the situation.
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| 4. |
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| 5. |
- Huvila, Isto, et al.
(författare)
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Empowerment or anxiety? : Research on deployment of online medical e-health services in Sweden
- 2013
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Ingår i: Bulletin of the American Society for Information Science and Technology. - : John Wiley & Sons. - 1931-6550 .- 1550-8366 .- 0095-4403. ; 39:5, s. 30-33
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Tidskriftsartikel (refereegranskat)abstract
- As early e-health efforts progress, it is critical to step back to study their effectiveness and inform expanded implementation. The DOME project is a Swedish research initiative to examine the methods and implications of providing patients access to their own medical records and other e-health services. The focus is on SUSTAINS, a patient access system established in 2012 in 11 European countries. Sweden’s Uppsala county opened access to residents to view their electronic health records with provider notes, lab results, diagnoses and treatments in late 2012. Pre- and post-implementation studies are being carried out through DOME and mixing with the public debate on benefits and drawbacks of easy online access to personal health information. Supporters and critics share concern for quality of care and data security. But advocates focus on better decisions by empowered patients, while detractors, including many healthcare providers, see patient anxiety resulting from insufficient information and lack of consultation. The DOME project is providing the opportunity to analyze all sides of expanded access to electronic health records.
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| 6. |
- Moll, Jonas, 1982-, et al.
(författare)
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Experiences of Patients With Mental Health Issues Having Web-Based Access to Their Records : National Patient Survey
- 2024
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Ingår i: JMIR Mental Health. - : JMIR Publications. - 2368-7959. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sharing mental health notes through patient accessible electronic health records (PAEHRs) is controversial. Many psychiatric organizations and regions in Sweden have resisted the implementation, as clinicians worry about possible harms when patients are reading their notes. Despite the documented benefits of PAEHRs, there is still a lack of knowledge regarding whether patients with mental health issues could reap similar benefits of reading their notes as other patient groups. Objective: The aim of the study is to examine the use, attitudes, and experiences of patients with mental health issues by reading their notes in the PAEHR and, moreover, whether their experiences differ from other patient groups, and if so, how. Methods: A national patient survey was conducted with answers from 2587 patients from different patient groups. In total, 504 respondents (19.5%) indicated that they experienced a mental health disease. Answers from this patient group were compared to the answers from all other respondents. Survey questions related to attitudes, information usage, and effects on contacts with care were selected for analysis. Mann-Whitney U tests were used to detect groupwise differences. Results: Patients with mental health issues use PAEHRs for checking that they have received the right care (mean_mental health 2.83, SD_mental health 1.39; mean_others 2.62, SD_others 1.37; P=.002) or suspected inaccuracies (mean_mental health 2.55, SD_mental health 1.34; mean_others 2.31, SD_others 1.30; P=.001), blocking access for professionals in other specialties (mean_mental health 3.43, SD_mental health 1.46; mean_others 3.04, SD_others 1.42; P<.001), and checking which care professionals have accessed their record (mean_mental health 4.28, SD_mental health 1.14; mean_others 4.05, SD_others 1.25; P<.001) to a significantly higher degree than other patients. On the other hand, the results show that a significantly lower proportion of patients with mental health issues (mean_mental health 3.38, SD_mental health 1.21; mean_others 3.52, SD_others 1.18; P=.02) believe that PAEHRs help them in shared decision-making compared to other patient groups. Conclusions: Patients with mental health issues who took part in the survey, as a group, express some minor differences in both the use of the PAEHR and their experiences regarding its usefulness, as compared to other patients, as a group. This patient group shows a slightly higher interest in 2 types of use: checking for accuracy of care in the record and blocking access to mental health notes for professionals from other parts of the health care system. Compared to other patient groups, these patients are less likely to experience that the PAEHR is a support in shared decision-making. The study indicates that the benefits of PAEHR on a general level are the same for this patient group as for other patients. The study does not support clinicians’ worry about possible harm to this patient group. Further research is however needed.
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| 7. |
- Moll, Jonas, 1982-, et al.
(författare)
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Patients’ Experiences of Accessing Their Electronic HealthRecords : National Patient Survey in Sweden
- 2018
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Ingår i: Journal of Medical Internet Research. - : J M I R Publications, Inc.. - 1438-8871. ; 20:11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internationally, there is a movement toward providing patients a Web-based access to their electronic health records (EHRs). In Sweden, Region Uppsala was the first to introduce patient-accessible EHRs (PAEHRs) in 2012. By the summer of 2016, 17 of 21 county councils had given citizens Web-based access to their medical information. Studies on the effect of PAEHRs on the work environment of health care professionals have been conducted, but up until now, few extensive studies have been conducted regarding patients’ experiences of using PAEHRs in Sweden or Europe, more generally.Objective: The objective of our study was to investigate patients’ experiences of accessing their EHRs through the Swedish national patient portal. In this study, we have focused on describing user characteristics, usage, and attitudes toward the system.Methods: A national patient survey was designed, based on previous interview and survey studies with patients and health care professionals. Data were collected during a 5-month period in 2016. The survey was made available through the PAEHR system, called Journalen, in Sweden. The total number of patients that logged in and could access the survey during the study period was 423,141. In addition to descriptive statistics reporting response frequencies on Likert scale questions, Mann-Whitney tests, Kruskal-Wallis tests, and chi-square tests were used to compare answers between different county councils as well as between respondents working in health care and all other respondents.Results: Overall, 2587 users completed the survey with a response rate of 0.61% (2587/423,141). Two participants were excluded from the analysis because they had only received care in a county council that did not yet show any information in Journalen. The results showed that 62.97% (1629/2587) of respondents were women and 39.81% (1030/2587) were working or had been working in health care. In addition, 72.08% (1794/2489) of respondents used Journalen about once a month, and the main reason for use was to gain an overview of one’s health status. Furthermore, respondents reported that lab results were the most important information for them to access; 68.41% (1737/2539) of respondents wanted access to new information within a day, and 96.58% (2454/2541) of users reported that they are positive toward Journalen.Conclusions: In this study, respondents provided several important reasons for why they use Journalen and why it is important for them to be able to access information in this way—several related to patient empowerment, involvement, and security. Considering the overall positive attitude, PAEHRs seem to fill important needs for patients.
