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eHälsa – Framtidsvision eller Verklighet?

Sabine Koch, Björn-Erik Erlandson

Bakgrund:

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?

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.

BACKGROUND: Shared 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. METHOD: User-centered scenario building in interdisciplinary working groups is applied for capturing cooperative work routines, information demands, and other central preconditions in shared homecare. RESULTS: Use 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. CONCLUSION: In 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.

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.

The phenomenon of an aging society is frequently raised in scientific, public and political discussions in the developed world. It is well known that a number of challenges related to the demographic, economic and societal development will lead to increasing demands for health and social care. To cope with these challenges, effective delivery of health and social care will be more dependent on different technological solutions. The objective of this paper is to identify emerging technological solutions and to relate them to the expected changes occurring in an aging society. Results from an analysis of existing literature show that ubiquitous care in aging societies is merely a social than a technical challenge as it will require a redesign of today's healthcare processes. Supportive technologies have to be adapted to older people's needs, self-care processes and coping strategies, and to support new ways of healthcare delivery under close surveillance of patient safety, legal and ethical issues.

Heuristic evaluation is a usability testing method aiming to improve the user interface design. Traditionally, a panel of experts in usability and human factor issues evaluate and judge the compliance of computer software according to recognized usability principles, the heuristics. In this paper, we investigate clinicians' attitudes towards learning and performing a heuristic evaluation and present the procedure of educating the healthcare staff and their accomplishment of the evaluation. 18 clinicians were recruited for a 2-hours education and filled in a post-education questionnaire regarding their opinions of the evaluation method when applied by clinicians. Six of the clinicians participated later in a heuristic evaluation of a web-based virtual health record,Their time spent for evaluation and analysis of results was approximately four hours each. Opinions from the six "clinical evaluators" were gathered in an post-evaluation form and compared to the post-education questionnaire. The results of 18 clinicians indicate that there is an interest in learning and participating in such evaluations. Our interpretation is that it is feasible to educate healthcare staff to perform rapid usability inspections to locate usability defects and additionally emphasize the domain specific problems residing in health information systems.