New Publication: Online Patient Accessible Electronic Health Journals Increase the Fear of Threat and Violence

We have a new and very interesting publication! This one is based on the great master thesis by Ulrika Åkerstedt and written together with her, Ture Ålander and Jonas Moll.

Digital patient records increase the fear of exposure to threats and violence in 40 percent of healthcare professionals in psychiatry and emergency care. This is shown a new study from my research team. However, the study shows no connection between the occurrence of threats and violence and digital patient records one year after the introduction.

Critical voices mean that digital patient records increase the risk of personnel being exposed to threats and violence and that they face greater threats to threats and violence. The problem of increased risk is described as being linked to the patient being able to get the full name of the person who provided care through the system. This is especially worrying in activities where the risk of being exposed to threats and violence is already high, such as emergency care and psychiatric care.

Our recently published study examined whether patients whose patients had access to the patient portal experienced greater threats to threats and violence and were subjected to more threats and violence. The survey was conducted one year after digital patient records were launched in Uppsala.

A total of 174 people responded to a web survey (35% response rate). 83 people were from an emergency department whose patients had digital records, and 91 were from a psychiatric department whose patients did not have it. Nearly two thirds of respondents were exposed to threats and violence in the last year.

The study shows no links between the occurrence of threats and violence and digital patient records, but that does not mean that that link does not exist. On the other hand, there is a clear link between digital patient records and healthcare professionals’ concerns about threats and violence

The study also shows that 40 percent of those working in these businesses believed that the risks of threats and violence had increased after launch. There was also a difference in experience between the occupational groups that responded to the survey. Nurses experienced greater risks than doctors. However, the study did not show that more events of threat and violence occurred after the launch. Only one person in the study reported that the patient’s access to the journal had played a significant negative role in relation to an incident.

I think that the concern of healthcare workers for an increased risk of threats and violence must be taken seriously and taken care of by county councils and regions. One needs to balance the healthcare staff’s working environment with the patient’s need for information. Here it would be good to find out how important it is for patients to see the names of healthcare staff.

The survey has been conducted by researchers from DOME and the goal is to create and disseminate knowledge about the introduction and use of eHealth services.

The paper is open access and can be found here: https://www.cogentoa.com/article/10.1080/23311908.2018.1518967

 

Excellent PhD Thesis by Dr Grünloh

Last week I attended Christiane Grünloh’s great PhD defence. Her thesis is a substantial contribution to knowledge in the area of eHealth services for patients. I especially think that the results related to patient empowerment is interesting and well worth reading.

Chrisitane Grünloh is really an excellent researcher. She is both brilliant and has the grit to pull through qualitative analysis of very high quality. The abstract of her PhD is copied below, and you find the thesis here. Christiane has also written a blog post about it found here. The defence was one of the best I have attended. Not only did Christiane do an excellent job shining like a bright star, her opponent was also brilliant and very well read up on her work. Taken together this was a great learning opportunity for everyone in the audience including me.

The picture for this blog post is borrowed from Twitter and Christiane’s twitter stream. If you need inspiration to write a PhD thesis of the same quality as Christiane has, then follow her on Twitter! 

Abstract

Healthcare systems worldwide face organisational and financial challenges due to increasing number of people with chronic conditions, increasing costs, and an ageing population. eHealth services have the potential to address some of these challenges, for example, by supporting patients who are engaged in self-care, improving quality of care, and reducing medical costs.

In 2012, Region Uppsala in Sweden launched an eHealth service that enabled patients to access their electronic health records through the Internet. The launch of the service was accompanied by strong criticism from healthcare professionals (HCPs) and was heavily debated in the media. Patients on the other hand were very positive towards the service.

Albeit promising, the potential of Patient Accessible Electronic Health Records (PAEHRs) cannot be realised if HCPs still have reservations towards the service and their concerns are not fully understood. The purpose of this research is therefore to enhance our understanding of how physicians view PAEHR in relation to both their work environment and the level of patient participation. Furthermore, the aim is to shed light on whether their concerns related to patients’ well-being have materialised in practice and how patients view and make use of the service. Finally, this thesis identifies implicated human values and value tensions related to PAEHR.

To enhance our understanding of the physicians’ perspective, semi-structured interviews with 12 physicians in Uppsala were thematically analysed. A national patient survey was conducted to investigate patients’ use of and their experiences with PAEHR. Furthermore, empirical and conceptual investigations were carried out to identify human values and value tensions.

