Publications by authors named "Vivian Vimarlund"

35 Publications

Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

On behalf of the Swedish interest organizations for Elderly, Stockholm, Sweden. Member of SeniorNet and Active Seniors non-profit organizations.

Background: The ambient assisted living (AAL) market is rapidly becoming fundamental to the delivery of health and social care services for the elderly. Worldwide many different steps have been taken to increase the engagement of older adults with these technologies. Much of this work has focused on the development of novel digital services that increase wellbeing or tackle social challenges.

Aim: The aim of the study was to identify and describe the demands for AAL-services from the perspective of older adults. We also examine the challenges and needs of the ambient assisted living market using a needs based approach.

Method: An exploratory case study was conducted with an aim to capture information about older adults' demands for AAL services. A survey was used to collect the data. The survey study respondents validated the results.

Results: The results of the study indicate that the area of AAL needs be studied from a multiple-sided market perspective. Our research suggests there is a need to describe and understand the factors that facilitate or constrain the implementation of services with focus on health and social care. There is also a need to describe and analyze the relationship between policy and practice and its effects on the AAL market. It is necessary to capture expressed demand, to identify market challenges at the macro level and to be able to understand how services should operate and serve older adults in practice. Such research is critical to the development of guidance for policy makers, suppliers and service providers.

Discussion: Older adults are asking for intelligent, assistive living solutions that help them to continue to live independent lives and remain socially included in their networks, associations, and communities. The elderly need services that stimulate and maintain their physical and intellectual capital. The development of innovative AAL environments is, however, a complex social process that involves the use and delivery of innovative ICT-based services. The implementation and use of AAL to support older adults involve service providers and elderly consumers.

Conclusions: The results of the study may be of interest to policy makers, entrepreneurs, technology suppliers, service providers and health and social care organizations, who are willing to innovate and influence the development of the AAL market through their choices and decisions.
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http://dx.doi.org/10.1055/s-0041-1726492DOI Listing
April 2021

Enhancing Safety During a Pandemic Using Virtual Care Remote Monitoring Technologies and UML Modeling.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Division of Clinical Informatics, Harvard School of Medicine, Harvard University, United States of America.

Objectives: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patient care while they are at home.

Methods: The authors describe their work in conducting literature reviews by searching PubMed.gov and the grey literature for articles, and government websites with guidelines describing the signs and symptoms of COVID-19, as well as the progression of the disease. The reviews focused on identifying gaps where RMT could be applied in novel ways and formed the basis for the subsequent modelling of use cases for applying RMT described in this paper.

Results: The work was conducted in the context of a new Home of the Future laboratory which has been set up at the University of Victoria. The literature review led to the development of a number of object-oriented models for deploying RMT. This modeling is being used for a number of purposes, including for education of students in health infomatics as well as testing of new use cases for RMT with industrial collaborators and projects within the smart home of the future laboratory.

Conclusions: Object-oriented modeling, based on analysis of gaps in the literature, was found to be a useful approach for describing, communicating and teaching about potential new uses of RMT.
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http://dx.doi.org/10.1055/s-0041-1726485DOI Listing
April 2021

International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study.

Methods Inf Med 2020 12 18;59(S 02):e46-e63. Epub 2020 Nov 18.

Clinical Informatics Center, Department of Pediatrics, Bioinformatics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, United States.

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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http://dx.doi.org/10.1055/s-0040-1715796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728164PMC
December 2020

Digital technologies for social inclusion of individuals with disabilities.

Health Technol (Berl) 2018 24;8(5):377-390. Epub 2018 Jun 24.

1Department of Informatics, Jönköping International Business School, Jönköping University, Jönköping, Sweden.

