Category Archives: Medical Records Online

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:


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! 


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.


Excellent PhD Thesis by Hanife Rexhepi

Some people are as magic as the sky in the photo for this blog post. These people are more brilliant than the rest of us, and it is a joy to discuss with them and learn from them. One such person is Hanife Rexhepi from Högskolan i Skövde. Not only is she knowledgeable and professional, but she is also a good team player and has great communication skills. I have worked with Hanife Rexhepi in many studies the last years as a part of the DOME consortium.  And I am looking forward to more collaborations in the future.

Next week Hanife Rexhepi will defend her excellent thesis that includes TWO papers awarded “Best paper” which says something about the quality of her work. I am really looking forward to listening to her presentation and to the discussion. I am sure that I will get lots of new ideas and insights! I will bring my iPad and take notes 🙂

Hanife Rexhepi has done research related to information systems in health care. The eight papers in the thesis are from her extensive work in the area, and are based on several research projects. Among other things her thesis contains an interesting study on cancer patients and their use of medical records online. This study has been presented on several occasions, one of which is found here. The study has also been widely discussed in media such as in this well written blog post by Christiane Gruenloh.  Hanife Rexhepi is also very active on Twitter and you find her Twitter account here

See you in Skövde at Hanife Rexhepi’s PhD defence on Tuesday the 22 of May 2018.

Key Note Speaker on International Workshop on Software Engineering in Healthcare Systems

I’m going to attend the 40th International Conference on Software Engineering. This is one of the ACM yearly conferences, described in this way on the web site:

ICSE, the International Conference on Software Engineering, is the premier software engineering conference, providing a forum for researchers, practitioners and educators to present and discuss the most recent innovations, research, experiences, trends and concerns in the field of Software engineering. In 2018 ICSE will celebrate its 40th anniversary, and 50 years of Software engineering – 50 years of tremendously successful promotion of research, education and practices in software engineering.

For me this will be the first time I visit this conference, and I will do a key note at one of the workshops of the conference. The workshop is called International Workshop on Software Engineering in Healthcare Systems. In my key note I will address the complexities of doing software engineering when stakeholders have conflicting needs and requirements, and give examples from the implementation of medical records online in Sweden.

The conference will be in Gothenburg in May 2018. I’ve been in Gothenburg a few times, and 90% of the cases it is raining and is really cold. I hope that the city is a bit nicer in May!

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. 




New Study : Managers and the Implementation of Medical Records Online

I am about to start a new study on the implementation of medical records online in different counties and regions in Sweden. This study is supported by INERA which is the coordinating organisation for you health services nationally in Sweden. It is also partly funded by my work in the NordWIT Centre.  The study is multidisciplinary, and there will be researchers coming from gender studies, medical Informatics and human computer interaction collaborating in the analyses and writing up of the data.

Next week I will do my first interviews, and later on we will distribute a survey to all regions and counties in Sweden. This study will focus on the implementation process and what happened in different parts of the country. The study will also focus on the experiences and careers of the managers and leaders who works with this.

The launch of medical records online for patients was indeed controversial in Sweden. Many physicians and nurses were worried that patients would read and become upset and anxious. Other concerns related to the work environment in healthcare, and the increased need of support from patients who might read their medical directors and be worried. At the same time many patients appreciated the system, and today the system is used by more than 1 million people in Sweden.

Sweden consist of autonomous County council and Regions when it comes to IT and eHealth. This means that they all individually decided what to show to patients, when to show it and also what not to show. In our study we will be investigating this process and what happened.

I am so thrilled about doing a study on my own again! Lately I’ve been supporting others very much, but now it’s finally my turn to do it myself again!

I will surely blog more about this in the future 🙂

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 


Trinity books-2362214__480.jpg

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.

PhD Dissertation by Thomas Lind – Save the Dates!

Excellent Thomas Lind will defend his PhD thesis in 2017. Thomas is one of the members of the HTO research group, and I am his main supervisor. Marta Larusdottir and Bengt Sandblad are co-supervisors.

Thomas has a background in socio-technical systems engineering, and his PhD is related to the deployment of ICT from a sociotechnical perspective.

Thomas Lind has started to wrap things up, and the preliminary title is:

A Sociotechnical Perspective on the Deployment of Information and Communications Technology

The thesis will be about deployment of ICT in organisations and it is based on his work in three different research projects:

  1. The Ivan project which was a collaboration with the county council in Uppsala where he worked together with Rebecca Janols and Bengt Sandblad.
  2. The DOME consortium where Thomas did studies on the design and deployment process used when implementing the system medical records online for patients.
  3. The SESSION project.  The New Ladok is probably the most important information system for higher education in Sweden. The system is currently being designed and gradually rolled out in parallel and will have a significant impact on the work practices of Swedish universities. Bengt Sandblad, Åsa Cajander, Thomas Lind and Gerolf Nauwerck are working in this project that started in 2012.

Preliminary dates for Thomas Lind’s Defence:

  • Final seminar: 24th of February 2017 in the afternoon (13-15). José Abdelnour Nocera is invited to discuss the first version of the thesis with Thomas.
  • Preliminary date for the PhD defence: 2nd of June 2017.