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  • 1. Bärkås, Annika
    et al.
    Scandurra, Isabella
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Analysis of Voluntary User Feedback of the Swedish National PAEHR Service.2019In: MEDINFO 2019: Health and Wellbeing e-Networks for All: Proceedings of the 17th World Congress on Medical and Health Informatics, 2019, Vol. 264, p. 1126-1130Conference paper (Refereed)
    Abstract [en]

    "Journalen" is a patient accessible electronic health record (PAEHR) and the national eHealth service for Sweden's citizens to gain access to their EHR. The Swedish national eHealth organization Inera, responsible for Journalen, created an inbox to receive voluntary user feedback about Journalen in order to improve the service from the user perspective. Based on voluntary user feedback via email. This study explored patients' experiences of using the national eHealth service and identified pros and cons. A mixed method content analysis was performed. In total, 1084 emails from 2016-2017 have been analyzed. 9 categories were identified, the most frequent ones related to questions about why some information was not accessible (due to regional differencies), feedback (including only positive or negative comments as well as constructive improvement suggestions), and emails about errors that user found in their record. These data can be successfully used to continuously improve an already implemented eHealth service.

  • 2.
    Hägglund, Maria
    et al.
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Heinze, Oliver
    Department of Medical Information Systems, Univ. Hospital, Heidelberg, Germany.
    Pobiruchin, Monika
    GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn University, Germany.
    Pohl, Anna-Lena
    Institute for eHealth and Management in HealthCare, Flensburg University, Flensburg, Germany.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Schreiweis, Björn
    Department of Medical Information Systems, Univ. Hospital, Heidelberg, Germany.
    Wiesner, Martin
    Dept. of Medical Informatics, Heilbronn University, Germany.
    Opportunities and Challenges of Consumer-centric eHealth Services: An Interdisciplinary Workshop2016Conference paper (Other academic)
  • 3.
    Hägglund, Maria
    et al.
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Does user centred design work in homecare for elderly?: a retrospective on the OLD@HOME case2011In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 11Article in journal (Refereed)
    Abstract [en]

    Introduction: Mobile information and communication technology (ICT) has been suggested to improve collaboration in integrated homecare, yet, few successful implementations are available. User centred design (UCD) can improve the usefulness of ICT, however, it is often claimed to be expensive and difficult to use in healthcare. In the action research project OLD@HOME (Sweden 2002–2005) a user centred approach was adapted to the specific context of integrated homecare for elderly.

    Aim: To revisit OLD@HOME and explore what methodological adjustments were needed to adapt UCD to integrated homecare of elderly, and what the long-term effects of using UCD were.

    Results: Our collaborative design method included all stakeholders and enabled development of both new work situations and new tools. Five years after implementation, the system is still used by home help service personnel, for both homecare- and office-based work, as it provides ubiquitous access to information and communication. Technical support is rarely needed; experienced users handle occurring problems, training and introduction of new users.

    Conclusions: We consider the development method a key factor for the OLD@HOME system’s success as it enabled the design of a homecare system that is not only easy to use, but adapted to the context of integrated homecare for elderly

  • 4.
    Hägglund, Maria
    et al.
    Karolinska Institutet.
    Scandurra, Isabella
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Empowering patients and relatives in elderly care by information access2008Conference paper (Refereed)
  • 5.
    Hägglund, Maria
    et al.
    Health Informatics Centre, Karolinska Institutet, Sweden.
    Åhlfeldt, Rose-Mharie
    Högskolan i Skövde, Institutionen för informationsteknologi.
    Koch, Sabine
    Health Informatics Centre, Karolinska Institutet, Sweden.
    Ålander, Ture
    Department of Public Health and Caring Sciences (IFV), Uppsala University.
    Scandurra, Isabella
    Informatics, School of Business, Örebro University, Sweden.
    Developing and implementing national eHealth services for patients: an interactive exploration of challenges andpotential solutions2015In: Digital Healthcare Empowering Europeans: Proceedings of MIE2015 / [ed] Ronald Cornet, Lăcrămioara Stoicu-Tivadar, Alexander Hörbst, Carlos Luis Parra Calderón, Stig Kjær Andersen, Mira Hercigonja-Szekeres, IOS Press , 2015Conference paper (Refereed)
    Abstract [en]

    In this workshop, examples and experiences from ongoing work todevelop and implement eHealth services for citizens will be provided. Challengesand potential solutions based on different international contexts will be discussedin interactive sessions. The results will form a report suggesting strategies andactivities that could provide potential solutions to the identified challenges.

