Workshop at EPJ, Uppsala University Hospital, about eHealth Benefits Realization

I attended a very interesting workshop last Thursday, arranged by Birgitta Wallgren at EPJ (the department for Electronic Patient Records), with the Advisory Board. The topic was eHealth Benefits Realization: “It doesn’t happen all by itself”.

Advisory Board is a global research, technology, and consulting firm helping hospital and health system leaders improve the quality and efficiency of patient care. At this occasion, the Global eHealth Executive Council’s Senior Research Director Doug Thompson discussed the major activities and purposes of eHealth benefits realisation, common challenges, and tools and solutions that could be of value to the hospital in Uppsala. The audience consisted of specially invited people from the hospital, managers (physicians) from different departments and specializations, project leaders, and IT-developers in different roles. The day included the talk from Doug, supported by a power point presentation, some practical exercises, and it included a break for lunch. In smaller groups, we discussed specific issues relevant for our hospital in Uppsala and then presented our ideas to the bigger group. We got valuable input from Doug on our thoughts and ideas.

The general question was how to realize performance improvements at the hospital with the support of information technology, such as the EPR, or clinical decision support (CDS). The message from the Advisory Board is that we need to work structured, and with an awareness that this is not only a “technology project”. By making use of six best practices, developed by the Advisory Board, it is possible to realize more potentials from EPRs than the “low hanging fruit” that were harvested already. The Advisory Board’s model is to have benefit driven implementation and optimization. By clearly stating the wanted benefits and by identifying what mechanisms are driving each benefit (making it occur) you create a common ground for actors where it is possible to analyze problems and decide on valid routes for action. Else, it may happen that your gut feeling is sending you a false image of what is going on. It is important that you know where you want to be heading, and you need some tools to make sure you are on the right track. This conclusion can certainly be of help in many situations in life!

Kick-off for a series of posts on teaching and learning

In addition to the research that we do, many of the members of HTO are involved in lots of teaching activities at the department of IT in Uppsala. Some of the courses we teach are in the area of health care, and here we have a very good collaboration with Region Uppsala. The setup of this collaboration is to aim for a win-win between students learning and the Region’s goals and visions. We have collaborated with the Region since around 2004, and it has resulted in many new learning opportunities as well as input to innovations in health care both for the Region and for the nation.

We also work with innovation and development of learning opportunities in our teaching. Åsa Cajander is a member of the Uppsala Computing Education Research Group, and this community gives lots of input and ideas for improvements of courses.

This semester we collaborate with Region Uppsala through our course on Medical Informatics and the course IT in Society. We also collaborate through joint master theses on topics of interest to the Region. We have asked a couple of our current students to write blog posts about their experiences during their thesis work, and this fall the HTO blog will contain a series of blog posts on teaching and learning activities related to the HTO group.

New Article in Press: Patients’ Experiences of Accessing Their Medical Records

In 2012, Region Uppsala gave its 300,000 citizens access to their medical records through a patient portal. Today, the service called Journalen has become the Swedish national service. The DOME consortium is conducting research on the effects of this service on healthcare and has conducted several research studies before, for example, an interview study with cancer patients, with physicians from different specialities, a survey with patients who have read their paper-based records, surveys with nurses and physicians. Given that the service has been launched already a few years ago, we wanted to investigate patients’ experience with the service and their motivation to access their record

Method: National Patient Survey

The questionnaire for the national patient survey was designed by several researchers in the DOME consortium and was informed by previous studies conducted. The process started in spring 2016 and was coordinated by Hanife Rexhepi from Skövde University. The final questionnaire addressed six areas:

  • General questions related to the PAEHR system
  • Questions targeting experiences from using the content of PAEHR
  • Information security
  • General questions about information needs, behaviour, and information-seeking styles
  • Personal health related questions
  • Demographics

Data was collected through the patient portal from June to October 2016.

Analysis: Overview of National Patient Survey

The questionnaire addressed several important aspects related to patients reading their electronic health records. To give an overview, we focused in this article on the following questions:

  • Why do patients in Sweden use Journalen? And how often do they use it?
  • What types of information are most valued by patients?
  • What are the general attitudes by patients towards Journalen?
  • What differences can be identified with regards to attitudes between different county councils in Sweden?

The analysis and writing process was led by Jonas Moll.

Summary Results

The survey was initiated by 2,587 patients on the national level. The majority of respondents responded to use Journalen about once a month and the most selected reasons for using it were:  1) to receive an overview of one’s own medical history and treatment, 2) to follow up on doctor’s visits, and 3) to become more involved in one’s own care.