Information technology can be an important facilitator of social inclusion for people with disabilities into society. However, the goals specified in this area by organizations such as the European Commission have not yet been achieved in their totality. The aim of this paper is to explore which types of information communication technology-based applications and/or digital services have been suggested to facilitate the social integration of people who suffer from different types of disabilities. We performed a literature review that included studies published during a period of 6 years (2010-2016). The results show that, in the data we have had access to, no concrete patterns can be identified regarding the type of technology or technological trends that can be used to support the social integration of individuals with disabilities. This literature review is of relevance to the identification of further research areas and to the identification of issues which have to be considered in the context of the development and implementation of technological innovations that are aimed at promoting or facilitating social inclusion of individuals with disabilities.
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http://dx.doi.org/10.1007/s12553-018-0239-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208746PMC
June 2018

The Role of PAEHRs in Patient Involvement.

J Med Syst 2018 Sep 25;42(11):210. Epub 2018 Sep 25.

International Business School, Jönköping University, P.O. Box 1026, 551 11, Jönköping, Sweden.

With increased patient access to data, healthcare services are experiencing change where patients are moving away from being mere passive actors towards becoming more active and involved participants. In this paper, we explore the role of patient accessible electronic health records (PAEHRs) with respect to this increase in patient involvement. The study was performed as a case study and included nine interviews with patients and a survey that was responded to by 56 patients. Our results show that PAEHRs have a role in the enhancement of patient involvement because PAEHRs (i) foster a more balanced relationship between patients and healthcare professionals and (ii) increase access to information.
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http://dx.doi.org/10.1007/s10916-018-1070-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153723PMC
September 2018

Same, same but different: Perceptions of patients' online access to electronic health records among healthcare professionals.

Health Informatics J 2019 12 7;25(4):1538-1548. Epub 2018 Jun 7.

Jönköping University, Sweden; Linköping University, Sweden.

In this study, we explore how healthcare professionals in primary care and outpatient clinics perceive the outcomes of giving patients online access to their electronic health records. The study was carried out as a case study and included a workshop, six interviews and a survey that was answered by 146 healthcare professionals. The results indicate that professionals working in primary care perceive that an increase in information-sharing with patients can increase adherence, clarify important information to the patient and allow the patient to quality-control documented information. Professionals at outpatient clinics seem less convinced about the benefits of patient accessible electronic health records and have concerns about how patients manage the information that they are given access to. However, the patient accessible electronic health record has not led to a change in documentation procedures among the majority of the professionals. While the findings can be connected to the context of outpatient clinics and primary care units, other contextual factors might influence the results and more in-depth studies are therefore needed to clarify the concerns.
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http://dx.doi.org/10.1177/1460458218779101DOI Listing
December 2019

Multi-Sided Markets for Transforming Healthcare Service Delivery.

Stud Health Technol Inform 2018 ;247:626-630

International Business School, Jönköping University, Jönköping, Sweden.

Changes in healthcare delivery needs have necessitated the design of new models for connecting providers and consumers of services. While healthcare delivery has traditionally been a push market, multi-sided markets offer the potential for transitioning to a pull market for service delivery. However, there is a need to better understand the business model for multi-sided markets as a first step to using them in healthcare. This paper addressed that need and describes a multi-sided market evaluation framework. Our framework identifies patient, governance and service delivery as three levels of brokerage consideration for evaluating multi-sided markets in healthcare.
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June 2018

Monitoring and Benchmarking eHealth in the Nordic Countries.

Stud Health Technol Inform 2018 ;247:86-90

National Institute for Health and Welfare, Information Department, Helsinki, Finland.

The Nordic eHealth Research Network, a subgroup of the Nordic Council of Ministers eHealth group, is working on developing indicators to monitor progress in availability, use and outcome of eHealth applications in the Nordic countries. This paper reports on the consecutive analysis of National eHealth policies in the Nordic countries from 2012 to 2016. Furthermore, it discusses the consequences for the development of indicators that can measure changes in the eHealth environment arising from the policies. The main change in policies is reflected in a shift towards more stakeholder involvement and intensified focus on clinical infrastructure. This change suggests developing indicators that can monitor understandability and usability of eHealth systems, and the use and utility of shared information infrastructure from the perspective of the end-users - citizens/patients and clinicians in particular.
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June 2018

I Got 99 Problems, and eHealth Is One.

