Winding Road to Become Professor of Human Computer Interaction

Next week it is time to celebrate that I have become a new professor of Human Computer Interaction. Up until a couple of years ago I would never had thought that this would happen. The typical professor in my world is odd or excentric, very smart and a man. Well, perhaps I am a bit excentric? Hmm. Especially when it comes to sleeping I do follow a slightly different orbit from the rest of society. I am indeed a proper party pooper and fall asleep early in the evenings  :-o. Also my winding background is not very traditional for professors. There was a recent paper about my background in ACM Crossroads found here for those who are curious. But I do not see myself as very smart at all, and I think I am quite an average person generally. Moreover, I am very happy about being a woman.

How did I then end up being a professor of Human Computer Interaction? Well, I think that my best abilities as a researcher is curiosity and being brave. Also I think that Human Computer Interaction is an area that fits well with my interests as it is transdisciplinary. In short: I can fit the areas that I am interested in well into the subject of Human Computer Interaction even though they transcend education, enterprise usability, eHealth, gender and wellbeing. There was a text about my research on the university’s web page found here. Finally, I am convinced that I would not have come this far without the fabulous people I work with both in the HTO group, the UpCERg group and internationally. In a good collaboration everyone is a winner and research becomes so much more fun. A good example of this is that my colleagues Mats Daniels and Arnold Pears are also inaugurated as full professors at the same ceremony as I am, and also the important research that my colleagues and I do.

The inauguration of full professors is a public ceremony with newly appointed professors and this year it takes place on the 16th of November at 15.00. The ceremony has its roots in the medieval times and has been held every year since 1625. Perhaps I’ll see you there?

inauguration.jpg

 

 

 

Philips Future Health Index 2018 released

Last July, I was approached by someone from the Philips team in London that works on the Future Health Index program. Previously they launched the first part of the 2018 Future Health Index, which is the indicator of the value delivered by 16 national health systems from around the world. For the second part, they wanted to produce some tangible guidelines on how things can improve and drive change within the industry.

In order to develop these guidelines, they interviewed 12 key opinion leaders (KOLs) across the Netherlands, US, UK, Australia, Germany, China, Sweden and Estonia – and I was one of them.

The Interview Questions

The interviewer was so kind to send me the transcript of my interview, otherwise I probably would not have remember them. I really enjoyed talking to him, which is not surprising given that people’s experiences with and attitude toward eHealth services is my PhD topic.

We started with my PhD research and I gave a background on the Swedish patient portal through which Swedish citizens can access their electronic health records online. We talked about the initial reaction from healthcare professionals and the conflict between the project and the local medical association (you can read about it in this article), how patients receive it, and what I think about this situation compared to, for example, Germany. Research within the DOME consortium indicates that the initial concerns of physicians might not have become reality and that many patients value direct access to their records, increased their understanding of their medical issues as well as their sense of control. In relation to that, I was asked whether the lesson would be to impose the intended change even if it is against heavy criticism of particular stakeholders. This really is a tricky question, especially in a context like healthcare in which a power-imbalance between clinician and patient still exists. I think, if real change is supposed to happen, sometimes consensus is impossible if the people who are supposed to change are against it. But at the end of the day, all stakeholders (like patients, family, physicians, therapists, nurses, management, insurance etc.) are (or should be) “in the same boat” so to speak and work together.

One of my favorite quotes on this is from Greenhalgh et al. (2012) who called for more effective inter-stakeholder dialogue in relation to telehealth and telecare:

The different interest groups described in this paper are likely to continue to exist in an uncomfortable truce with one another, competing for dominance as they gain more or less public appeal, professional credibility, political power, resource and so on.

and with reference to Checkland & Holwell (1998) they add:

While consensus is not a realistic or even desirable goal, surfacing such things as assumptions and values, and inviting debate on their significance through intersectoral and interdisciplinary dialogue will help achieve what systems thinkers have called ‘accom- modation’ (acknowledgement of, and adaptation towards, other perspectives and practices).