The top three reasons why patients believe that Journalen is important are that it 1) makes them feel more informed, 2) improves their communication with care, and 3) results in a better understanding of one’s own health status. The most important resource, according to the survey, is test results. In general, the respondents had a very positive attitudes towards Journalen as a reform and considered access to their medical records as good for them. The attitudes did not differ greatly between respondents from different county councils.

The paper has been accepted for publication by the Journal of Medical Internet Research, is currently in press, and can be read as pre-print here.

Feature Image by rawpixel on Unsplash

Visiting period at the HTO May – June 2018 – Shweta Premanandan

Hello!
I had the opportunity to visit Uppsala University again during May-June 2018. And this time I was welcomed by the warm Swedish summer! I was at the HTO group to work with my co-supervisor Dr. Åsa Cajander on my PhD work. My earlier visit in November 2017 to the group was very successful during which I collected survey and interview data from the Swedish context. My research is to understand the role of culture in the acceptance and use of e-government systems. And hence, data from two contexts is really important for the quality of my work.

During the duration on my visit, I worked on analysing my interview data. I discussed my work with Dr. Marta Larusdottir and Dr. Minna Karlsson, apart from discussions with my supervisor. These meetings opened me to a wide variety of ideas to work on with my interview data and they look promising. I also took a training session at the University Library on the use of Nvivo 12 for analysing interviews and organizing my literature review section. I also presented my analysis work in the Vi2 research seminar. We had some interesting discussions and I received good feedback. I am now in the process of writing chapters of my thesis. Discussions with other group members and my office-mates also were extremely helpful in this regard. The most helpful aspect of being at Uppsala university is to be able to meet so many PhD students at the department (or at the local watering hole) who may not be from my area and who are doing some really amazing work and be able to discuss research.

Uppsala never ceases to amaze me! I got a good cultural experience when I got to be a part of the staff Midsummer party. The music and the dancing was just amazing. Interacting with a multi-cultural community also helped my research work immensely. I hope to share my research work through this blog site soon!

Organization, Artifacts and Practices, 8th workshop in Amsterdam

Organizations, Artifacts and Practices (OAP) yearly workshops remind of the fact that work in organizations happens in certain physical spaces, need certain time and is performed with the help of artifacts – even in the digital age. The theme for this year’s conference was ”Rematerializing organizations in the digital age” An overarching theme in the sessions I attended was places where we work – working from home or working in open space offices, especially hot-desking, i.e. not having a designated desk.

Timon Beyes’s opening keynote on ”The work of disconnection” discussed the increasing trend of learning to disconnect from the digital world – for example digital detoxes. His descriptions of how digital media has invaded our ways of thinking even when we try to disconnect was quite thought-provoking. The occasional giggle in the audience indicated that we to a certain extent recognised ourselves in the descriptions.

In the final panel the three days’ presentations on locations and open office spaces were summed up, and, generally, open offices were criticised on basis of many surveys and interview studies, some of them done in universities. The lack of privacy was acutely felt. In the overall effort of creating open offices, even people with functions the really demand private spaces (counselling, for example) found it difficult to assert their needs, as in Bernadette Nooij’s study. Identity crises – “who am I without my books”, as a university staff asked. And, actually, some people felt more lonely, when chatting at the door of a colleague was no longer possible. As Marie Hasbi has found out, there can be gender issues – not only had female workers problems in finding a space for their handbags (the lockers relatively far away, and nowhere to lock away the handbag when moving from the desk), the acts to re-territorialise desks could have gender aspects, as well as being exposed to all colleagues all the time. And the negatives seemed to persist.

Increased working from home often goes hand-in hand with hot-desking (so the number of desks can be kept lower than the number of employees). Melanie Goisauf had studied a well functioning public bureaucracy, where working from home was introduced and found out that control of the employees by the managers increased when the team control, built on common ethos and responsibility and supported by daily interaction diminished. Instead of “us” having responsibility towards the public, single employees shifted their responsibility towards the management, and the team spirit deteriorated as competition regarding individual performance increased. As managerial control based on performance measures increased, tacit knowledge disappeared from managers’ view.

Joshua Firth’s study from New Zealand at an ICT development company, developing tools for healthcare goes in line with the HTO results: Practitioners/healthcare workers find it difficult to really get a voice in development processes, even if they would be formally enlisted, and this trend seems to get stronger the longer the process goes on. Firth talked of building in neotaylorism in the healthcare software, and just like Taylorism in its time, it profoundly changes work practices, disempowers the (healthcare) workers and centralises managerial power.

