| 1. |
- Ammenwerth, Elske, et al.
(författare)
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International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study
- 2020
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Ingår i: Methods of Information in Medicine. - : Georg Thieme Verlag KG. - 0026-1270 .- 2511-705X. ; 59:S2, s. e46-e63
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Tidskriftsartikel (refereegranskat)abstract
- Background Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare. Objectives This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country. Methods The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators. Results Availability of patient-related information varies strongly by country. Health care professionals can access patients most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden. Conclusion Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.
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| 2. |
- Davoody, Nadia, et al.
(författare)
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Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform : a case study
- 2019
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Patients and citizens need access to their health information to get a retrospective as well as a prospective view on their care and rehabilitation processes. However, patients' health information is stored in several health information systems and interoperability problems often hamper accessibility. In Sweden a national health information exchange (HIE) platform has been developed that enables information exchange between different health information systems. The aim of this study is to explore the opportunities and limitations of accessing and interacting with important health information through the Swedish national HIE platform.METHODS:A single case study approach was used for this study as an in-depth understanding of the subject was needed. A fictive patient case with a pseudo-name was created based on an interview with a stroke coordinator in Stockholm County. Information access through the national health information exchange platform and available service contracts and application programming interfaces were studied using different scenarios.RESULTS:Based on the scenarios created in this study, patients would be able to access some health related information from their electronic health records using the national health information exchange platform. However, there is necessary information which is not retrievable as it is either stored in electronic health records and eHealth services which are not connected to the national health information exchange platform or there is no service contract developed for these types of information. In addition, patients are not able to share information with healthcare professionals.CONCLUSION:The national Swedish HIE platform provides the building blocks needed to allow patients online access to their health information in a fragmented and distributed health system. However, more complex interaction scenarios allowing patients to communicate with their health care providers or to update their health related information are not yet supported. Therefore it is of great importance to involve patients throughout the design and evaluation of eHealth services on both national and local levels to ensure that their needs for interoperability and information exchange are met.
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| 3. |
- Davoody, Nadia, et al.
(författare)
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Collaborative interaction points in post-discharge stroke care.
- 2014
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Ingår i: International Journal of Integrated Care. - : Ubiquity Press, Ltd.. - 1568-4156 .- 1568-4156. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Lack of appropriate electronic tools for supporting patient involvement and collaboration with care professionals is a problem in health care.METHODS: Care and rehabilitation processes of post-discharge stroke patients were analysed using the concept of interaction points where patients, next-of-kin and care professionals interact and exchange information. Thirteen interviews with care professionals and five non-participatory observations were performed. Data were analysed using content analysis and modelling of interaction points in the patient journey.RESULTS: Patient participation and interaction patterns vary; patients requiring home care have a passive role and next-of-kin or nurses become advocates by coordinating care on behalf of the patient, whereas patients who are able to visit primary care coordinate their own care by initiating interactions. Important categories of participation include the following: participation in care planning, in monitoring risk factors and in rehabilitation planning.CONCLUSIONS: Designing a supportive electronic tool requires understanding the interactions and patients' activity levels at each interaction point. A tool for patients with higher activity level should support them to coordinate their own care, whereas for a less-active patient group, the tool could focus on supporting next-of-kin and care professionals in motivating, guiding and including passive patients in their care and rehabilitation processes.
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| 4. |
- Davoody, Nadia, et al.
(författare)
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Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia : Usability Study
- 2023
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Ingår i: JMIR Human Factors. - 2292-9495. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. Objective: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. Methods: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. Results: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients’ disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. Conclusions: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group.
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| 5. |
- Davoody, Nadia, et al.
(författare)
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Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services.
- 2016
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients' information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes.METHODS: Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients' information needs was explored using patient journey model.RESULTS: Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients' post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients' journeys.CONCLUSIONS: Patient journey models and qualitative analysis of patients' information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients' understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients' information needs, it is imperative to understand the current care and rehabilitation processes and identify patients' information needs throughout their journey.
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| 6. |
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| 7. |
- Department of Computer and Information Science (IDA) Linköpings Universitet, SE - 581 83 Linköping, Sweden, Vivian, et al.
(författare)
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Organizational effects of the use of information and communication technology (ICT) in elderly homecare : a case study
- 2008
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Ingår i: Health Informatics Journal. - : Sage Publications. - 1460-4582 .- 1741-2811. ; 14:3, s. 195-209
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Tidskriftsartikel (refereegranskat)abstract
- The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users' involvement and commitment, stimulating them to test and improve the prototype until the final version.