Stud Health Technol Inform 2017 ;245:258-262

International Business School, Jönköping University, Jönköping, Sweden.

Many eHealth initiatives are never implemented or merely end as pilot projects. Previous studies report that organisational, technical and human issues need to be properly taken into consideration if such initiatives are to be successful. The aim of this paper is to explore whether previously identified challenges within the area have remained in the Swedish eHealth setting or whether they have changed. After interviewing experts in eHealth, we present a classification of areas of concern. Recurrence of previously identified challenges was found, but also new issues were identified. The results of the study indicate that there is a need to consider organisational and semantic issues on both national and international levels. Legal and technical challenges still exist but it seems even more important to support eHealth initiatives financially, increase practitioners' knowledge in health informatics and manage new expectations from patients.
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June 2018

Guidance Through Use: Value as a Pathfinder in e-Health Services Implementation.

Stud Health Technol Inform 2017 ;245:151-155

International Business School, Jönköping University, Jönköping, Sweden.

The lack of awareness and confidence in eHealth solutions among certain stakeholders creates a barrier for the implementation of e-Health services. The aim of this paper is to explore issues that promote the development and implementation of patient-centered care services for the elderly. An exploratory case study approach is applied to a e-Health monitoring service that was developed and piloted in 38 homes for the elderly in Sweden and the Netherlands. The unit of analysis, concept of 'value-in-use', was used in order to determine how pilot participants felt about a service of this kind benefiting them the most. The findings were then translated into actionable considerations for implementing organizations. The results indicate a need for active participation, technical support infrastructure, mobility demands, and an extension of the concept of trust in e-Health services. The knowledge presented in the study is important for decisions makers, public organization strategists, and policy writers.
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June 2018

Use Model for a User Centred Design in Multidisciplinary Teams.

Stud Health Technol Inform 2017 ;242:1063-1066

Jönköping University, International Business School (JIBS), Jönköping, Sweden.

The Use Model identifies user groups who will be using services and products the Prosperity4All infrastructure offers. The Model provides developers a tool to keep in mind the full diversity of users while building and designing the infrastructure.
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April 2018

All that Glitters is not Gold: Six Steps Before Selecting and Prioritizing e-Health Services.

J Med Syst 2017 Aug 29;41(10):154. Epub 2017 Aug 29.

Department of Computer and Information Science, Linköping University, Ingång 29C Campus Valla, 58183, Linköping, Sweden.

Since the market for e-health applications is constantly growing, it is getting an ever more complex endeavor to select and prioritize the right service offering given a particular situation. In examining the extant literature, it was revealed that little emphasis is actually placed on how to analyze contextual or environmental factors prior to the selection and prioritization of e-health services. With this paper, we therefore propose a formative framework consisting of six fundamental yet very pragmatic steps that may support decision makers in identifying the most important contextual pre-requisites that e-health services need to fulfill in order to be considered as effective for their environment to be implemented.
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http://dx.doi.org/10.1007/s10916-017-0801-9DOI Listing
August 2017

The Role of ICT in Home Care.

Stud Health Technol Inform 2017 ;241:153-158

International Business School, Jönköping University, Sweden.

With an ageing population and limited resources, ICT is often mentioned as a solution to support elderly people in maintaining an independent and healthy lifestyle. In this paper, we describe how ICT can support access to information and rationalization of work processes in a home care context. We do this by modelling the workflow and identifying the possible impact of ICT. The results show a complex process and indicate that the available resources are not used in the best possible way. The introduction of ICT could increase patient safety by reducing the risk of misplacing information about the care recipients and at the same time provide real time information about the care recipients' needs and health at the point of care. However, to rationalize the work processes there is a need to combine ICT with a changed procedure for handling keys.
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April 2018

Understanding Through Use: Elderly's Value Identification in a Service Experience.

Stud Health Technol Inform 2017 ;241:103-108

Jönköping University - International Business School, Jönköping, Sweden.