Also Joao Cunha’s study on how people enlist other people’s help when they have to use online communication is interesting in healthcare, where more and more communication is supposed to use electronic forms instead of personal interaction. Cunha found that when people just have to send a message to a great unknown, and, thus positional power or personal relationships cannot ensure that their request will be heard, they invent different strategies in trying to ensure that the request is dealt with swiftly.

The workshop made great efforts for breaking up traditional academic lecturing styles with a number of panels and question-answer sessions. In this context Vrije Universiteit Amsterdam had an artefact I haven’t encountered before: A conference microphone shaped like a soft cube (see image). Instead of people running around with microphones, the “dice” was thrown around in the lecture hall. Fun – but also demanding that the person who had something to say had a fair ball sense to be able to catch and throw precisely enough. Still another academic ability coming on?

Inauguration of Åsa Cajander as New Full Professor

Åsa Cajander will be installed as one of around 20 new full professors at Uppsala University on the 16th of November 2018 between 15-17. There will be plenty of other people from the department at the same inauguration as we seem to be very successful this year in promoting full professors.

The inauguration ceremony has its roots in the medieval university, and is really one of the university’s grand ceremonies. During the week before the inauguration all the new professors will do lectures presenting their work. These lectures are recorded and can be found online for the curious reader.

Doktorspromotionen jan 2018 Foto. Mikael Wallerstedt

Uppsala University also has a very grand Conferment Cermony. The Conferment Ceremony and the Inauguration of Professors are the ceremonies which exist att all Swedish universities and research university colleges. While the Conferment Ceremony is connected to the individual faculties, each with its own promotor, the Inauguration is common to the whole university.

 

Workshop at Uppsala Health Summit 2018: Using Data for Better Cancer Treatments

The international Uppsala Health Summit is an annual meeting for dialogue on challenges for health and healthcare. The summit is a collaborative effort between eleven Swedish public and not-for-profit partners, led by Uppsala University. Each year, the summit focuses on one challenge for health and healthcare and the question on how to overcome obstacles from implementing knowledge from research and innovations. Around 200 personally invited experts from all over the world and from different sectors come together to engage in dialogues in plenum sessions and in solution-oriented workshops. Last year, delegates came from 39 different countries.

Summit 2018: Care for Cancer

This year’s summit takes place form 14-15 June 2018 is themed Care for Cancer. Patients today have more opportunities than ever to survive and even to recover from cancer. However, the world is facing growing incidence and prevalence of cancer and preventive actions (e.g., adopting a healthy life-style) can only solve some parts of the problem. The provision of financial resources as well as equal access to treatments is challenging for healthcare systems around the world, despite growing treatment opportunities.

Uppsala Health Summit 2018 focuses on how we can open up these opportunities for a growing number of patients, by making better use of data and technologies and on how such use can pave way for a more equitable access to the best possible treatment and diagnostics within any given context.

The programme is available here and addresses a broad range of topics in workshops and plenum sessions. Some of these are: precision medicine in cancer care, patients as a driving force to develop care, long term care for cancer survivors, access to treatments and diagnosis, implementing physical exercise in cancer care, and many more.

Our Workshop: Using Data for Better Cancer Treatments

HTO group members Åsa Cajander, Christiane Grünloh, and Jonas Moll are also organising a workshop on Using Data for Better Cancer Treatments.  In our workshop, we will make use of the Critical Incidents workshop format we have used before at other venues (e.g., at NordiCHI 2016, which is described in more detail in this paper, and at Medical Informatics Europe 2018, which Jonas wrote about on his blog).

A critical incident is an event that has happened to a person and that this person regards as important or significant in some way. Such an incident can be very useful to learn from, and thus it can be an event that is perceived as positive or as negative. Critical incidents have been used a lot for critical reflection in areas such as aviation (e.g., to analyse failures or human errors), health, education and social work.

For our workshop we reached out to experts and asked for incidents we could use in our workshop to inspire discussion in the group work. Kelechi Eguzo, Marije Wolvers, and Isabella Scandurra will present their critical incidents, which have been illustrated by Maja Larsson.

As the aim of our workshop is to develop Visions of the Future, we are very happy that Prof. Bengt Sandblad will give a keynote on Future Workshops, which is a well established method that has been used in various domains (e.g., healthcare, traffic control, administrative work). Making use of the instructions for a future workshop, we will then develop visions of the future from different perspectives: researcher, physician, nurse, or patient.