  • 6.
    Scandurra, Isabella
    et al.
    APRI eHealth, Själevad, Sweden.
    Hägglund, Maria
    Karolinska University.
    An ICT development method containing Continuous User Validation improves the entire care process AND the individual work situation2009Conference paper (Refereed)
    Abstract [en]

    Introduction: Integrated care involves different professionals, belonging to different care provider organizations and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process.

    Purpose: To present a method for development of usable and work process-oriented information and communication technology (ICT) systems for integrated care.

    Theory and method: Based on Human-computer Interaction Science and in particular Participatory Design, we present a new collaborative design method in the context of health information systems (HIS) development. This method implies a thorough analysis of the entire interdisciplinary cooperative work and a transformation of the results into technical specifications, via user validated scenarios, prototypes and use cases, ultimately leading to the development of appropriate ICT for the variety of occurring work situations for different user groups, or professions, in integrated care.

    Results and conclusions: Application of the method in homecare of the elderly resulted in an HIS that was well adapted to the intended user groups. Conducted in multi-disciplinary seminars, the method captured and validated user needs and system requirements for different professionals, work situations, and environments not only for current work; it also aimed to improve collaboration in future (ICT supported) work processes. A holistic view of the entire care process was obtained and supported through different views of the HIS for different user groups, resulting in improved work in the entire care process as well as for each collaborating profession.

  • 7.
    Scandurra, Isabella
    et al.
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Hägglund, Maria
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Developing and implementing national eHealth services for patients: an interactive exploration of challenges and potential solutions2015In: Driving Quality in Informatics: Fulfilling the Promise, 2015Conference paper (Refereed)
    Abstract [en]

    Developing and Implementing National eHealth Services for Patients – An Interactive Exploration of Challenges and Potential Solutions Isabella Scandurra, Informatics, School of Business, Örebro University, Sweden; Maria Hägglund, Health Informatics Centre, Karolinska Institutet, Sweden As a means to address current challenges for and demands on health and social care, e.g. quality of care and patient empowerment, information and communication technologies (ICT) are being used to supply citizens with various health services. One example is to give patients web access to their own electronic health records (EHRs). In this workshop, we will provide examples and experiences from ongoing work in Sweden to develop and implement eHealth services for citizens; SUSTAINS [1] and My Care Pathways [2].The workshop participants will be engaged in interactive discussions regarding challenges and potential solutions based on their experiences from different contexts. The aim of the workshop is twofold: 1. To explore challenges for developing and implementing e-health systems for citizens to access their patient information and other e-health services online. 2. To suggest strategies and activities that could provide potential solutions to the identified challenge. Workshop structure The disposition of the workshop is as follows: a 90 minute session, a 15 minutes break and another 75 minute session. The two sessions will contain both presentations from the workshop organizers and interactive discussions and work in smaller groups to engage all participants and share experiences from different contexts. This disposition requires active participants to generate new ideas and knowledge through discussions and reflections where all participants contribute with their knowledge and understanding of the problem. The topic is expected to engage a lot of people, maybe not only those present at the workshop or at the conference. The workshop organizers will encourage live tweeting during the sessions and invite followers. 

  • 8.
    Scandurra, Isabella
    et al.
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Hägglund, Maria
    Karolinska Institutet, Stockholm, Sweden.
    How to introduce a mobile ICT system in homecare?: a socio-technical implementation process dis-/ covering staff’s opinions and intention to use ICT2008Conference paper (Refereed)
  • 9.
    Scandurra, Isabella
    et al.
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Hägglund, Maria
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Johansen, Monika
    Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, the Artic University of Norway (UIT), Tromsø, Norway.
    Bergmo, Trine
    Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.
    Zanaboni, Paolo
    Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.
    Impact of Patient Accessible EHRs: An Interactive Workshop to Share Experiences and Explore Evaluation Approaches2017Conference paper (Other academic)
  • 10.
    Scandurra, Isabella
    et al.
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Koch, Sabine
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden.
    Clinicians’ opinions towards learning and performing Heuristic Evaluations of Health Information Systems2007In: Proceedings of 5th Scandinavian Conference on Health Informatics (SHI 2007) (Skandinaviska hälsoinformatik- och termkonferensen 2007) / [ed] Göran Petersson et. al., Kalmar: eHealth Institute , 2007, p. 62-62Conference paper (Refereed)
  • 11.
    Scandurra, Isabella
    et al.
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Koch, Sabine
    Karolinska University.
    Multi-disciplinary Thematic Seminars – a method for continuous user validation of system requirements in integrated care2008Conference paper (Other (popular science, discussion, etc.))
  • 12.
    Scandurra, Isabella
    et al.
    Uppsala University, Uppsala, Sweden.
    Hägglund, Maria
    Karolinska Institutet, Stockholm, Sweden.
    Åhlfeldt, Rose-Mharie
    Skövde University, Skövde, Sweden.
    Persson, Anne
    Skövde University, Skövde, Sweden.
    Building usability into National eHealth strategies: An Action Research Approach2013In: Action Research, Interventions, and Participatory Design, 2013Conference paper (Refereed)
  • 13.
    Scandurra, Isabella
    et al.
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Pettersson, Maria
    Inera AB, Stockholm, Sweden.
    Hägglund, Maria
    Karolinska Institutet, Stockholm, Sweden.
    When do people read their health record?: analysis of usage data of a national eHealth service giving patients access to their electronic health record2017Conference paper (Other academic)
    Abstract [en]