Future Health Index: Key Recommendations

I recommend to read the full report, which you can download here: Part 1, Part 2. According to the Future Health Index research, ‘universal’ electronic health records plays an important role in the future, for example regarding integration of and more effective use of data. They identified five key concrete recommendations to overcome challenges and drive integrated care:

  1. Get regulation right.Clearly defined polices and robust data privacy and security standards at the national level build confidence in all parts of the healthcare continuum and help healthcare institutions develop their own data codes of practice, as well as encouraging healthcare professionals and the general population to collect, share and analyze data with greater confidence.
  2. Modernize education.Healthcare professionals won’t demand EHRs and AI tools at work if they don’t learn to rely on them during medical training. Increasing healthcare professionals’ adoption of these tools must start with their integration into medical school curriculums.
  3. End top-down implementation.Healthcare professionals are unlikely to adopt new tools when they’re presented as a ‘fait accompli’ by technologists. Creating EHRs and AI solutions in collaboration with both healthcare professionals and the general population will have a significant impact on successful integration.
  4. Prove and explain value.Both healthcare professionals and patients need to be able to easily understand how data collection and analytics tools make a difference. Constantly measuring and communicating outcomes will create a body of evidence that will help bridge the understanding gap.
  5. Harmonize data standards.Companies, healthcare professionals and governments in each market must work together to reach a greater degree of consensus on data formats and protocols.

Parts of this post originally appeared in a slightly different form on the my personal blog.

Closed Loop Medication

My name is Iosif Kakalelis and I’m towards the end of my master studies in computer science at Uppsala University. I have finished my four-year bachelor in my hometown Thessaloniki in Greece, where I studied Applied informatics at the University of Macedonia, a business school. My degree combines IT with business, marketing and economics. Here in Sweden, it is more flexible in terms of forming study plans. During my first year l, I experimented with different courses but in the end I realized that I was still more interested at working in real-life projects dealing with  needs of society. Hence, I chose to do my master-thesis at Uppsala University Hospital.

Nowadays, technology has been embraced by society in almost every applicable field. Healthcare is no exception. New, innovative technologies are gradually being introduced in different health facilities around the globe in order to make healthcare more effective, less costly and better monitored.

Uppsala University Hospital intends to introduce Closed Loop Medication [1] to its whole workflow. Pre-studies have already been carried out and certain funds are available for this ambitious project. This suggested solution concerns almost everyone involved in healthcare. Most often the end-users are nurses, who first check and then administer the prescribed medicine to patients. Other examples of people affected by this change are doctors who prescribe, pharmacists who control and verify the correct medicine doses but may also include storekeepers who inspect the availability of medical supplies. 

 The selected medication is prescribed on an unverified prescription order that is then transcribed. Transcribing includes performing multiple crosschecks of the prescription order to real-time patient information, healthcare industry practices, and medication information to generate a verified prescription order. After transcribing, the appropriate dispensing method is determined for the prescription order and dispensed. The dispensed medication is administered after confirmation by the administering clinician of the right patient, right medication, right dosage, right route, and right time. The whole process of medication use described above is monitored continuously in real-time. The monitored information is communicated to the prescribing, transcribing, dispensing and administering parts of the system. [1]

In other words, automation is part of the entire process, starting from the doctors who are prescribing medicine, pharmacists checking and verifying the prescribed medicine, nurses receiving medicine from vending machines and finally the patient being given prescribed meditation in a customized package for him. The reason for automating the process is ultimately to achieve improvement in the accuracy and speed of the medicine distribution chain. Although the hospital today is considered technologically advanced, they are currently using different software, which was developed and often owned by third parties, for each part of the chain. Furthermore, for some specific tasks there is not even an available software solution. The drawback of this approach is that, often, there is limited to no communication and connection between the different software.

Even worse, there is not efficient communication and real time information between the different departments of the same hospital, because, as mentioned above, different databases and software are used, sometimes even for the same functions. Therefore, it is not uncommon for nurses, for example, to manually search for the available medicine on shelves, or doctors to call other departments to ask if a specific medicine is available there. All those factors contribute to making the whole procedure more time consuming and lead to harsher working conditions for employees and generally lead to the diminishment of productivity. Clearly, there is a need for the right medication, in the right place, at the right time, with the least possible effort and risk. Effectiveness could be achieved with closed loop medication through a centralized, interconnected, and interoperable information system which embraces all the functionalities of the current solutions. This system should be closely aligned with the current routines and working habits of the staff. The fact that the end-users are usually nurses or doctors, whose time is always prioritized toward patients, should spend the minimum possible time learning and using a software for their daily tasks.

Implementing a closed-loop system, is a broad and ambitious vision that people at the hospital shares, which involves many different specialists and knowledge from different fields including logistics. The area of my study is going to be the pharmaceutical verification step in close-looped-medication. Here in Sweden, doctors prescribe medicine to patients, but before the latter receive them, the prescription has to be verified and approved by pharmacists for safety reasons. After a meeting I had at the hospital with Dr Anders Westermark and some other medical personnel, I was told that currently there is no software responsible for implementing and monitoring that process. However closed loop medication necessitates a verification solution to be implemented. Thus, this is the part I want to get involved with and below my plan is described.