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| 8. |
- Edman, Anneli, et al.
(författare)
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A Web-based User Adaptive Learning Environment
- 2000
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Ingår i: Proceedings in form of a CD. - : SSGRR 2000 computer and business conference.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- We present a design structure for constructing web based user adaptive learning environments. Currently the web offers huge amounts of unstructured information but no facilities for exploiting this in a problem solving situation. Our aim is to gather and
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| 9. |
- Engström, Maria, 1966-, et al.
(författare)
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Evaluation of OLD@HOME virtual health record : staff opinions of the system and satisfaction with work
- 2009
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Ingår i: Telemedicine journal and e-health. - : Mary Ann Liebert Inc. - 1530-5627 .- 1556-3669. ; 15:1, s. 53-61
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present research was to study outcomes of use of the OLD@HOME Virtual Health Record with regard to staff opinions about information, communication technology, and satisfaction with work. A quasi-experimental design was used. Staff opinions about the information and communication technology were assessed using a study-specific questionnaire at the test site (n =22) and at other settings in the municipality (n =172). Staff (n =22) job satisfaction, perceived quality of care, and psychosomatic health were assessed using the Satisfaction with Work Questionnaires before and after a 5-month period of testing the technology in an intervention and a comparison group. Staff opinions about the information and communication technology were significantly more positive at the test site compared to other settings in the municipality. For the total scale of quality of care and the factor documentation, there were significant differences in change scores between intervention and comparison groups, with improvements for the comparison group. For job satisfaction and psychosomatic health, there were no differences in change scores between the groups. Participatory design enhances staff opinions about information and communication technology. However, a 5-month test period showed no benefits regarding staff satisfaction with work when compared to a comparison group. On the contrary, the comparison group improved in documentation, and for the intervention group, there was a trend toward deterioration, which may be due to their knowing how to document, but not having time when using both paper-based and electronic systems.
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| 10. |
- Erlandson, Björn-Erik, et al.
(författare)
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eHälsa – Framtidsvision eller Verklighet?
- 2005
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Ingår i: Svenska Läkarsällskapets Riksstämma, 2005.
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Konferensbidrag (refereegranskat)abstract
- eHälsa – Framtidsvision eller Verklighet?Sabine Koch, Björn-Erik ErlandsonBakgrund:Sverige står, som de flesta länder i västvärlden, inför ett antal problem för framtidens hälso- och sjukvård/vård och omsorg:- ökning av antalet äldre och ökande incidens av kroniska sjukdomar beroende på förändrade livsstilar- alltmer decentraliserad sjukvård inkl. hemsjukvård i syfte att avlasta den slutna vården- krav på högre effektivitet och kvalitet i vård och omsorg trots begränsade ekonomiska resurser- problem med att rekrytera och behålla personal i framtiden.Inom hälso- och sjukvården har man sedan länge använt begreppen telemedicin. Enligt WHO definieras Telemedicin som ”Utövande av hälso- och sjukvård genom att använda interaktiv kommunikation av ljud, bild och data. Detta inkluderar diagnos, konsultation och behandling såväl som utbildning och överföring av medicinska data”. Under den senaste tiden har begreppet eHälsa eller eHealth etablerats samtidigt som begreppet får alltmera tyngd med tanke på europeiska satsningar som “e-Europe – An Information Society for All”. e-Europe är ett politiskt initiativ vars mål är att kommande generationer inom Europeiska unionen skall kunna dra nytta av de förändringar som informationssamhället för med sig. e-Hälsa är ett starkt interdisciplinärt område som knyta ihop olika kompetenser för att bli framgångsrikt bl. a: Medicin och vårdvetenskap, Medicinsk informatik och teknik, Kognitionspsykologi och beteendevetenskap, Sociologi, Ekonomi, Etik och Juridik.Metod:Områden för eHälsa omfattar både metoder och system för hälso- och sjukvårdspersonal och för patienter och anhöriga. En trend kan ses från att utveckla system för att stödja personalen i att utöva vård till att stödja patientens egenvård samt att använda eHälsa i sjukdomsförebyggande syfte.Resultat:Några eHälsa projekt har utvecklats i Uppsala och dessa syftar till att öka patientmedverkan, att förbättra informationsförsörjning mellan professionen och att stödja anhöriga. Ett projekt, Webtjänst för diabetespatienter, framtagen utifrån patientens behov och testad av patienter, läkare och sjuksköterskor under en 5 månaders testperiod (http://www.medsci.uu.se/mie/project/dino). Ett annat projekt handlar om webbaserade stödsystem som hjälper personer med kognitiva funktionshinder att sköta sin vardag på ett bättre sätt och ett tredje projekt syftar till att förbättra informationsöverföring mellan olika yrkesgrupper och informationsförsörjning för vårdtagare och anhöriga tekniker inom äldreomsorg och hemsjukvård (http://www.medsci.uu.se/mie/project/closecare).Sammanfattning:Många bra utvecklingar har gjorts inom områden som elektroniska patientjournaler, informationssystem, elektroniska kort, patientövervakning, telemedicin m fl. Nationella samordningsinitiativ är på gång på olika områden. Ändå finns det många relativt isolerade system och ännu fler utvecklingsprojekt vars spridning till fler verksamheter saknas. Huvudorsakerna till det är bristande interoperabilitet, otillräcklig acceptans samt legala, ekonomiska och organisatoriska hinder. Även om många tekniska problem är lösta idag, återstår dock konsekventa utvärderingar, effektstudier och nyttoanalyser ur olika perspektiv. Allt viktigare frågor blir också patientsäkerhet och etik. Även om eHälsa är inte en ren framtidsvision längre är frågan hur mycket av den teknologin som är möjligt vi vill ha?
