HTO Participating in Discussions about AI and Digitalisation

Many from the HTO group are working in the area of AI, automation and digitalisation. Bengt Sandblad is writing a book in the area related to security. Gerolf Nauwerck does a study on automation of an application process in Social Services and Åsa Cajander is interested in the area from a work environment perspective. Also, we follow some of the ongoing digitalisation efforts with automation in health care through the DISA project.

We are all going to this interesting event where the effects on working life and work is discussed.

See you there!


Inbjudan AI AW 5.4.19

Gendered Healthcare Hierarchies, Ethics and Information Systems

Minna Salminen Karlsson did a very interesting seminar last week from the DISA research project. It was based on the doing gender perspective. The starting point was that we all behave in a spectrum with femininity and masculinity. In this way of looking nursing is coded as more feminine. And computer science is coded more as being masculine. These two communities also have two ways of looking at the world, and they are very different.

For example: Technical rationality dominates the computer science way of looking at the world, whereas nursing is more based on caring ethics. One difference in their world views is that technical rationality is bases on linear time view, whereas nursing care can be circular, parallel to other things and not always linear. Minna Salminen Karlsson also mention several other interesting differences.

Some assumptions that computer scientists often make when designing the system is hence:

  1.  “Expecting autonomous individuals with linear time”. However, nurses the nurses document at the end of the day and the system is not built for this. Nurses instead do many things in parallel.
  2.  “Obstructing a holistic view of patients = patients are a sum of their conditions.” The summary of the diagnoses is not useful for nurses, since it is built on the idea that all diagnoses are equally important and a part of the summary.

The abstract of her talk was the following:

The hierarchy of healthcare is gendered. This matters in the acquisition and implementation of information systems. The issues in and consequences of implementation of IS in healthcare can be better understood if they are seen as influenced by relationship between technology, as something that is mostly “done” by men (e.g. developers) and care, that is mostly “done” by women (e.g. nurses), in a (societal) context where technology is valued higher than care, and where the digitalization of healthcare is pushed forward by perceived economic imperatives. This is exemplified by analyses of the data collected for the DISA project (The effects of digitalization on nurses’ work environment), using theories of gender in organizations and the concept of ethic of care.

We are looking forward to hearing more about this interesting research!

The DISA project embarking on its last stage

The DISA team had a workshop with their reference group earlier in March, to prepare for the last stretch of the project: creating the eWorkEnvironment framework. To start with, the reference group, representing both people working in healthcare and other researchers, was given an update of the last developments of the project. Both Diane Golay’s presentation about nurses’ invisible work and Thomas Lind’s presentation of an interview study with the people responsible for acquiring, implementing and maintaining the systems inspired a lively discussion about further problems and in particular the gaps between the different actors: decision makers, IT professionals and nurses, and how usability falls in these gaps. The survey presented by Minna Salminen showed that younger nurses sometimes can be more negative to increased use of ICT, and that attitudes to a digital tool are not only grounded in attitudes to technology, but also, for example, in attitudes to patients and patient empowerment.

The afternoon was spent in discussions where the DISA team got several inputs to their original ideas of what should go into the eWorkEnvironment framework. The definition of the target group was one of the tricky questions discussed: “Decision makers” in the process of acquiring and implementing digital tools for healthcare are the target group, but they can be found at many different levels and in many different roles in the healthcare hierarchy and, in addition, the organization varies between different regions in Sweden. Once these “decision makers” are conceptualized, strategies are needed to make them interested in and observant to the effects of digitalization on nurses’ working environment, for them to be interested in the eWorkEnvironment framework in the first place. The reference group had valuable ideas of what strategies could be used to get the message through.

While the message from the DISA team has been that nurses need to be heard when implementing new digital systems, the reference group pointed out that also outside eyes are needed in the process: in addition to nurses’ experiences, outside eyes may help to verbalize aspects that may go unnoticed by nurses themselves.

The DISA team and the reference group agreed that a major problem is the “parallel pipelines” approach to digitalization: there are several actors who all work for more digitalization, but nobody has a whole picture on how the situation looks from the daily working perspective of a nurse and the different systems are not integrated. The normal way of working in projects exacerbates the situation: each introduction is a project of its own, that not only is not connected to other projects running in parallel, but is also often terminated long before the new digital tool has become a natural and useful part of nurses’ daily work.

Having a diverse and competent reference group is certainly an important asset for a project! We are grateful for their time – and are further inspired to try to give something in return, both for the healthcare staff and for the scientific community.