Together with more than 60 delegates who signed up for our workshop, we will sketch A Day In a Life in 2050. As workshops at the Uppsala Health Summit are solution-oriented, we are including answers to questions such as:

  • Who must be involved?
  • Who can take the first step?
  • How will this contribute to more efficient cancer care?
  • How will this contribute to more equal cancer care?
  • Improve to the individual patient’s quality of life
  • How can this influence which health decisions the patient and her kin can make?

We are really looking forward to the Health Summit and will also attend other workshops and plenary sessions. You can read the pre-conference report where all workshops are outlined here.

ECSCW–the Rise of the Machines?

ECSCW 2018 took place in the beautiful French town Nancy and was hosted by Inria. As always there was a friendly atmosphere and a nice mix of presentations. I was there to present an exploratory paper by Rebecka Cowen Forssell and myself, on the Digital Work Environment. (A presentation most likely to remembered mainly for the art nouveau homage to Nancy, I’m afraid). However, there were a lot of interesting presentations, and here I will highlight just a few topics that I personally found interesting.*

The initial keynote by Antonio Casilli on the micro work behind AI was worth the trip alone. It was a great presentation on a very important topic. Indeed, this dispelling of the myth of AI was a theme that came up in a number of talks, not least in relation to the promises of automation in Industry 4.0. I also had the opportunity in one of the breaks to listen to Edgar Daylight’s historical perspective on this–AI being notoriously famous for recurring hypes.

The presentations covered a wide range of topics, from the Tatbeer ritual (Majdah Alshehri) over socio-technical heuristics (Alexander Nolte) to digital sticky notes (Sarah-Kristin Thiel) but somehow it all fitted together. I guess part of this can be explained by some of the traditions of the ECSCW community.  Here, Stuart Geiger’s presentation of documentation work was a fine example of the ever present ethnographic perspective. The humanistic values were evident in Renwen Zhang’s talk on online support groups for depression in China as well as in Isaac Holeman’s plea for Silence.

There were quite a few presentations that were more directly relevant for my own work, including Luigina Colfini on work-life balance, Nina Boulus-Rødje on supporting knowledge workers and Pernille Bjørn on variations in oncology consultations. I also found Yuri Lima’s poster on a tool for assessment of disruptive ICT in the workplace very promising. In their study on collaborative design projects in school contexts Netta Ilvari and her colleagues used service research as a theoretical lense, a theory I have been considering using myself. 

However, the conference had a special focus on computer support for qualified industrial work—Industry 4.0/the industrial internet of things—and the challenges were well summarised by Thomas Ludwig from Siegen. The Siegen crowd was as always strong in quality as well as in quantity. There is a lot of interesting research going on there that seems to touch on many of the same topics we are studying, although in an industrial setting. As proven by the panel discussion, similar studies are of course taking place in other countries as well, examples were given from Austria and France.

Speaking of Austria, ECSCW 2019 will take place in Salzburg and we got a glimpse of the venu and the playful new facilities that Verena Fuchsberger and her colleagues are enjoying.

Who knows, maybe I’ll be back…

*A formal note: I refer just to the presenter here, in most cases there were co-authors, see the Eusset proceedings for full information.

Article in Interactions Highlighing the SIGCHI/EIT Health Summer School

Last summer many from the HTO group joined the SIGCHI/EIT Health Summer School that was organised in Dublin and in Uppsala/Stockholm. The photo in the blog post is from the amazing library at Trinity Colleague.

The magazine Interactions highlighted the summer school in their latest edition.

The article highlights some of the learning experiences from organising such a summer school, such as that demand is high for such summer courses, patient participation is very valuable and that it was easy to recruit contributors to the summer school.

I know that the other organisers of the summer school thought that it was a lot of administration, but all agreed that it was also great fun!

Interactions also highlighted some of the HTO groups’ blog posts about the summer school found here:

Jonas Moll: https://molljonas.wordpress.com/2017/07/01/ehealth-summer-school-in-dublin-day-5/

Christiane Grünloh: https://www.htogroup.org/2017/07/08/behaviour-change-social-practice-theory-and-learned-helplessness/

Diane Golay: http://dianegolay.ch/2017/07/05/on-humans-computers-and-why-users-should-not-be-blamed-for-struggling-with-computerized-systems/

 

Another Excellent Teacher in the HTO group!!

Now the HTO group has two excellent teachers as Åsa Cajander was awarded the title last week joining Lars Oestreicher who was awarded the title several years ago.

Uppsala University has a formal process for awarding skilled teachers the title “Excellent teacher”, and the title is connected to a salary raise. There is a board that appoints excellent teachers at each faculty, and the faculty of science and technology has one Board for Appointment of Excellent Teachers that meet every semester.

The curious reader find the guidelines for admittance of excellent teachers online in this pdf document.