| 1. |
- Thomas, Steve, et al.
(författare)
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Variation in resource allocation in urgent and emergency Care Systems in Ireland
- 2019
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Ingår i: BMC Health Services Research. - London, UK : BioMed Central. - 1472-6963. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland.Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county.Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions.Conclusions: This analysis advances the traditional approach of evaluating individual services or hospital resourcing. There are notable differences in utilisation of hospital-based emergency care resources at the regional level, indicating that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process.
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| 2. |
- Alaqra, Ala Sarah, et al.
(författare)
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Machine Learning–Based Analysis of Encrypted Medical Data in the Cloud : Qualitative Study of Expert Stakeholders’ Perspectives
- 2021
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Ingår i: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 8:3, s. 1-15
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Tidskriftsartikel (refereegranskat)abstract
- Background:Third-party cloud-based data analysis applications are proliferating in electronic health (eHealth) because of the expertise offered and their monetary advantage. However, privacy and security are critical concerns when handling sensitive medical data in the cloud. Technical advances based on “crypto magic” in privacy-preserving machine learning (ML) enable data analysis in encrypted form for maintaining confidentiality. Such privacy-enhancing technologies (PETs) could be counterintuitive to relevant stakeholders in eHealth, which could in turn hinder adoption; thus, more attention is needed on human factors for establishing trust and transparency.Objective:The aim of this study was to analyze eHealth expert stakeholders’ perspectives and the perceived tradeoffs in regard to data analysis on encrypted medical data in the cloud, and to derive user requirements for development of a privacy-preserving data analysis tool.Methods:We used semistructured interviews and report on 14 interviews with individuals having medical, technical, or research expertise in eHealth. We used thematic analysis for analyzing interview data. In addition, we conducted a workshop for eliciting requirements.Results:Our results show differences in the understanding of and in trusting the technology; caution is advised by technical experts, whereas patient safety assurances are required by medical experts. Themes were identified with general perspectives on data privacy and practices (eg, acceptance of using external services), as well as themes highlighting specific perspectives (eg, data protection drawbacks and concerns of the data analysis on encrypted data). The latter themes result in requiring assurances and conformance testing for trusting tools such as the proposed ML-based tool. Communicating privacy, and utility benefits and tradeoffs with stakeholders is essential for trust. Furthermore, stakeholders and their organizations share accountability of patient data. Finally, stakeholders stressed the importance of informing patients about the privacy of their data.Conclusions:Understanding the benefits and risks of using eHealth PETs is crucial, and collaboration among diverse stakeholders is essential. Assurances of the tool’s privacy, accuracy, and patient safety should be in place for establishing trust of ML-based PETs, especially if used in the cloud.
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| 3. |
- Alaqra, Ala Sarah, et al.
(författare)
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Using PAPAYA for eHealth – Use Case Analysis and Requirements
- 2020
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Ingår i: 2020 IEEE 33rd International Symposium on Computer-Based Medical Systems (CBMS). - : IEEE. - 9781728194295 ; , s. 437-442
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Konferensbidrag (refereegranskat)abstract
- This paper presents an eHealth use case basedon a privacy-preserving machine learning platform to detectarrhythmia developed by the PAPAYA project that can run inan untrusted domain. It discusses legal privacy and user requirementsthat we elicited for this use case from the GDPR andvia stakeholder interviews. These include requirements for securepseudonymisation schemes, for allowing also pseudonymous usersto exercise their data subjects rights, for not making diagnosticdecisions fully automatically and for assurance guarantees, conformancewith specified standards and informing clinicians andpatients about the privacy protection. The requirements are notonly relevant for our use case but also for other use cases utilisingprivacy-preserving data analytics to classify medical data.
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| 4. |
- Alaqra, Ala Sarah, et al.
(författare)
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Wearable devices and measurement data : An empirical study on ehealth and data sharing
- 2020
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Ingår i: Proceedings - IEEE Symposium on Computer-Based Medical Systems. - : Institute of Electrical and Electronics Engineers (IEEE). - 9781728194295 ; , s. 443-448
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Konferensbidrag (refereegranskat)abstract
- The development of medical applications and services is growing but is hampered by security and privacy concerns and a lack of trust by users. This interview study with 29 users of wearable devices reports perspectives on privacy concerns towards sharing of measured data in general, and measured stress data in the workplace. Participants consider stress data to be sensitive (73%), and report that privacy protection is a requirement for both the technology and the workplace. Sharing behavior is shown to be strongly coupled with clear purposes and incentives. Sharing measured fitness data is accepted (72%), and sharing stress measured data for the common good (48%), despite privacy concerns. Over half mistrust the technology not to leak data. Technology solutions should provide clear and sound purposes for storing, sharing, and processing measured data, as well as provide assurances from workplace and cloud.
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| 5. |
- Asmussen, L., et al.