This paper uses a qualitative approach, specifically; narrative analysis, to contextualize user's formulation of an understanding of a personalized meal planning service within the ambient assisted living domain. By focusing on how user's, in this case elderly over 65, formed an understanding of a service, and, what they thought valuable in using the service, based on their understanding. The results indicate how user's compare their initial understanding to their experienced understanding, formed during usage, and how this affects their value formulation of specific service aspects. The paper gives not only provides valuable insight into contextualizing aspects of health and wellness services, but to aspects of importance for implementation, by showing how value aspects of services from a user perspective are important to consider during these processes.
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April 2018

Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

Health Informatics J 2019 03 30;25(1):203-215. Epub 2017 Apr 30.

School of Health and Welfare, Jönköping University, Sweden.

The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.
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http://dx.doi.org/10.1177/1460458217704258DOI Listing
March 2019

Healthcare in the age of open innovation - A literature review.

Health Inf Manag 2016 Dec 14;45(3):121-133. Epub 2016 Apr 14.

Jönköping International Business School, Sweden.

Background: In spite of an increased interest in open innovation and strategies that call for an increased collaboration between different healthcare actors, there is a lack of open innovation research in public contexts.

Objective: This article presents the results of a review regarding the healthcare sector's engagement in open innovation as well as constraining factors and positive outcomes of open innovation in healthcare.

Method: The literature search focused on papers published in English between 2003 and 2014. Based on specified inclusion criteria, 18 articles were included.

Results: Results reveal that most studies focus on inbound open innovation where external knowledge is integrated with the internal knowledge base at an initial phase of the innovation process. Innovation primarily results in products and services through innovation networks. We also identified constraining factors for open innovation in healthcare, including the complex organizations of healthcare, the need to establish routines for capturing knowledge from patients and clinicians, regulations and healthcare data laws as well as the positive outcome patient empowerment.

Conclusion: The healthcare sector's engagement in open innovation is limited, and it is necessary to perform further research with a focus on how open innovation can be managed in healthcare.
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http://dx.doi.org/10.1177/1833358316639458DOI Listing
December 2016

Challenges of stimulating a market for social innovation - provision of a national health account.

Stud Health Technol Inform 2015 ;210:546-50

Jönköping International Business School, Sweden.

Innovation in healthcare can be associated with social innovation and the mission to contribute to a shared value that benefits not only individuals or organizations but the society as a whole. In this paper, we present the prerequisites of stimulating a market for social innovations by studying the introduction of a national health account. The results show that there is a need to clarify if a national health account should be viewed as a public good or not, to clarify the financial responsibilities of different actors, to establish clear guidelines and to develop regulations concerning price, quality and certification of actors. The ambition to stimulate the market through a national health account is a promising start. However, the challenges have to be confronted in order for public and private actors to collaborate and build a market for social innovations such as a national health account.
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November 2016

What type of innovation effects can you expect when offering e-services in the AAL domain.

Stud Health Technol Inform 2013 ;192:1050

Department of Informatics, Jönköping International Business School, Jönköping University, Jönköping, Sweden.

The objective of the AAL-FOOD project (funded by the AAL Joint Programme and VINNOVA) is to develop e-services that assist elderly in their procurement, preparation and the social construct of eating food to maintain a diverse nutritional intake, and hence stay healthy longer. The project consists of members from Denmark, Italy, Netherlands, Romania and Sweden. The AAL-FOOD project has so far completed collecting user requirements from potential users in Italy, Romania and the Netherlands and identified opportunities for design solutions made available through an IT-platform under development. Service classifications have been identified as well as identification of 13 potential e-services which in turn have been ranked in accordance of technical feasibility and implementation. Here we present preliminary results from on-going evaluation work conducted in the AAL-FOOD project. The evaluation aims at identifying effects of innovations through the offering of e-services directed at elderly within their homes.
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April 2015

Towards capturing innovation effects of a CDSS (NjuRen).

Stud Health Technol Inform 2013 ;192:1049

Department of Informatics, Jönköping International Business School, Jönköping University, Jönköping, Sweden.