The results of this research show that the physicians’ assumptions and views of PAEHR and its consequences for patients were different from the views and actual experiences of patients using the PAEHR system. The physicians were mainly concerned about potential increase in their workload and that it could be harmful for patients to access their Electronic Health Record (EHR), for example, as it might evoke anxiety or worry. The vast majority of patients appreciated timely access to their results, felt more involved in their care, and read their records to become more involved. The investigation of human values associated with PAEHR identified values such as Ownership & Property, Professional Autonomy, Responsibility, Human Well-Being, Accountability & Transparency, and Trust. Furthermore, value tensions were identified that may occur between direct and indirect stakeholders (here: patients and physicians), or are related to an interpretation of PAEHR.

This thesis contributes to current research on eHealth in Human-Computer Interaction (HCI) by instigating a critical discussion of values associated with eHealth technologies that might be perceived as conflicting given a stakeholder’s framing of the technology. For example, tensions that emerge between values that prioritise placing the responsibility on a physician for their patients versus a value system that prioritises patient autonomy. The findings of this thesis suggest that while policymakers and government agencies adhere to a system of values that place a premium on patient empowerment, paternalistic tendencies are still present among physicians. However, an eHealth service like PAEHR is an important first step towards patient participation. The results of this thesis suggest that the support of patient participation in their own care through PAEHR outweighs the potential harm.

 

Care for Cancer – Reflections on Uppsala Health Summit 2018

This summer I participate in and organised Uppsala Health summit together with lots of other people. For me the theme of the Health summit was indeed top priority as I have many friends and family with cancer. I have seen how cancer treatment work at close hand through my husband who was diagnosed and treated with cancer a few years ago. Since I have done studies on patients and health care professionals, this experience gave me another depth in my understanding of cancer. It is difficult to imagine living with the uncertainty of treating cancer, and also the change of adapting your whole life to cancer treatments. Luckily my husband has had few side effects from the cancer, and everything has gone very well so far.

As a part of organizing the Uppsala Health Summit we wrote a debate article that was published in Dagens Samhälle, found here. Some of the things we say in this debate article are:

  • We need to work with the infrastructure so that IT systems can share information and data. I have seen this at close hand, and the computer systems are sometimes like black holes in health care. The system at the different departments did not talk to each other, so there was little coordination between radiation and chemotherapeutic treatment for example.
  • Physical treatment needs to be an integrated part of all cancer treatment, and also a part of what is recommended as a part of life for cancer survivors. No one mentioned that physical activity was so crucual during my husband’s treatment and we didn’t understand that it was that important.
  • Cancer treatment needs to be more equal across the world. During the Uppsala Health Summit it was shocking to hear the circumstances in other parts of the world, and to listen to the presentations made about the understanding of cancer. This is an area that I would like to get involved more in and to try to help!

I hope that the Uppsala Health Summit has contributed to some steps being taken towards better cancer care.

Less Screen Time and More Family Time

Now it’s soon time for annual leave through a slow summer holiday. My plans are very few and include reading non-work related booked, having lots of barbeque dinners, watching kids swim in the pool and going jogging. I will avoid working and only do very little, and deadline driven things.

Spring 2018 was really good and the two large achievements was being promoted to Excellent teacher and Full Professor. Few semesters have that kind of happenings 👍🏼.

I will be back blogging when the semester starts again in the end of August. I hope that you will have some time off too!!

Attending Conferences and Bringing Kids Along

I have four kids, and I have frequently attended conferences when they have come along. Perhaps it is not always optional to bring them, but the alternative would be to stay at home – and I don’t want that. Then I think it is better for me to go and try to balance work-life as good as I can and I adapt the trip to the kid so that they get a nice experience too.

When my youngest son was one years old he had been to many countries (nine?), and one result from us travelling so much with him is that he speaks OK English at the age of six. This is many years before he starts English at school.

The picture below is from Gothenburg and ICSE 2018 where I did a key note, and my husband attended one of the workshops on computer science education. We also met our very good colleague Tony Clear who helped Sixten try the conference T-shirt.

Tony and Sixten

Some tips for making it work to bring kids: 

  • Perhaps grand-parents have the possibility to travel with you to the conference with you? It could be a nice experience for them and for the kid
  • If it doesn’t work 100% as expected that is quite normal. Having kids is often a bit like leaving the planning to someone else… 🙂
  • If you go to the conference as a couple you can share responsibility for the kid. We often try to share the responsibility
  • Plan something that the kid likes to do so that the trio becomes a positive experience for everyone
  • Be prepared to replan things, and make up a plan B if plan A fails.

Writing Full EU Project Proposal Instead of Having a Vacation

My vacation is a bit postponed this year. Our pre-proposal for a co-funded project with Gender-Net Plus was accepted!!! :-))  And now I am writing a full proposal instead of having a vacation.

The team onboard writing the proposal is indeed excellent, and we span all research areas relevant for the idea of the proposal. I will not write the details here in the blog as I’m not sure that that would be ok given the review process of the proposals.