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| 11. |
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| 12. |
- Grünloh, Christiane
(författare)
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To Share or Not to Share? : Expectations of and Experiences with eHealth Services that Allow Users Access to their Health Information
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates expectations of and experiences with eHealth services that allow users access to their health information. Although eHealth services are endorsed by many politicians and patients, they are met with strong resistance by health care professionals. Lacking this support hinders the uptake of the full potential of the service, especially with relation to patient participation and empowerment.This research investigates the frames of reference that are constructed by stakeholders in relation to eHealth services, such as direct-to-consumer genetic testing and electronic health records. The results are based on empirical data gathered during an experiment with media informatics students in Germany, and from interviews with physicians in Uppsala, Sweden.The eHealth services in question were framed by the participants of the conducted studies as potentially harmful for its users. The negative expectations were based mainly on a generalized view of patients as not sufficiently knowledgable and hence unable to understand the health information provided by the service. The participants in the reported studies (physicians and students in their role as designers) felt a responsibility to prevent any potential harm for the users of the eHealth service. Due to the framing based on assumed negative consequences for a supposedly vulnerable user group, the participants preferred to advocate against access rather than for patient empowerment and participation. Accessing health information was associated as holding little value for the users.This research enhances the understanding of the elements underlying this skepticism and concern. It shows that a specific view of patients and/or prospective users of an eHealth system can result in incongruent technological frames and value attribution. In line with participatory and value-sensitive design approaches as well as the aim to increase technology acceptance, patients and health care professionals should not only be included in the design process but also engage in joint activities in order to enable reframing.
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| 13. |
- Hoffmann, Mikael, et al.
(författare)
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Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems : report by an international expert workshop at Karolinska Institutet
- 2020
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Ingår i: Expert Review of Clinical Pharmacology. - : Taylor & Francis. - 1751-2433 .- 1751-2441. ; 13:9, s. 925-934
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap. Areas covered The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed. Expert opinion Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.
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| 14. |
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| 15. |
- Hyppönen, Hannele, et al.
(författare)
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Nordic eHealth Indicators: Organisation of research, first results and plan for the future.
- 2013
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Ingår i: Medinfo 2013. - Netherländerna : IOS Press. - 9781614992882 ; , s. 273-277
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Konferensbidrag (refereegranskat)abstract
- eHealth indicator and benchmarking activities are rapidly increasing nationally and internationally. The work is rarely based on a transparent methodology for indicator definition. This article describes first results of testing an indicator methodology for defining eHealth indicators, which was reported at the Medical Informatics Europe conference in 2012. The core elements of the methodology are illustrated, demonstrating validation of each of them in the context of Nordic eHealth Indicator work. Validation proved the importance of conducting each of the steps of the methodology, with several scientific as well as practical outcomes. The article is based on a report to be published by the Nordic Council of Ministers.
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| 16. |
- Hypönnen, Hannele, et al.
