Category Archives: Uncategorised

Many Factors Behind IT Stress

The magazine Publikt did a survey study with public authorities. The results showed that there are enormous work environment problems related to the IT systems. Many of the union elected representatives who responded to Publik’s survey indicate that employees are stressed and frustrated due to the shortcomings of IT tools.  In their presenteation of the survey, I was asked to comments on the results:

“Most people I interview now have 15 to 20 different systems, including smaller systems like phones and other. If you go back ten years in time, nobody could know or suspect that this development could happen. The situation has just arisen, and this has contributed to this enormous problem.”

Some of the problems experienced by users can be linked to the difficulty of meeting the needs of the business with standardized systems.

“Standard system fits no one,” says Åsa Cajander. There are too long distances between those who use the systems and those who develop them. Even if you have user groups or the like, it’s very hard to make it work.

Developing and managing your own system is of course much more expensive than buying a standard system, she states.

“But you start counting the costs in a big organization, then maybe it would pay off. This could be a research study.”

The full article in Swedish is found here:


Making Films as a Part of Your Learning: Adoption and Evaluation of the Self Flipped Classroom Concept

We got some funding for pedagogical development work from the Faculty of Science and Technology at our university. This will give us the possibility to explore the self-flipped classroom concept in two different courses, and to evaluate the effects of the approach. The idea that we have used so far is that students make films that other students learn from. The films are discussed in workshops to get a thorough understanding of them.

I will collaborate with Mats Daniels and Anne Peters in this project, and hopefully we will also get some help from Anna Vasilchenko from NewCastle University.

Here is the abstract of the application: 

Learning by making, as pointed out by for instance Seymour Papert, is a well known strategy for efficient learning. However, the ideas are rarely used in practice. The self-flipped classroom (SFC) concept is a promising idea for using the learning by making approach with a reasonable time cost for students. It is also a student contributing pedagogy, which is one of the focus areas in our faculty. We will adopt, implement and evaluate the SFC concept for two different courses, where we will have a focus on making videos. The overarching aim for this project is to develop pedagogically anchored strategies for using the SFC concept that will help teachers who want to use this concept in a scholarly manner. This work will include tailoring the SFC concept to two different course contexts, studying how the pedagogical interventions are received by the students, including effects on their learning, and working on dissemination of findings and observations.

New Publication: Patients reading their medical records: differences in experiences and attitudes between regular and inexperienced readers

The national patient survey related to medical records online has resulted in a new publication. This one is focusing on older patients and their use of the system. The paper is a collaboration with the HIBA project in Finland led by professor Isto Huvila. The team behind the paper also included Jonas Moll, Heidi Enwald, Noora Hirvonen and Rose-Mharie Åhlfeldt.

The results are not super surprising, but still relevant. Older patients are more likely to use the phone when seeking clarification, whereas younger people use the internet. There are clear clear age differences shown in the data.

The abstract is coped below. And the full paper is available online:


Introduction. Patient accessible electronic health records can be used to inform and empower patients. However, their use may require complementary information seeking since they can be difficult to interpret. So far, relatively little is known of the information seeking that takes place in connection to health record use, and especially the way it varies in different age groups. A better understanding of patients’ preferences of where and how to find explanatory information provides valuable input for the development of health information provision and counselling services.

Method. The analysis is based on the results of a national survey of Swedish individuals (N=1,411) who had used a national patient accessible electronic health record system (Journalen).

Analysis. The data were analysed in SPSS 24.0 using Kruskal-Wallis tests for detecting group-wise differences and Jonckheere-Terpstra tests for discovering age-related trends in the data.

Results. Older patients were more likely to use a telephone and younger patients to use social contacts to ask for clarification. Generally, older adults born between 1946–1960 appear as passive information seekers.

Conclusion. Age groups differ in their preferences on how to seek clarification, which underlines the importance of a better understanding of individual differences in delivering not only technically but also intellectually accessible health information. Calling by telephone could be a habit of present older generations whereas, to a degree, searching information online could be a comparable habit of current younger generations.