The e-service NjuRen is a clinical decision support system used by physicians to calculate patients' renal function and provide support for selection of appropriate drug and dosage for patients with renal failure. Project NjuRen is a collaboration between Stockholm County Council and Jönköping International Business School and aims at evaluating the socio-economic impact of implementing IT-systems in healthcare. The project consist of several steps, first the development and adaptation of a model to measure innovation effects. In the second step the development of a survey to capture factual impacts and effects. Finally, in the third step to translate the effects into socio-economic terms. The result will help decision makers to identify the achieved benefits and outcomes that the implementation of the system has brought with it.
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April 2015

Barriers and opportunities to the widespread adoption of telemedicine: a bi-country evaluation.

Stud Health Technol Inform 2013 ;192:933

Jönköping International Business School and Linköping University, Sweden.

Recognizing that current practices for healthcare delivery are no longer sustainable, OECD governments are focusing more and more on how to leverage ICT to facilitate superior healthcare delivery. One such possibility is the use of Telemedicine. A major goal of telemedicine today is to develop next-generation telemedicine tools and technologies. However, key "classic" barriers continue to challenge widespread telemedicine adoption by health care organizations. These barriers include technology, financial, legal/standards, business strategy, and human resources issues. This comparative study explores the current status of barriers and opportunities to the widespread adoption of telemedicine in two different countries: Sweden, and USA.
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April 2015

My care pathways - creating open innovation in healthcare.

Stud Health Technol Inform 2013 ;192:687-91

Stockholm County Council, Sweden.

In this paper we describe initial results from the Swedish innovation project "My Care Pathways" which envisions enabling citizens to track their own health by providing them with online access to their historical, current and prospective future events. We describe an information infrastructure and its base services as well as the use of this solution as an open source platform for open innovation in healthcare. This will facilitate the development of end-user e-services for citizens. We have technically enabled the information infrastructure in close collaboration with decision makers in three Swedish health care regions, and system vendors as well as with National eHealth projects. Close collaboration between heterogeneous actors made implementation in real practice possible. However, a number of challenges, mainly related to legal and business issues, persist when implementing our results. Future work should therefore target the development of business models for sustainable provision of end-user e-services in a public health care system such as the Swedish one. Also, a legal analysis of the development of third party provider (nonhealthcare based) personal health data e-services should be done.
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April 2015

Nordic eHealth indicators: organisation of research, first results and plan for the future.

Stud Health Technol Inform 2013 ;192:273-7

Information Department, National Institute for Health and Welfare, Helsinki, Finland.

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 [4].
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April 2015

Steps to consider for effective decision making when selecting and prioritizing eHealth services.

Stud Health Technol Inform 2013 ;192:239-43

International Business School, Jönköping University, Linköping University, Sweden.

Making the best choice for an organization when selecting IT applications or eHealth services is not always easy as there are a lot of parameters to take into account. The aim of this paper is to explore some steps to support effective decision making when selecting and prioritizing eHealth services prior to implementation and/or procurement. The steps presented in this paper were identified by interviewing nine key stakeholders at Stockholm County Council. They are supposed to work as a guide for decision making and aim to identify objectives and expected effects, technical, organizational, and economic requirements, and opportunities important to consider before decisions are taken. The steps and their respective issues and variables are concretized in a number of templates to be filled in by decision makers when selecting and prioritizing eHealth services.
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April 2015

The need of a multi-actor perspective to understand expectations from virtual presence: managing elderly homecare informatics.

Inform Health Soc Care 2011 Dec 4;36(4):220-32. Epub 2011 Mar 4.

SAP Research Center St. Gallen, Blumenbergplatz 9, CH-9000 St. Gallen, Switzerland.

Background: Different studies have analysed a wide range of use cases and scenarios for using IT-based services in homecare settings for elderly people. In most instances, the impact of such services has been studied using a one-dimensional approach, either focusing on the benefits for the patient or health service provider.