(författare)
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Nordic eHealth Benchmarking
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The report presents results of the Nordic eHealth Research Network, a subgroup of the eNordic Council of Ministers Health group. The network defined and collected data for altogether 49 common eHealth indicators from the Nordic Countries. Health information was quite comprehensively electronically available from other organisations in all the Nordic countries by end of 2014. Intensity of use of nationally stored data remained low except in Denmark. Sweden had best availability of the Patient portal functionalities. Patients used patient portal functionalities rarely except in Denmark. Doctors in Iceland had most positive experiences of their health information systems. Even with limitations, the current work presents a solid basis for working towards the goal of the eHealth network: generating comparable information to support development of Nordic welfare.
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| 17. |
- Hägglund, Maria, et al.
(författare)
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A New Approach for Goal-oriented Analysis of Healthcare Processes
- 2010
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Ingår i: World Congress on Medical and Health Informatics (Medinfo'10). - : IOS Press. ; 160:Pt 2, s. 1251-5
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The development of efficient e-services for patient-centered healthcare requires insight into concrete problems in administrative and clinical work processes as well as an understanding of the strategic goals that should guide these healthcare processes. However, considering both concrete process-related problems and high-level strategic goals during process analysis and solution design can be proble-matic. To address this, we propose a structured approach for analyzing both high- and low-level goals in a healthcare process and relating these to identified problems. Thereby proposed solutions for each problem in form of, e.g. e-services can be connected to strategic goals. The approach consists of five steps; process modeling; process-based problem identification and classification; process goal identification; mapping to strategic goals; and solution pro-posal. The approach is illustrated by examples from a case study of Swedish stroke care. In conclusion, the approach enables analysis of high- and low-level goals in a healthcare process by relating these to identified problems. The results thereof form a basis for redefinition of current care processes, as well as for design of supporting e-health solu-tions.
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| 18. |
- Hägglund, Maria, et al.
(författare)
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Bridging the gap : a virtual health record for integrated home care
- 2007
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Ingår i: International Journal of Integrated Care. - : Ubiquity Press, Ltd.. - 1568-4156 .- 1568-4156. ; 7:June, s. e26-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The coexistence of different information systems that are unable to communicate is a persistent problem in healthcare and in integrated home care in particular. THEORY AND METHODS: Physically federated integration is used for design of the underlying technical architecture to implement a mobile virtual health record for integrated home care. A user centered system development approach is followed during design and development of the system. RESULTS: A technical platform based on a service-oriented approach where database functionality and services are separated has been developed. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardized way. A physically federated integration enables point-of-care documentation, integrated presentation of information from different feeder systems, and offline access to data on handheld devices. Feeder systems deliver information in XML-files that are mapped against an ideal XML schema, published as an interface for integration with the information broker, and inserted into the mediator database. CONCLUSIONS: A seamless flow of information between both different care professionals involved in integrated home care and patients and relatives is provided through mobile information access and interaction with different feeder systems using the virtual health record.
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| 19. |
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| 20. |
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| 21. |
- Hägglund, Maria, et al.
(författare)
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Experiences as input to eHealth design - a hip surgery patient journey case.
- 2015
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Ingår i: Studies in health technology and informatics. - 1879-8365. ; 210, s. 672-4
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Konferensbidrag (refereegranskat)abstract
- The objective of the study is to describe the planned hip-surgery care process as experienced by patients and healthcare professionals, as well as a qualitative analysis of problems. Data was collected through 3 focus group meetings with patients and healthcare professionals. We present the results in form of a patient journey model, examples of problems as expressed by patients and examples of proposed eHealth services by both patients and care professionals. The results indicate that although the patient journey is similar for most patients, their experiences are highly individual and designing eHealth to improve the patient journey will require flexibility and adaptability to the individual's needs.
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| 22. |
- Hägglund, Maria, et al.
(författare)
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Integrated Care Plan for Shared Home Care : the technical architecture
- 2005
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Ingår i: Journal on Information Technology in Healthcare. - Wallington : Optimum. - 1479-649X. ; 3:5, s. 287-294
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Tidskriftsartikel (refereegranskat)abstract
- The move towards decentralising healthcare services from traditional care settings towards home care has produced new requirements for care planning and documentation of procedures performed in the home environment. To meet these requirements, a virtual care plan (VCP) has been developed that gives both district nurses and home help service personnel (HHS) access to their respective care plans in a mobile work situation. In this paper we present the technical architecture of this VCP, and describe how it integrates information from different feeder systems and allows for documentation at the point of care (POC) using mobile devices.
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| 23. |
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| 24. |
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| 25. |
- Hägglund, Maria, et al.