First, I plan to understand, analyze the workflow of this step from the perspective of all professions involved (i.e. doctors, pharmaceutical employees). A verification system should check if prescribed medicines uphold some predefined standards and/or whether they take into account each patient’s special needs or peculiarities. In case discrepancies are found, relevant warning indicators and messages should be triggered.

Second, I will try proposing solution ideas about this verification system answering questions about how it will look like, and how that would effectively fit inside the workflow, based on feedback I will receive from all the involved actors. This thesis motivates me to study papers regarding eHealth and automation in order to discover how knowledge of the others could give nice ideas for my project.  Since the topics is about improving healthcare, potentially I could also make a small literature research about AI and automation in health. The optimal solution would include a verification system that self learns and improves.

 It is also important to study the outcome this automation will have to the people. Role of technology is to serve people’s needs and not vice-versa. They should have control and opinion in the whole process and not kept outside the loop, like simple spectators. Therefore, it is my plans to study about potential problems that automation could bring. My final suggestions should take into consideration people’s considerations and concerns.

 

References

 

Henderson, D., Richard, L., Marklewicz, E., Tobin,C. (2003). CLOSED LOOP MEDICATION AND METHOD.

 

 

NordiCHI’18 – Key Note by Carly Gloge on Moonshot thinking at Google X and Pippi Longstocking Reflections

This week several members of the HTO group attended the NordiCHI 2018 conference in Olso, with the theme “revisiting the life cycle”. Here are some highlights from the first key note that we attended. In this key note Carly Gloge presented some work at company X which is Google’s “moonshot factory”. Their idea is to start with the really big problems first, and trying to solve them with innovation and technology. Some examples of innovations are self driving cars, here presented as reinventing the car driver.

This key note was really also addressing diversity as a success factor for the Moonshot factory, as well as being brave. Google X has really focused on diversity, and Carly Gloge says that this is one of the reasons why Google X has been so successful. A veryinteresting thing that came up related to this in the discussions section was the fact that Google is sued by Caucasian men that feel that they don’t have equal opportunities as other people at Google. They have ended up being accused of discrimination towards Caucasian men!

“If I would have known then what I know now, I would really have focused on diversity on my team in my previous jobs”.

Carly Gloge also presented their finding that psychological safety is at the core of successful teams. This finding is based on a Google investigation on successful teams where they ended up understanding that psychological safety was the only way to create a successful team, and not combining Type A personalities or “alpha males”.

They also very much focus on the growth mindset as a way of thinking, which means that you can always learn new things and that it is not innate to be an expert in something. This mindset is also mentioned as the “YET” mindset – I don’t know this yet and some in our HTO group has done some research on this mindset in computer science. This made us think of one of the famous quotes from Pippi Longstocking:

“I have never tried that before, so I think I should definitely be able to do that.”

― Astrid Lindgren, Pippi Longstocking

Carly Gloge tells us that the importance of diversity is also gaining traction in the asset management community, with large actors such as the US company Blackrock identifying diversity as a success factor that they include when creating their investment strategies.

Google has acquired a lot of companies, small and large, and Carly Gloge’s team is one composed of several such acquisitions. As with any acquisition this has its challenges, especially for a company aiming for radical solutions to the world’s problems. As Carly puts it, they frequently need to ask themselves “are we [our group/team] just a solution looking for a problem, or what are the problems we really would like to tackle?”

A suitable quote from Carly to start off this conference:
“If you obsess over your users, you can’t go wrong”

What is DevOps? Is it a person? A tool? Maybe a culture? Or all of the above?

DevOps illustration by Kharnagy [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

My name is Mikaela Eriksson and I am studying my last year to become an engineer in IT with a master in HCI. This autumn I will do my master thesis around the subject of DevOps and is fortunate to have  Åsa Cajander as my subject reviewer.

The project will be based on interviews held with people that are either working with or have thought about working with DevOps and especially focus on peoples views and feelings on the term.

After just a couple of weeks of research I can say that DevOps is without definition. For some companies it is a person, an engineer that knows how to ”make a process more DevOps”, for others it is about implementing a specific tool that helps the process to be more agile or a culture that is about renewing peoples way of thinking. However, it is still said to bring good results and productivity to a company.

How can a term that is interpreted differently and always evolving be of success where it sets its foot, or is it just that people say that they use this ”so called DevOps” to be cool on the market and that in real life the people within the process does not like it at all? At the end of this project, in January next year sometime, I hope to have the answer to this. To see what the common denominators are between the different organisations and what makes one group more successful than another, and most importantly, how DevOps perceived by the people working with it.

I will show my discoveries and research with you on this blog www.htogroup.org along the way!

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?