Category Archives: DOME

DOME meeting in Örebro

DOME is the name of the consortium that does research on Patient Accessible Electronic Health Records. We are a group of around ten active researcher coming from five different universities in Sweden. It is really a well functioning research consortium, and we meet every three weeks on Skype and once per semester in real life.

This semester we are meeting in Örebro two days. The first day will be dedicated to a forthcoming application for a reserach grant. It is Rose-Mharie Åhlfeldt who coordinates us in this work, and we have been given tasks in advance related to planning of the application. In the eventing we usually meet at a nice restaurant and have dinner together. Day two will mostly be dedicated to planning of the VITALIS and MIE events in April. We will have presentations together with INERA related to our latest studies, and we’ll spend some hours planning this event.

Using Themes from Qualitative Interviews as Lens to Analyse Survey Data – Workshop paper

Methods are truly important when you do research, and depending on your research tradition there are indeed many strong opinions about what is a good and bad method. Generalizability, validity and reliability are for some the only quality criteria possible. And if you do an interview study you need an enormous number of interviews according to some people.

Some would argue that human-computer interaction is indeed a melting pot of different opinions and perspectives on methods. Indeed, I have seen some very harsh comments on some of the methods that I have used from people with a completely other world-view. The problem when I get these comments is that I don’t really know what to write as an answer. Please take a course in qualitative research and relevant quality criteria for that kind of research is perhaps not the most politically correct rebuttal text to write.

One of my favorite stories related to methods is from my supervisor, Jan Gulliksen who was a part of a long review process where one other researcher claimed that the method was un-important:

I don’t care that the method is flawed. I like the results!

 

Before the Christmas holiday Christiane Grünloh presented a workshop paper that we wrote together that presents a mixed methods approach to analyzing interviews.

“Human-Computer Interaction (HCI) is a melting pot of different theories and methods. The combination of qualitative and quantitative methods in studies is still quite rare, but has become more and more common. In this paper, we present our experiences from doing a combination of quantitative and qualitative analysis to shed some light on patient accessible electronic health records. We conducted a national survey to patients to learn about their experiences of accessing their electronic health records. The questionnaire was informed by previous interviews with physicians related to effects on their work environment, and we made use of identified themes from that study as a lens to analyse survey data.”

 

You find the paper free for download here. 

 

 

 

Radio Interview on Medical Records Online

I was interviewed on the P4 Västmanland radio the other day. The reporter was interested in patients reading their medical records online, and the research in the DOME consortium, and asked me questions such as:

  • Do patients contact health care with more questions?
  • What does reserarch say about getting cancer results, or other negative results from Journalen?

You find the interview 8 min into this radio program

 

EIT Summer School in Dublin

It’s been a great week in Dublin so far, despite quite cloudy days and occasional rain. The week has been full of good lectures related to the eHealth from different perspectives. The lecture hall in itself was amazing, and during one lunch break we went to visit the old library which was an amazing building (se pictures of this blog)!

There has been many great lectures this week, and I can’t write about them all. Among other things Ann Blandfords presentation of a study made by Hanna Schneider (Msc) of patients different perspcecitves on a system for communicating with health care and the four categories of roles they found in their interveiw material: 1) Controller 2) Collaborator 3) Cooperator 4) Avoider. In this study the self determination theory (Ryan & Deci) was used. I would love to read up some more on that one!

Jonas Moll from the HTO group has written several more detailed blog posts about the lectures and the content. Hop on to his blog and read about these 🙂

Day 1 

Day 2 

Day 3 

 

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In a few weeks the EIT summer school will meet again in Stockholm and Uppsala. Jan Gulliksen and I have worked out a good schedule that will include a visit to the Visualisation studie at KTH and other things. The day in Uppsala will be organised in conjunction with Region Uppsala and the EPJ division, as well as the DOME consortium. There are indeed good and interesting lectures coming up!

 

DOME conference on Medical Records Online in Skövde

We had a great Dome conference in Skövde about our research on medical records online. There were 12 reserachers present during this conference from a large number of universities. The first day there were some presentations of new and upcoming studies of the effects of patients reading their medical records online.

Erebouni Arakelian who has a PhD in medicine joined a Dome meeting for the first time and presented the plan for a study on the patient group that she is working with, and that she has done studies on before. She will do 30 interviews during the coming years, and has already gotten ethical approval for her study.

Bridget Kane who does reserch in HCI and in Computer Supported Collaborative Work also joined the meeting for the first time and she did a presentation of her previous studies and what she has done in her work. She has covered a very interesting, and large area related to eHealth.

It was interesting to hear about the plans for the upcoming studies, and to discuss what areas we should look more into based on previous findings. Here are some of the upcoming  studies:

  • Interview study with cancer patients by Ereboni Arakelian as a follow up to the national survey sent out in the fall of 2016 and the interviews made around 2013.
  • Interview and survey study with health care professionals at the Oncology department about the effects on the work environment. Jonas Moll it in charge of this study and bloggs about this study here if you want to know more. (this study is a part of the Disa project)
  • Interviews with patients in primary care about their use of medical records online (as a part of Maria Hägglund and Isabella Scandurra’s project Pacess)

There were some new members of the consortium present at the conference, and some old members have moved on to other research areas. I am however really glad to see that we have created an open and well functioning community where newcomers are very welcome.

