| 1. |
- Grünloh, Christiane, et al.
(författare)
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Patient Empowerment Meets Concerns for Patients : a Study of Patient Accessible Electronic Health Records in Sweden
- 2016
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Ingår i: Exploring Complexity in Health. - : IOS Press. - 9781614996774 - 9781614996781
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Konferensbidrag (refereegranskat)abstract
- BackgroundAs part of a EU project, the Swedish county Uppsala launched a patient portal, Journalen in 2012 [1]. Patients can now access their Electronic Health Records (EHR) online, which is aimed to increase patient empowerment. The medical professionals reacted strongly on patients accessing the medical records. Main concerns were related to quality of care, the effect on their work environment, providing bad news through the eHealth service, and also the wellbeing of patients. While the opportunities of implementing these e-health services seem promising, the concerns of the medical professionals have to be understood and addressed, as well as the actual use of the system by patients. This presentation integrates results from two interview studies with physicians and patients related to patients accessing their medical records online [2,3].MethodThe presented results are synthesis of the interviews studies with 12 physicians [2] and 30 patients [3], which took place about 6–12 months after the launch of the portal. The synthesis presented in this paper focus on Technological Frames [4] of physicians and patients including the attitudes and experiences in relation to possible (1) anxiety creation, (2) increased of workload, and (3) the general value of patients reading medical records.Results Anxiety creation due to receiving bad news. Many physicians believe that breaking bad news to patients during a patient encounter is vital as this would give them the possibility to also explain treat- ments and answer questions. Somewhat unexpectedly, some patients preferred receiving bad news through Journalen instead of waiting for the physicians. The patients argue that waiting times causes more anxiety. The choice of not accessing is also important, as there are patients who do not want to receive bad news before a patient encounter. Workload increases. Many physicians are worried about the work- load of doctors, as reading the medical record online may result in increased number of phone calls because of anxious patients. However, many patients did not tend to take any additional contacts to ask questions. Some of the patients even believe that access to their medical records reduces the number of contacts with healthcare. Usefulness of accessing online. Many physicians are concerned that online access will have a negative impact on the patient such as increased anxiety and misconceptions as they lack understanding of medical terms. Unlike the doctors’ perspective, many patients argue that they do not have major difficulties in understanding the contents. They also argue that Journalen was central to their coping with their decease.Conclusion From this study it is clear that the Technological Frames of physicians differ from those of patients, and that they have different attitudes and experiences towards the system. The intention from the politicians was that the system would contribute to Patient Empowerment, but that framing of the technology differs from the physicians’ view, as they are concerned of the consequences. More research is needed on the framing of the technology and how that has been changed after the launch of the system.[1] Erlingsdottir, G., Lindholm, C. When patient empowerment encounters professional autonomy: The conflict and negotiation process of inscribing an eHealth service. Scandinavian journal of public administration 2015;19(29):27- 48.[2] Grünloh, C., Cajander, Å., Myreteg, G., “The Record is our Work Tool!” - Physicians’ Framing of a Patient Portal in Sweden. J Med Internet Res (submitted).[3] Rexhepi, H., Åhlfeldt, R.-M., Cajander, Å, & Huvila, I. (2015). Cancer Patients’ Attitudes and Experiences of Online Medical Records, 1–8. Proceedings of the 17th International Symposium on Health Information Management Research ISHIMR 2015.[4] Orlikowski, W.J., Gash, D.C. Technological Frames: Making sense of information technology in organizations. Transactions on Information Systems 1994;12(2):174–207. doi: 10.1145/196734.196745
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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. |
- 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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| 4. |
- Myreteg, Gunilla, 1968-, et al.
(författare)
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Affärssystem för verksamhetsutveckling
- 2013. - 10
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Ingår i: Controllerhandboken. - Stockholm : Liber. - 9789147099085 ; , s. 471-504
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Myreteg, Gunilla, 1968-, et al.
(författare)
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Affärssystem för verksamhetsutveckling
- 2018. - 11
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Ingår i: Controllerhandboken. - Stockholm : Liber. - 9789147127016 ; , s. 515-547
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Controllerns roll är att se till att information om resurser och resultat speglar vad som är viktigt i en verksamhet, att den når fram dit den bör och kan påverka tankar och handlingar. I dag finns controllers i alla branscher, från offentlig verksamhet till mindre företag. Controllerns arbete måste därför i allt högre grad anpassas till skiftande förutsättningar. Controllerhandboken är en heltäckande handbok i hur man kan utforma och använda ekonomistyrningen inom olika organisationer, oavsett bransch och sektor. Fokus ligger på hur bokens verktygslåda av metoder och modeller kan tillämpas på ett situationsanpassat sätt.I denna elfte upplaga finns nya kapitel om prissättning, internpriser och riskhantering. Nya författare har bidragit vid revideringen av befintliga kapitel, och de som medverkar sedan tidigare har aktualiserat sina kapitel. Redaktörernas inledningar och inramande kapitel gör att boken även går att läsa som en sammanhängande lärobok.
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| 6. |
- 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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Forskningsöversikt (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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| 7. |
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| 8. |
- 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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| 9. |
- Myreteg, Gunilla, 1968-
(författare)
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Förändringens vindar : En studie om aktörsgrupper och konsten att välja och införa ett affärssystem
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Management accounting is performed with the support of enterprise resource planning (ERP) systems. Because of their integrated design and use of joint databases, such systems are often said to present companies with various opportunities for improving operations. In practice, however, difficulties have been encountered in attempting to realize these promised opportunities. Research into the ERP implementation process has explained these problems in terms of a tendency of companies to preserve the status quo instead of realizing change, or as representing the unintended consequences of ERP implementation. However, existing studies are limited in several respects. They define the implementation process as separate, unconnected to the process by which the ERP system was evaluated and chosen in the first place. Furthermore, they limit the process by analyzing it in terms of norms and rules, or power, or as solely cognitive, instead of defining it as complex, comprising all these dimensions at once. A final limitation is that the organization is often defined as a harmonious unit, lacking internal conflict or opposition; if internal conflict is taken into account, it is considered to occur only between different professions in the company, for example, production staff as opposed to accountants. These limitations constrain our knowledge of management accounting change in the setting of ERP systems. The objective of this empirical study is to enhance our knowledge of how a company – consisting of actor groups having different interests and purposes – chooses and implements an ERP system. The study defines this as a structuration process, with a duality between structure and action. Change and stability are co-existent. Social structures are defined as three-dimensional structures in which participation, images of IT systems, and conceptions of IT use as norms are simultaneously present in agency (i.e., speech and behaviour). The actor groups are defined as secondary groups, formal relationships existing between their members. The objective of the study is to create a deeper understanding of how social structures influence the process. A longitudinal case study examined a manufacturer having three distinct business areas. Material was collected mainly through interviews and observation, by also by examining documentation. The use of an abductive approach, aiming to improve theory, resulted in a detailed proposal as to how to operationalize the three modalities of the structuration model. The search for deeper knowledge resulted in the identification of six actor groups and several propositions as to how social structures influence the process. The concepts of uncertainty and practical experience were found to be especially important.
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| 10. |
- Myreteg, Gunilla, 1968-
(författare)
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Organizational Learning and ERP systems in the post-implementation phase : Where do we stand? A literature review
- 2015
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Ingår i: Electronic Journal of Information Systems Evaluation. - : Academic Conferences and Publishing International Limited. - 1566-6379. ; 18:2, s. 119-128
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Forskningsöversikt (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 in the post-implementation phase between the years 2005-2015. A total number of 18 research articles were identified. 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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