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| 8. |
- Myreteg, Gunilla, 1968-
(författare)
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Cost-benefit evaluation of e-health services : acceptance and value creation are interactive forces
- 2015
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Ingår i: Health Systems. - : Palgrave Macmillan. - 2047-6965 .- 2047-6973. ; 4:3, s. 204-211
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Tidskriftsartikel (refereegranskat)abstract
- Resources are limited in health care. There is a scarcity of knowledge on how to economically evaluate e-health. The present study is a review of research in this area. The article proposes a theoretical frame of reference for cost-benefit evaluation of e-health services from the vantage point of electronic health records. The basis of the evaluation needs to acknowledge the context of all relevant heterogeneous stakeholder groups. Acceptance is linked to the unique situation, as one group may perceive costs while another realizes the benefits. The model is expressed as a loop, where expected values and realized values within the processes are intricately connected to one another, evolving over time.
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| 9. |
- Myreteg, Gunilla, 1968-
(författare)
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ERP systems and organizational learning : Where do we stand? A literature review
- 2014
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Ingår i: Proceedings of the 8th European Conference on IS Management and Evaluation, ECIME 2014. - : Academic Conferences and Publishing International Limited. - 9781910309438 ; , s. 155-162
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Konferensbidrag (refereegranskat)abstract
- ERP systems are today implemented in a great number of organizations. Research has invested much energy and time to make descriptions and recommendations regarding how the implementation should best be managed. The next step in practice as well as in research is how to continue to develop the business processes and ERP systems in order to take advantage of all their promises, and to refine how ERP systems are used in day-to-day activities. A starting point for the present study is that organizations today are characterized by strong external and internal pressure. In order to response to and deal with these, organizations strive to balance demands regarding stability and change. This implies that organizations put effort into designing and maintaining or changing practices, rules and routines. Within the general fields of organization theory and management accounting/control the ambition to create deliberate change is often conceptualized as processes of organizational learning (OL). This concept has also been used in the context of ERP systems. The research field is however heterogeneous and findings are scattered and inconsistent. There is a need for further development of our knowledge about the role of ERP systems in processes of organizational learning after the implementation phase. The present paper strives to consolidate and synthesize the current knowledge. The research question is to what extent and how do research conceptualize organizational learning and its interactions and involvement with the ERP system? The paper is a literature review of research on OL in the context of ERP systems. The aim is to analyze and classify previous research, and also to give suggestions for avenues suitable and fruitful for future research. The review compares and contrasts approaches in order to analyze similarities and dissimilarities and to investigate what topics or issues have been addressed by previous research. The analysis shows that overall there is a lack of definitions and stringency in research on OL in an ERP systems context in the post-implementation phase. The final section also forwards some suggestions for future research.
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| 10. |
- Myreteg, Gunilla
(författare)
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Learning to understand what the ERP system is all about: A literature review.
- 2009
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Ingår i: The Proceedings of the 3rd European Conference on Information Management and Evaluation. - Reading, UK : Academic Publishing Limited. - 9781906638443 ; , s. 339-347
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Konferensbidrag (refereegranskat)abstract
- The purpose of an enterprise resource planning (ERP) system is to bring several benefits to the company by using a mutual database and real time data. Though, empirical studies show that several companies judge the ERP project as unsuccessful. Research has tried to explain why users are disappointed with the ERP system, but findings are scattered and inconsistent. There is need for further development of our knowledge on how ERP systems are viewed and used in companies. Organizational learning (OL) is a concept that has been used in research within the fields of organization theory and management. Still, only a few empirical studies have been conducted on OL in the context of ERP systems. To what extent and how do research conceptualize the ERP system as involved in the organizational learning process? The paper is a review of research on OL in the context of ERP systems: selection, implementation and use. Twelve articles were found in full text. The purpose is to compare and contrast approaches in order to analyze similarities and dissimilarities. The analysis shows that overall there is a lack of definitions and stringency in research on OL and ERP systems. The complexity of the ERP system and how that can be understood, how the artifact functions or interplays with the organization and the organizing process, is seldom discussed in greater detail. If learning in organizations, at least partially, depends on the use of enabling technologies, it would be a worthwhile effort to analyze more closely how, when and why an ERP system can be used in this respect. A major suggestion for future research is that it should be more explicitly engaged with the relationship between OL and the ERP system. Regarding the ERP system as a part of the organizational memory might be a fruitful way to go.
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