Collaboration with the Department of EMR in Region Uppsala

We have had a very good collaboration with the department of EMR in the Region Uppsala since a few years. We call this collaboration the Dive (Digital work enVIronment and Ehealth) project, and we are a group of 3-4 reserachers who participate.  This collaboration has been in the form of an action research project where researchers from our department worked togehter with people from the EMR department in designing a new IT system for surgical planning. We have also collaborated in doing some evaluations of usability aspects that has been used in the deployment of the system. We will also do follow up evaluations of usability. Now we have moved on to looking into decision support systems, and my collegues do vision seminars and will work on a design.

The department of EMR also collaborate with us around the IT in Society class  that has resulted in a report, a presentation and also visibiliy at Vitalis 2017.

The Disa project is also supported by the department of EMR, and we collaborate around this project too. This project includes around 10 reserachers who will look into the effects of digitaliczation in health care and the project will result in concepts and a eWorkenvironment framework possible to use when implementing IT in health care. The department of EMR has an excellent and very active representative on the advisory board of the project who has helped us a lot in understanding the organisation.

In these kinds of collaborations it is crucial to find a win-win situation, where both the reserachers and the organisations feels that they get energy and effect from the collaboration. In our case the collaboration in the  Dive project has given us much insight in eHealth development and in the complexities of working with IT in health care, which is crucial to be able to work in that area. And I know that the department of EMR are very pleased with the input regarding design that we have given hem. The Disa project has just started, and hopwfully that will result in a win-win too.

We are extremely happy about this colllaboration, and strongly recommend other reserach groups to try the same approach to collaboration!

Pod from MT-Talks on Medical Records Online

Before Christmas Jonas Moll and I were interviewed in a pod cast at  about our research on medical records online. The pod cast was produced by department of media technology at Södertörn högskola.

You can find the pod at the MT web page: http://www.mttalks.se/pod/

There seem to be many very interesting pods at this pod cast, and I will make sure to listen to them all in the near future!

 

Seminar on Digital Work Environment with Examples from Health Care and DOME

Last week Gerolf Nauwerck and I did a presentation about Digital Work Environment at the Swedish Ergonomic Society’s yearly meeting. This blog post will shortly describe this presentation. It was the first time that Gerolf and I presented together, but despite limited time for preparing it went really well much thanks to Gerolf and an enthusiastic audience.

Gerolf started off the presentation by discussing the term Digital Work Environment that is used by for example Digitaliseringskommissionen, Prevent and Vision. For example Digitaliseringskommisionen defines it as:

 “The work environment in the digital economy”.

There is no scientific definition of the word, and in research other terms are used such as work engagement and healthy work.

Twenty years ago there were numerous different professions that worked with different tools, but working life has changed and today most work is done using a computer or an iPad, or other ICT technology, see image below:

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When looking at the digital work environment there are numerous alarm reports from health care such as Isabella Scandurras “Disturbing or Facilitating“. Most health care professionals use around 25 different computer systems in their work, and these are often not connected or made to work well together even though they spend much of their time working through these systems. Physicians spend around 50% of their time working with the computer, and around 50% doing other things such as meeting patients. There are numerous media articles about the problems with ICT in health care, see the picture of the blog post. The problems are alarming, and health care professionals are as a consequence not always positive to changes related to IT.

One example of digitalisation in health care is medical records online for patients. Most physicians and nurses are very worried of the effects of this system. Mostly they are worried about the effects on the patient, but they are also worried about the effects on their work environment through the following changes:

  • Changes in well established work routines
  • Time pressure
  • Less time for preparation
  • Increased risk of misjudgements

Health care is not the only area where the digital work environment is problematic. Unionen (one of the largest Swedish unions) distribute a yearly or biannual survey to their members to investigate the digital work environment. The sub-titles of their reports called “The digital work environment of white-collar workers” tell us about the results from the survey:

2008: Why doesn’t it get better?

2010: A system error?

2011: Always online – never relaxed

2012: One step forward and two steps back

2014: No lightning ahead

In the seminar we continued with discussing what is known about software development and success factors, and we presented the results from the CHAOS report and research reports that show that one of the most important things when developing good IT for work is user involvement. But I guess that you already knew that 🙂

 

Patient Empowerment Meets Concerns for Patients – a Study of Patient Accessible Electronic Health Records in Sweden

The DOME consortium presented a paper at the conference Medical Informatics Europe (MIE 2016), in conjunction with Health – Exploring Complexity: An Interdisciplinary Systems Approach (HEC 2016), At Munich, Germany this summer.

Both the slides and the short abstract for the presentation is found on Research Gate. 

The paper contrasts the perspectives of physicians and nurses when it comes to putting medical records online for patients to read and discusses how patient empowerment (which is one of the goals of putting medical records online) meets concerns for patients.

The presentation at the conference was made by the very professional Christiane Grünloh and  Hanife Rexhepi, and the paper was written by then and other DOME researchers: Rose-Mhaire Åhlfeldt, Gunilla Myreteg,  Isto Huvila and me.

The paper addresses the  difference in perspective between physicians and patients that we have seen in our studies.

It is a paper well worth reading, and the presentation has excellent slides presenting the difference. Read it!