(författare)
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Integration architecture of a mobile virtual health record for shared home care
- 2005
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Ingår i: Connecting Medical Informatics and Bio-Informatics. - : IOS Press. - 9781586035495 - 9781607501350 ; , s. 340-345
-
Bokkapitel (refereegranskat)abstract
- The coexistence of different information systems that are unable to communicate with each other is a persistent problem in health care in general, and in shared care in particular. This is especially critical when it comes to information access needed at the point of care, e.g. in the patients home. The purpose of this paper is to present the technical architecture of a virtual health record (VHR) that both integrates information from different electronic health records (EHRs) and allows for documenting at the point of care using mobile devices. The VHR supports a seamless information and communication flow between different care providers giving them mobile access to selected patient-oriented information. A service oriented system architecture where database functionality and services are separated has been implemented. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardised way. Major requirements for the VHR have been documentation support at the point of care, integrated presentation of the information from different feeder systems, and the possibility of offline access to the data on handheld devices. Therefore, publishing was chosen for the integration design. A patient centred XML schema is published as an interface for integration with the information broker. The feeder systems deliver their information in XML.-files that are mapped against the ideal schema and inserted into the mediator database. The paper describes both an online web application and an offline solution that was implemented on personal digital assistants (PDAs). The system has been introduced in a Swedish home care district with an established fiber-optical network infrastructure connecting all the locations forming the study site.
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| 26. |
- Hägglund, Maria, et al.
(författare)
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Living with Lung Cancer--Patients' Experiences as Input to eHealth Service Design.
- 2015
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Ingår i: Studies in health technology and informatics. - 1879-8365. ; 216, s. 391-5
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Konferensbidrag (refereegranskat)abstract
- The objective of the study is to describe the lung cancer care process as experienced by patients, as well as to perform a qualitative analysis of problems they encounter throughout the patient journey. A user-centered design approach was used and data collected through two focus group meetings with patients. We present the results in the form of a patient journey model, descriptions of problems related to the journey as expressed by patients and proposed eHealth services discussed by patients in the focus groups. The results indicate that not only is the patient journey fragmented and different for each patient going through it depending upon their specific type of lung cancer and treatment options, but their experiences are also highly individual and dependent on their personal needs and interpretations of the process. Designing eHealth to improve the patient journey will therefore require flexibility and adaptability to the individual's needs.
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| 27. |
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| 28. |
- Hägglund, Maria, et al.
(författare)
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Modeling shared care plans using CONTsys and openEHR to support shared homecare of the elderly.
- 2011
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - : Oxford University Press (OUP). - 1067-5027 .- 1527-974X. ; 18:1, s. 66-9
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Tidskriftsartikel (refereegranskat)abstract
- This case report describes how two complementary standards, CONTsys (European Standard EN 13940-1 for continuity of care) and the reference model of openEHR, were applied in modeling a shared care plan for shared homecare based on requirements from the OLD@HOME project. Our study shows that these requirements are matched by CONTsys on a general level. However, certain attributes are not explicit in CONTsys, for example agents responsible for performing planned interventions, and support for monitoring outcome of interventions. We further studied how the care plan conceptual model can be implemented using the openEHR reference model. The study demonstrates the feasibility of developing shared care plans combining a standard concept model, for example CONTsys with an electronic health records (EHR) interoperability specification, that is the openEHR, while highlighting areas that need further exploration. It also explores the reusability of existing clinical archetypes as building blocks of care plans and the modeling of new shared care plan archetypes.
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| 29. |
- Hägglund, Maria, et al.
(författare)
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Scenarios to Capture Work Processes in Shared Home Care – from analysis to application
- 2010
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 79:6, s. 126-134
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundShared homecare is increasingly common, and in order to develop ICT that support such complex cooperative and interdisciplinary work it is crucial to obtain an understanding of work processes at the clinical level before the development is initiated. It is also crucial, but difficult, to correctly transfer this insight to the development team.MethodUser-centered scenario building in interdisciplinary working groups is applied for capturing cooperative work routines, information demands, and other central preconditions in shared homecare.ResultsUse of scenarios for analysis of cooperative work and as information carrier is described via a case from the multi-disciplinary OLD@HOME project. Both current and future work scenarios were elicited. To illustrate the process of transforming scenarios into more technical descriptions (use cases), and finally into an application, examples showing the transparency in resulting use cases and in the implemented system are provided.ConclusionIn this case study, scenarios proved to be useful not only in initial system development phases but throughout the entire development process, improving accessibility and assessment of end user needs. For the development team, scenarios assisted in solving usability issues, and served as a basis for describing use cases and for further system development. More importantly, the shared care scenarios ensured the provision of different perspectives on common work processes, which are often neglected in conventional requirements specifications. This also improved understanding between different clinical groups and between clinicians and developers.