    Introduction: eHealth services for citizens provide support for patients and families, as well as for healthcare professionals. In Sweden different eHealth services have been developed since the late 1990s and they are now used by millions of users. One of the national eHealth services that provides opportunities for increased participation in care is the Patient Accessible Electronic Health Record (PAEHR). To date (February 2017) over one million citizens (of 10 million inhabitants) have accessed their own electronic health record (EHR). In this study, we describe current usage by analysing log-data from the service. Who are the users, and how and when do they use the service?

    Method: Data collection of routinely captured usage data was administered by Inera AB, owner of all Swedish national eHealth services. Data was analyzed through IBM SPSS in accordance with the declaration of Helsinki. Queries for this quantitative study were created based on previously published results regarding concerns often expressed by healthcare professionals (HCP) as well as routinely captured log-data. Descriptive usage statistics were analysed towards such HCP concerns, e.g. increased workload due to worried patients reading but not understanding the PAEHR content.

    Results: Current status of the Swedish PAEHR is presented, e.g. number of users, demographic data (age, gender) in relation to log-in statistics. Regarding log-ins, first-time users and unique hits show that attention by national media has an impact a news cast resulted in 31,000 logged in compared to a week day average of 20,000. To date more than 1 million citizens have chosen to log in and the numbers are increasing. A newly connected region (Örebro) has an average of 500 new users a day. This can be compared to the first region (Uppsala) which during the first year (2012- 2013) had approx. 100 new users a day, although the strategy then was not to advertise the service. In total 10,000 to 13,000 new users log in every day nationally. More women than men log in and their mean age are 23-32 years. The older the users get the less they use the PAEHR, however some users are older than 93 years. During weekends the activity decreases, as opposed to HCP expectations. More often, users log in on week days, e.g. on Monday morning.

    Discussion: Usage statistics were related to concerns of HCP, which seem to have little resemblance to reality. One concern was that the service would not provide benefit for patients, here contradicted by the increasing number of both first-time and recurrent users. However, such indicators need to be further analysed. Paper records and PAEHR usage are difficult to compare, due to lack of statistics regarding printout reading. Usage comparisons between PAEHR solutions of different counties would however be interesting.

    Conclusion: Recurrent concerns of mainly HCP seem to be contradicted by actual usage by patients. This may lead to a decreased controversy of how PAEHR is experienced by patients and HCP. Knowledge about how users actually use PAEHR may also improve the service as such.

  • 14.
    Scandurra, Isabella
    et al.
    Uppsala University, Department of Information Technology.
    Åhlfeldt, Rose-Mharie
    Högskolan i Skövde, Institutionen för kommunikation och information.
    Persson, Anne
    Högskolan i Skövde, Institutionen för kommunikation och information.
    Hägglund, Maria
    Karolinska institutet, Health Informatics Centre; Sweden.
    Challenges in Applying a Participatory Approach in a Nation-wide Project -The Case of ‘Usability of Swedish eHealth Systems 2013’2013In: Past History and Future Challenges of Human Work Interaction Design (HWID): Generating cross-domain knowledge about connecting work analysis and interaction design / [ed] Torkil Clemmensen, Bengt Sandblad, Arminda Lopes & Jose Abdelnour-Nocera, Cape Town: INTERACT , 2013, p. 33-38Conference paper (Refereed)
    Abstract [en]

    Many healthcare organizations are currently committed to organizational change and quality improvement projects. Unfortunately, little effort is put into health information system development according to usability requirements and methodology, leading to bottlenecks in the eHealth systems when implemented into daily practice. This paper presents the experiences of applying a participatory approach in a nation-wide project. The aim of this national initiative was to build usability of eHealth systems into the Swedish national eHealth strategy and its action plan to ensure impact on practice. Action researchers within the health informatics domain collaborated with representatives of different care professions to propose high-priority changes necessary to improve the usability of health information systems. Reflections from the first phase of this initiative are further explored in terms of methodological challenges and recommendations, whereof one recommendation is to increase the use of HI-U specialists – health informaticians with usability and human work interaction design expertise within national and local eHealth development.

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