Last week we all met at Arlanda airport to discuss the project details, and to agree on the set up of the project. It was indeed a productive day with lots of ideas. It was also a day full of great Swedish fika and nice food.

If we are funded we will be working together in this project in eHealth for the coming three years. I will be the coordinator of the project, but I have very experienced help in my team and I think that I will do fine.

Interviewed for ”Research Profile of the Month”

Being interviewed is always a learning experience, as you get questions that you seldom ask yourself. The interview for the “Research Profile of the Month at the Faculty of Science of Technology” took several hours (3?), and the questions were related to all my areas of research. The person who interviewed was really a good listener, and had planned the interview carefully.

For me the interview created lots of reflection, and I will make use of it while thinking about where I want to go in my work life. Perhaps I will take a few minutes and relax in the grass, as illustrated in this blog post picture, during summer holidays.

Some of the questions were:

  • Why have I chosen the research questions that I am studying?
  • What are my plans forward?
  • How is it to do research on areas that have no clear and simple answers?
  • How is it to combins family and research?
  • What is my strongest personality trait?

In the link below my research is presented at Uppsala University’s web page.

http://www.teknat.uu.se/news/nyhetsdetaljsida/?id=10926&area=5,32&typ=artikel&lang=en

Reflections from Uppsala Health Summit ”Care for Cancer”

I will spend a few very good days at Uppsala Health summit with the theme “Care for Cancer”. If you ever have the chance to participate in one of these summits, I strongly recommend it.

What is Uppsala Health Summit? Uppsala Health Summit is a policy arena for dialogue addressing challenges for health and health care. I helped organize a workshop on use of technology for preventing childhood obesity a few years ago, and this time I am organizing a workshop on using existing data for diagnosing and treating cancer.

Who are participating? The people who are at the summit are personally invited decision makers, opinion formers and experts from around 35 countries in the world. The health summit is initiated by Uppsala University, the Swedish University of Agricultural Sciences, Uppsala County Council, Uppsala City Council and World Class Uppsala.

Sightseeing at the Scandion Clinic. Wednesday eventing we were invited to visit the Scandion clinic which is world class cancer clinic treating patients with proton therapy which makes it possible to treat cancer more efficiently and with fewer side effects. The building in itself ware really worth the visit, as it was designed with care and very appealing.

Before the visit it felt quite odd to do sightseeing in a cancer clinic, but it was really an inspiring experience. One of the reflections from visiting was that the nurses working there are actually doing a very technically oriented work with large computers. When I asked them about this they said that they have studied technical aspects of radiology as a part of their education to radiology nurses.

Christiane has written more about Uppsala Health Summit in this blog post if you want to know a bit more about our workshop on using existing data for treating and diagnosing cancer.

The Self-Flipped Classroom Concept: Underlying Ideas and Experiences – paper accepted for Frontiers in Education

Anna Vasilchenko, Mats Daniels and I had a paper accepted for Frontiers in Education very much based on Anna’s excellent work!!

The paper is a conceptual paper on self-flipped classrooms and we will continue working on research in the area in the fall. We will make use of experiences from the new course that I am teaching with Diane Golay.

Anna, Mats and I have also done one application for funding of this research and I really hope that we will get that!!

Here is the abstract:

In the modern fast changing world no formal education is able to provide learners with a complete set of knowledge, skills and competences that they would need to successfully compete on tomorrow’s job market. Therefore, the role of universities is increasingly shifting towards provision of an environment where students have a chance to acquire lifelong learning skills. This paper presents underlying ideas of, and practical experiences with, an innovative pedagogy that addresses the lifelong learning skills acquisition along with additional benefits for science and technology students. The proposed approach is called Self-Flipped Classroom (SFC) and it is built on a synergy of two pedagogies: learning through making (“self” part of the name) and Flipped Classroom (“flip” part of the name). To unveil the construct of the SFC concept, we discuss each of its components individually presenting appropriate theoretical grounding. We also report on our experiences from Self-Flipped Classroom implementations in two countries, CountryA and CountryB, and in three different educational settings. From our work with the SFC concept we have identified four different roles the students can assume in a SFC scenario: creators, collaborators, communicators, and learners. We present our observations regarding challenges and opportunities related to the identified roles that have been found in the studied settings. We also outline future research directions in this space.

Five Rejected Papers in 48 hours

Sometimes academia is not so great, and now and then I run into periods of lots of failure. Impostor syndrome doesn’t help either and hits me straight away when things are not going my way: “Do I really belong?”

This past week I got five papers rejected in 48 hours. Gah!! This was really tough! A personal record indeed. I thought that the papers were really OK, and some of them well written – but reviewers (completely) disagreed.

So far, I haven’t really had the energy to read the reviews either so I can’t really proudly say that I failed and learned lots of things through the failures. So far I have just failed and felt like a failure.