Recent Publication: Why do They Need to Check me?” eHealth as Power Struggle in the Doctor-Patient Relationship

Physicians have a very stressful situation and many of them risk stress symptoms due to working too hard. The situation in health care is indeed alarming, and the numerous new IT systems introduced and changing health care are not always well received. One doctor I met asked:

What is the problem they are trying to solve with these new systems, the only thing they do is to create new problems!!

There is also research studies describing this situation such as as Sofie Wass and Vivian Vimarlunds publication named: I got 99 problems and eHealth is one which signals the same thing as the above quote.

When patient accessible electronic health records was launched into the lives of physicians many of them strongly disliked the idea. Some of them even thought of the system as a threat to their profession, and thought that the system was there to monitor physicians and the mistakes they make. Like the cat in the picture who sneaks and peaks on something patients would use patient electronic health records to sneak on physicians and control them as in the question in the title of the paper “Why do they need to check me?”.  There was indeed a very long list of things physicians worried about, and in this publication we dig into and explore some of their perspective on the system. The abstract is coped below, and the full publication can be found here.  The paper is written together with the excellent Christiane Grünloh, Gunilla Myreteg and Hanife Rexhepi.


Background: Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients.

Objective: This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians’ constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement.

Methods: A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed.

Results: Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient’s role, lack of skills (technical or regarding medical jargon), motives to read, and patients’ characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care.

Conclusions: Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of “power” in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of “monitoring the doctor” but to make sense of the situation.


We Need to Digitalise Carefully – My Professor Installation Lecture

I did my professor installation lecture last week. And of course I was super nervous. And of course I as usual felt:

“Why on earth did I agree on doing this”.

This was of course also combined with a sense of imposture syndrome including thinking that everyone else that is a full professor has understood everything about their subject area. My area just evolves and becomes more difficult to explain by the day. Sigh.

The abstract of the lecture is found below:

Systemutvecklingsarbete är svårt, och många IT-system fungerar inte på ett tillfredsställande sätt trots intensiv teknikutveckling. Min forskning handlar både om att förbättra situationen och att förstå vad problemen beror på. Jag forskar på att ta fram förbättrade arbetssätt i de organisationer och i de projekt som utvecklar och inför IT. Fokus här är användarcentrerade metoder, genus, sociotekniskt perspektiv och agil utveckling. Jag har också forskat på de kompetenser som personerna i projekten behöver bemästra för att kunna arbeta med utveckling av komplexa system som stödjer människor på ett bra sätt.

The lecture is found here:

Investigations in Primary Care – this Years’ IT in Society Project

I am one of the faculty scaffolding students in the course “IT in Society”. I work together with Cary Laxer, Anne Peters and Mats Daniels on the course. This is a course where students work on a joint project together with Region Uppsala. Region Uppsala is a politically managed organization responsible for health, public transport, culture, and regional development issues. According to their web they work with the county’s municipalities, colleges, business and other actors to create the best conditions for us as residents. The Region comes up with a burning hot topic for the students to investigate, and this year they have chosen primary care.

Primary care in Sweden has quite an awful situation, and there are lots of people who quit their jobs and move to other part of health care. This results in an even worse situation for those who stay in primary care who for example get more patients, and the costs for hiring temporary staff is alarming. The number of patients increase every year due to an ageing population that live longer with multiple kinds of deceases. Turnaround of staff in primary care makes patients meet different doctors more often than the same doctor when needing care. Also they experience that primary care cannot offer an appointment quick enough when you are ill. This also results in a new market for digital doctors where patients can get an appointment using for example their iPad and a video meeting. These appointments are easy to get, and often within 30-45 min you get to meet a doctor and at the same cost as going to a primary care unit. However, studies have shown that the digital doctors get to meet patients that want advise of a kind that you traditionally in Sweden do not see a doctor for getting. This Has lead to enormous costs for society, but at the same time to patients thinking that they get good service.

My team in the IT in Society course this year are looking into the situation for frequent patients and primary care. This means people who frequently have the role to be patients and who have for example a chronicle condition such as diabetes. Often these people are older, as in the picture in the blog post, and many are not very prone to use technology but prefer people. In this they are investigating connected health as a phenomenon, and clinical support systems from the perspective of shared decision making. I am really enjoying the project this year, and most of the students are really brilliant and work hard.

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.


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!!