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| 30. |
- Hägglund, Maria, Lektor, 1975-
(författare)
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Sharing is Caring : Integrating Health Information Systems to Support Patient-Centred Shared Homecare
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives.The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare.An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts.In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need.
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| 31. |
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| 32. |
- Hägglund, Maria, et al.
(författare)
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User-centred deployment process for ICT in health care teams : experiences from the OLD@HOME project
- 2006
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Ingår i: Ubiquity - Technologies for Better Health in Aging Societies. - : IOS Press. - 9781586036478 - 9781607501923 ; , s. 167-172
-
Bokkapitel (refereegranskat)abstract
- Objective: To present a user-centred method for introducing ICT in health care organisations, taking factors that influence acceptance into account.Methods: User centred methods are used in combination with previous research regarding factors that affect user acceptance, in order to facilitate users' acceptance of new ICT tools.Results: A method is presented that supports the introduction of ICT in team work. The method consists of three major steps; (1) the start-up seminar, (2) end user education and (3) continuous follow-up during the deployment phase. Important results of the start-up seminar are documentation of the users' expectations, and an agreement of ground rules that supports both the social norm factor and the users' perceived behavioural control. Education and follow-up also improve perceived behavioural control, and by involving super users perceived usefulness and ease of use can be improved through subjective norm.Conclusion: Key factors in the deployment process are; user participation, end user experience and education, and continuous follow-up of the process.
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| 33. |
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| 34. |
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| 35. |
- Hägglund, Maria, Lektor, 1975-, et al.
(författare)
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Världsbäst på eHälsa kräver internationellt samarbete
- 2017
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Ingår i: Svenska dagbladet. - Stockholm, Sweden : Svenska Dagbladet AB & Co.. - 1101-2412.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Det är glädjande att myndigheter nu äntligen tittar mer på internationellt delade detaljerade dokumentationsmodeller för innehåll i journaler. Vi hoppas att de ger tillräckligt kraftfulla och tydliga budskap så att de upphandlande vårdgivarna också ser vikten av detta. Om vi ska bli världsbäst på eHälsa krävs internationellt samarbete, skriver flera forskare i medicinsk informatik.
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| 36. |
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| 37. |
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| 38. |
- Kabukye, Johnblack K, et al.
(författare)
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User Requirements for an Electronic Medical Records System for Oncology in Developing Countries : A Case Study of Uganda.
- 2017
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Ingår i: AMIA ... Annual Symposium proceedings. AMIA Symposium. - 1942-597X. ; 2017, s. 1004-1013
-
Konferensbidrag (refereegranskat)abstract
- Cancer is a major public health challenge in developing countries but the healthcare systems are not well prepared to deal with the epidemic. Health information technologies such as electronic medical records (EMRs) have the potential to improve cancer care yet their adoption remains low, in part due to EMR systems not meeting user requirements. This study aimed at analyzing the user requirements for an EMR for a cancer hospital in Uganda. A user-centered approach was taken, through focus group discussion and interviews with target end users to analyze workflow, challenges and wishes. Findings highlight the uniqueness of oncology in low-resource settings and the requirements including support for oncology-specific documentation, reuse of data for research and reporting, assistance with care coordination, computerized clinical decision support, and the need to meet the constraints in terms of technological infrastructure, stretched healthcare workforce and flexibility to allow variations and exceptions.
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| 39. |
- Keuter, Sabine, et al.