(författare)
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The Experience of Healthcare Workers Following the Implementation of an IT-System in a Home for the Aged
- 2017
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Ingår i: Irish Journal of Medical Science. - : Springer. - 0021-1265 .- 1863-4362. ; 186:Suppl.4, s. S161-S161
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Tidskriftsartikel (refereegranskat)abstract
- We report on how health personnel at a home for the aged wereaffected by the introduction of an IT-system to help when nursedocumentation of patient activity and condition. The design of ITsystems for documentation by care-givers in healthcare is topicalbecause of the challenges posed by the need for high levels of safety,confidentiality and ethical responsibility. Health care staff work underextreme time-pressure including emergency situations. It is criticallyimportant to have IT-systems that are easy to use: to find informationand make records.This qualitative study utilises observation and interviews to gaindeep understanding. Observation data guide the interviews. Interviewswith nurses (10) and an IT analyst (1) are reported.Lack of time is a contributing factor as to why health personnel donot have a positive attitude to the use of IT documentation systems.Nurses feel that the lack of time does not afford them the opportunityto learn properly about the IT-system, and many of the staff haveworked with paper for over 20 years. It is also seen as a problem thatthere are many steps (clicks) before one can make a note or findinformation. One of the advantages reported with using IT-systems isthat all information is at one site. Everything is safety copied andconfidentiality is easier to secure.Using IT documentation systems facilitates the use of careplansthat are individualized for patient needs, instead treating all patientswith a particular disease, e.g. dementia, in the same way
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| 6. |
- Barry, Phelim, et al.
(författare)
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Global Virtual Team Working during the Covid-19 Pandemic
- 2023
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Ingår i: Interacting with computers. - : Oxford University Press. - 0953-5438 .- 1873-7951. ; 35:5, s. 681-690
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Tidskriftsartikel (refereegranskat)abstract
- RESEARCH HIGHLIGHTS: center dot A qualitative study of Global Virtual Teams (GVTs) and their challenges during the Covid-19 Pandemic. center dot GVT members became proactive in dealing with the challenges of 100% remote working. center dot GVTs adapt their methods of working and the tools available to them. center dot Communication failures, building trust and relationships, and resolving conflict are significant challenges. center dot Lack of informal communication opportunities adversely affects relationships in GVTs. center dot Further investigation of gender differences in attitudes and practices are prompted; and the associations between trust and conflict resolution in virtual relationships. Virtual work introduces distinct challenges when compared to face-to-face or on-site work. Communication and collaboration are key factors in team development and in team performance. When teamwork is of a global nature, imposed because of a pandemic, then additional variables are introduced into the equation. The challenges that global virtual teams (GVTs) encounter when communicating and developing in the context of the Covid-19 pandemic impacts how work is structured and teams develop. This qualitative study was conducted just over 1 year after the start of the Covid-19 pandemic when working from home became mandatory and particular challenges for GVTs became apparent. Data are gathered through an online anonymous survey and followed by semi-structured video-mediated interviews with staff in a large multinational software development company. Findings show that GVTs encounter a number of distinct challenges than face-to-face teams. However, individuals are actively adapting to the situation in which they find themselves and are learning to deal with the challenges by being proactive. Even though the tools used previously may not be entirely suitable for virtual work, GVTs learn to change how tools are used to be more productive and collaborative. Challenges continue to exist in areas, such as knowledge gathering and knowledge sharing. Communication failures can lead to delays and confusion. The findings also indicate that even though GVTs are not communicating as much informally or socially with their colleagues because of remote working in the pandemic, being remote is not having a negative effect on the ability to get work done. Some aspects of team development can be negatively affected when working in GVTs. Impacts are identified relating to trust and relationship building, as well as being able to identify and resolve conflict. These results prompt further research opportunities as organizations and individuals continue to adapt and embrace global virtual teamwork.
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| 7. |
- Bjerkan, Jorunn, et al.
(författare)
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Citizen-Patient Involvement in the Development of mHealth Technology : Protocol for a Systematic Scoping Review
- 2020
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Ingår i: JMIR Research Protocols. - : JMIR PUBLICATIONS. - 1929-0748. ; 9:8
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Forskningsöversikt (refereegranskat)abstract
- Background: The development of mobile technology for information retrieval and communication, both at individual and health organizational levels, has been extensive over the last decade. Mobile health (mHealth) technology is rapidly adapting to the health care service contexts to improve treatment, care, and effectiveness in health care services. Objective: The overall aim of this scoping review is to explore the role of citizen-patient involvement in the development of mHealth technology in order to inform future interventions. By identifying key characteristics of citizen-patient involvement in system development, we aim to improve digital communication and collaboration between health care providers and citizen-patients, including sharing of health care data. Methods: The systematic scoping review will follow the Joanna Briggs Institute methodology for scoping reviews by searching literature in 3 steps. We will include literature reporting on the public, citizens, and patients participating in the development of mobile technology for health care purposes in MEDLINE, CINAHL, Scopus, EMBASE, and ProQuest Dissertations and Theses. A preliminary search was completed in MEDLINE and Scopus. The screening process will be conducted by 2 of the authors. Data will be extracted using a data extraction tool prepared for the study. Results: The study is expected to identify research gaps that will inform and motivate the development of mHealth technology. The final report is planned for submission to an indexed journal in November 2020. Conclusions: To our knowledge, this review will be the first review to provide knowledge about how citizen-patients participate in system developments for mHealth tools and the value that such involvement adds to the system development process.
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| 8. |
- Bärkås, Annika, et al.
(författare)
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Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients : Results from a Nationwide Survey in Sweden
- 2023
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. OBJECTIVE: The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. METHODS: Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. RESULTS: Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were "very important," but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups. CONCLUSIONS: About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records.
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