Purpose: The objective of this contribution is to explore a model for identifying and understanding outcomes of IT-based homecare services from a multi-actor perspective.

Methods: In order to better understand the state of the art in homecare informatics, we conducted a literature review. We use experiences from previous research in the area of informatics to develop the proposed model.

Results: The proposed model consists of four core activities 'identify involved actors', 'understand consequences', 'clarify contingencies', 'take corrective actions', and one additional activity 'brainstorming IT use'.

Conclusion: The primary goal of innovating organisations, processes and services in homecare informatics today, is to offer continued care, better decision support both to practitioners and patients, as well as effective distribution of resources. A multi-actor analysis perspective is needed to understand utility determination for the involved stakeholders.
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http://dx.doi.org/10.3109/17538157.2011.554931DOI Listing
December 2011

Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work.

Work 2010 ;35(2):143-51

Division of Community Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.

In Sweden, the activities initiated to promote return to work (RTW) are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The aim was to gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients. Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects. First, the analysis identified that the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constructive in that it facilitated recognition and mobilisation of strengths and abilities. Fourth, the differences in rules and regulations between the social insurance and the unemployment insurance standards were often perceived to induce problems, for example, on how to assess the work capacity of clients. The assessments of work capacity represent important and complex tasks that professionals must perform without having access to either scientific knowledge or consensus agreement on which to base their decisions.
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http://dx.doi.org/10.3233/WOR-2010-0966DOI Listing
May 2010

Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory.

BMC Med Inform Decis Mak 2009 Dec 31;9:52. Epub 2009 Dec 31.

Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.

Background: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care.

Methods: The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods.

Results: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001).

Conclusions: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.
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http://dx.doi.org/10.1186/1472-6947-9-52DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809050PMC
December 2009

Health information system implementation: a qualitative meta-analysis.

J Med Syst 2009 Oct;33(5):359-68

Department of Computer and Information Sciences, Linköping University, Linköping, Sweden.

Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.
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http://dx.doi.org/10.1007/s10916-008-9198-9DOI Listing
October 2009

Understanding business intelligence in the context of healthcare.

Health Informatics J 2009 Sep;15(3):254-64

Institute of Information Management, University of St Gallen, St Gallen, Switzerland.

In today's fast changing healthcare sector, decision makers are facing a growing demand for both clinical and administrative information in order to comply with legal and customer-specific requirements. The use of business intelligence (BI) is seen as a possible solution to this actual challenge. As the existing research about BI is primarily focused on the industrial sector, it is the aim of this contribution to translate and adapt the current findings for the healthcare context. For this purpose, different definitions of BI are examined and condensed in a framework. Furthermore, the sector-specific preconditions for the effective use and future role of BI are discussed.
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http://dx.doi.org/10.1177/1460458209337446DOI Listing
September 2009

Implementing an integrated computerized patient record system: Towards an evidence-based information system implementation practice in healthcare.

AMIA Annu Symp Proc 2008 Nov 6:616-20. Epub 2008 Nov 6.

Department of Computer and Information Sciences, Linköping University, Linköping, Sweden.

A large number of health information system (HIS) implementations fail due to insufficient organizational harmonization. The aim of this study is to examine whether these problems remain when implementing technically integrated and more advanced generations of HISs. In a case study, data from observations, interviews, and organizational documents were analyzed using qualitative methods. We found that critical issues in the case study implementation process were the techniques employed to teach the staff to use the integrated system, involvement of the users in the implementation process, and the efficiency of the human computer interface. Comparisons with a literature review showed both recurrence of previously reported implementation problems and new issues specific to the integrated system context. The results indicate that the development of evidence-based implementation processes should be considered.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655989PMC
November 2008

Organizational effects of information and communication technology (ICT) in elderly homecare: a case study.

Health Informatics J 2008 Sep;14(3):195-210

Department of Computer and Information Science (IDA) Linköpings Universitet, SE - 581 83 Linköping, Sweden.

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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http://dx.doi.org/10.1177/1081180X08092830DOI Listing
September 2008