(författare)
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Some like it cold : the cellular organization and physiological limits of cold-tolerant nitrite-oxidizing Nitrotoga
- 2022
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Ingår i: Environmental Microbiology. - : John Wiley & Sons. - 1462-2912 .- 1462-2920. ; 24:4, s. 2059-2077
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Tidskriftsartikel (refereegranskat)abstract
- Chemolithoautotrophic production of nitrate is accomplished by the polyphyletic functional group of nitrite-oxidizing bacteria (NOB). A widely distributed and important NOB clade in nitrogen removal processes at low temperatures is Nitrotoga, which however remains understudied due to the scarcity of cultivated representatives. Here, we present physiological, ultrastructural and genomic features of Nitrotoga strains from various habitats, including the first marine species enriched from an aquaculture system. Immunocytochemical analyses localized the nitrite-oxidizing enzyme machinery in the wide irregularly shaped periplasm, apparently without contact to the cytoplasmic membrane, confirming previous genomic data suggesting a soluble nature. Interestingly, in two strains we also observed multicellular complexes with a shared periplasmic space, which seem to form through incomplete cell division and might enhance fitness or survival. Physiological tests revealed differing tolerance limits towards dissolved inorganic nitrogen concentrations and confirmed the generally psychrotolerant nature of the genus. Moreover, comparative analysis of 15 Nitrotoga genomes showed, e.g. a unique gene repertoire of the marine strain that could be advantageous in its natural habitat and confirmed the lack of genes for assimilatory nitrite reduction in a strain found to require ammonium for growth. Overall, these novel insights largely broaden our knowledge of Nitrotoga and elucidate the metabolic variability, physiological limits and thus potential ecological roles of this group of nitrite oxidizers.
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| 40. |
- Klionsky, Daniel J., et al.
(författare)
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Guidelines for the use and interpretation of assays for monitoring autophagy
- 2012
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Ingår i: Autophagy. - : Informa UK Limited. - 1554-8635 .- 1554-8627. ; 8:4, s. 445-544
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Forskningsöversikt (refereegranskat)abstract
- In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. A key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process vs. those that measure flux through the autophagy pathway (i.e., the complete process); thus, a block in macroautophagy that results in autophagosome accumulation needs to be differentiated from stimuli that result in increased autophagic activity, defined as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (in most higher eukaryotes and some protists such as Dictyostelium) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the field understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused on these processes. These guidelines are not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to monitor autophagy. In these guidelines, we consider these various methods of assessing autophagy and what information can, or cannot, be obtained from them. Finally, by discussing the merits and limits of particular autophagy assays, we hope to encourage technical innovation in the field.
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| 41. |
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| 42. |
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| 43. |
- Koch, Sabine, et al.
(författare)
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Controlled Diagnosis-Oriented Enhancement of Automatically Segmented Radiographs in Dentistry
- 1998
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Ingår i: Computer Methods and Programs in Biomedicine. - 0169-2607 .- 1872-7565. ; 57:1-2, s. 125-131
-
Tidskriftsartikel (refereegranskat)abstract
- A method for controlled diagnosis-oriented enhancement of selected regions of interest in intraoral radiographs is presented. Image enhancement is accomplished by adaptive non-linear grey scale transformation depending on the result of objective quality measurement. In order to assure reliable image duality measurement as well as controlled image enhancement, automatic image segmentation is applied to avoid the influence of disturbing factors (e.g. metallic restorations) on quality measurement and image enhancement. Based on existing a-priori knowledge about object structure and composition of the selected regions of interest in intraoral radiographs, different image segmentation algorithms and image enhancement procedures were developed for different types of diagnosis. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.
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| 44. |
- Koch, Sabine, et al.
(författare)
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Critical advances in bridging personal health informatics and clinical informatics
- 2012
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Ingår i: IMIA Yearbook of Medical Informatics. - Netherländerna : Schattauer Gmbh. - 0943-4747. ; 7, s. 48-55
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To provide a survey over significant developments in the area of linking personal health informatics and clinical informatics, to give insights into critical advances and to discuss open problems and opportunities in this area.Methods: A scoping review over the literature published in scientific journals and relevant conference proceedings in the intersection between personal health informatics and clinical informatics over the years 2010 and 2011 was performed.Results: The publications analyzed are related to two main topics, namely "Sharing information and collaborating through personal health records, portals and social networks" and "Integration of personal health systems with clinical information systems". For the first topic, results are presented according to five different themes: "Patient expectations and attitudes", "Real use experiences", "Changes for care providers", "Barriers to adoption" and "Proposed technical infrastructures". For the second topic, two different themes were found, namely "Technical architectures and interoperability" and "Security, safety and privacy issues".Discussion: Results show a number of gaps between the information needs of patients and the information care provider organizations provide to them as well as the lack of a trusted technical, ethical and regulatory framework regarding information sharing.Conclusions: Despite recent developments in the areas of personal health informatics and clinical informatics both fields have diverging needs. To support both clinical work processes and empower patients to effectively handle self-care, a number of issues remain unsolved. Open issues include privacy and confidentiality, including trusted sharing of health information and building collaborative environments between patients, their families and care providers. There are further challenges to meet around health and technology literacy as well as to overcome structural and organizational barriers. Frameworks for evaluating personal health informatics applications and pervasive health technology are needed to build up an evidence basis.
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| 45. |
- Koch, Sabine
(författare)
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Designing clinically useful systems – Examples from Medicine and Dentistry
- 2003
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Ingår i: Adv Dent Res. ; 17, s. 65-
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Tidskriftsartikel (refereegranskat)abstract
- We present a design structure for constructing web based user adaptive learning environments. Currently the web offers huge amounts of unstructured information but no facilities for exploiting this in a problem solving situation. Our aim is to gather and
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| 46. |
- Koch, Sabine, et al.
(författare)
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Health informatics and the delivery of care to older people.
- 2009
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Ingår i: Maturitas. - : Elsevier BV. - 0378-5122 .- 1873-4111. ; 63:3, s. 195-9
-
Tidskriftsartikel (refereegranskat)abstract
- In the light of an aging society, effective delivery of healthcare will be more dependent on different technological solutions supporting the decentralization of healthcare, higher patient involvement and increased societal demands. The aim of this article is therefore, to describe the role of health informatics in the care of elderly people and to give an overview of the state of the art in this field. Based on a review of the existing scientific literature, 29 review articles from the last 15 years and 119 original articles from the last 5 years were selected and further analysed. Results show that review articles cover the fields of information technology in the home environment, integrated health information systems, public health systems, consumer health informatics and non-technology oriented topics such as nutrition, physical behaviour, medication and the aging process in general. Articles presenting original data can be divided into 5 major clusters: information systems and decision support, consumer health informatics, emerging technologies, home telehealth, and informatics methods. Results show that health informatics in elderly care is an expanding field of interest but we still do lack knowledge about the elderly person's needs of technology and how it should best be designed. Surprisingly, few studies cover gender differences related to technology use. Further cross-disciplinary research is needed that relates informatics and technology to different stages of the aging process and that evaluates the effects of technical solutions.
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| 47. |
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| 48. |
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| 49. |
- Koch, Sabine, et al.
(författare)
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Informatics and socio-technical challenges when designing for integrated eCare
- 2014
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Ingår i: Achieving effective integrated e-care beyond the silos. - Hershey PA : IGI Global. - 9781466661394 - 9781466661387 ; , s. 108-134
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Bokkapitel (refereegranskat)abstract
- The central role of eHealth to enable the successful implementation of integrated care is commonly acknowledged today. This is easier said than done. To provide correct, understandable, and timely information at the point of need and to facilitate communication and decision support for a network of actors with different prerequisites and needs are some of the big challenges of integrated care. This book chapter focuses on the specific challenges related to informatics and socio-technical issues when designing solutions for integrated eCare. Methods for requirements elicitation, evaluation, and system development using user-centred design in collaborative environments involving a variety of stakeholders are presented. Case studies in homecare of older patients, in the care of stroke patients, and regarding citizen eHealth services in general illustrate the application of these methods. Possible solutions and pitfalls are discussed based on the experiences drawn from the case studies. To address the main infor-matics and socio-technical challenges in integrated eCare, namely informatics-supported collaborative work and to provide coordinated continuity for the patient, top-down activities such as health informatics standardization, and bottom-up activities resulting in the definition of concrete patient journey descrip-tions, interaction points, information needs (that can be transformed into standardized data sets), as well as visualization and interaction patterns need to go hand in hand.
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| 50. |
- Koch, Sabine
(författare)
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Meeting the Challenges : The Role of Medical Informatics in an Ageing Society
- 2006
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Ingår i: Ubiquity. - Amsterdam : IOS Press. - 9781586036478 ; , s. 25-31
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Konferensbidrag (refereegranskat)abstract
- The objective of this paper is to identify trends and new technological developments that appear due to an ageing society and to relate them to current research in the field of medical informatics. A survey of the current literature reveals that recent technological advances have been made in the fields of "telecare and home-monitoring", "smart homes and robotics" and "health information systems and knowledge management". Innovative technologies such as wearable devices, bio- and environmental sensors and mobile, humanoid robots do already exist and ambient assistant living environments arc being created for an ageing society. However, those technologies have to be adapted to older people's self-care processes and coping strategies, and to support new ways of healthcare delivery. Medical informatics can support this process by providing the necessary information infrastructure, contribute to standardisation, interoperability and security issues and provide modelling and simulation techniques for educational purposes. Research fields of increasing importance with regard to an ageing society arc, moreover, the fields of knowledge management, ubiquitous computing and human-computer interaction.
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