IT and Nurses’ Daily Work: An Invisible Burden – a Licentiate Seminar by Diane Golay

Last week Diane Golay defended her licentiate degree thesis with an opponent. A licentiate degree seminar is very similar to a PhD defense in Sweden and you have an invited external opponent to discuss the research done.

After an introduction to the proceedings of the licentiate seminar by Åsa Cajander, the main supervisor, Diane Golay provides an excellent overview of her work towards her PhD so far in the DISA project, studying the effects of digitalization on the work environment of nurses. The licentiate thesis is based on three research papers:

    1. Golay, D., Löscher, I., Lind, T. (Submitted): The Impact of Information and Communication Technology on Work, Workers, and the Psychosocial Work Context: Research Trends from 2000-2017.
    2. Golay, D. (2018): Analyzing Work-Related Technology Use From a UX Perspective: The HolisticUX Method. NordiCHI’18. The paper is found here.
    3. Golay, D. (Submitted): More Work, Same Hours: Invisible HIT-Induced Tasks in Nurses’ Everyday Work.

In her work Diane Golay concludes that nurses daily work life with healthcare information technology has clear benefits, such as more efficient ways or working. But healthcare information technology also results in “unexpected, unintended adverse consequences”. According to her research typical issues include “loss in efficiency, extra effort to carry out routine tasks, and the creation of new, HIT-induced work activities”. Diane Golay also concludes that health technology leads to new kinds of work that are invisible in the sense that, for example, these new activities are not recognized by management as work nor something taken into account when introducing more HIT.

The Abstract for the Licentiate Thesis: 

Information and Communication Technology (ICT) has been an increasingly pervasive component of most workplaces throughout the past half century. In healthcare, the turn to the digital has resulted into the broad implementation of Healthcare Information Technology (HIT). The impacts of ICT on work life have been investigated predominantly through surveys, although some researchers have advocated for the use of a qualitative, experience-based approach. Meanwhile, the existing body of research on the impacts of HIT on clinicians has painted a mixed picture of digitalization. Despite some clear benefits, HIT has indeed been found to have unexpected, unintended adverse consequences for hospital staff. Typical issues include loss in efficiency, extra effort to carry out routine tasks, and the creation of new, HIT-induced work activities. Simultaneously, research outside of the healthcare domain has shown that ICT could require extra effort from some users in order for the sociotechnical system to function properly – extra work often invisible to developers. Based on observation, interview and focus group data collected at a large Swedish hospital, this thesis set out to investigate the impact of HIT on hospital nurses from an experience based perspective, resulting in four main contributions. First, a method supporting experience-based data analysis, the HolisticUX method, is introduced. Second, 13 forms of HIT-induced additional tasks in nurses’ workload are identified, five of which are not acknowledged in previous research. Third, task avoidance is identified as a consequence of nurses’ increased workload, negatively affecting patient safety, care quality and nurses’ professional satisfaction. Finally, four factors are argued to contribute to a suggested invisibility of the HIT-induced time burden in nurses’ work life to management and developers: 1) lack of a holistic perspective, 2) the hidden cost of a single click, 3) the invisibility of nursing work, and 4) visible data, invisible work.

After Diane Golay’s great presentation of her work, Lina Nilsson invites Diane Golay to a discussion about her research so far as well as her plans for the future.

The discussion, touching on all parts of the thesis and diving into the particulars of the three papers, is mainly centered on how to improve on the work even more and interesting venues and possibilities for this in the remaining studies towards Diane’s PhD thesis. The overall impression of the discussion is of Lina being impressed with the work done so far, and Diane being very grateful for the discussion about the future and the additional input and tips moving forward. The discussion also touched upon subjects such as reliability and validity in this type of research, cultural differences between research areas studying IT in health care such as sociology and computer science, and much else. Throughout, Diane had no problems defending and motivating her choices and proved well aware of the limitations and risks involved in her research. Her research so far has already provided us with interesting contributions to the knowledge in our field, and we are looking forward to her future studies! 

By the end of the day we celebrated the Licentiate degree being awarded to Diane Golay with a set of delicious cakes.

Seminar with Lina Nilsson on “Social Challenges when Implementing eHealth in Healthcare – Organisational Experiences from Research and Development Projects”

Lina Nilsson’s does research on implementation of eHealth. She is a senior lecturer at the Linneaus University and works in health informatics. She has a background in sociology with leadership and management.

Lina did her PhD project in Applied Health Technology (up until 2014), on using IT to improve communication between patients and healthcare staff. In her thesis, she identified social challenges when implementing Information systems in a Swedish healthcare organization: power, alienation, professional identity and encounters are aspects that may influence the implementation process.

Today, she is engaged in education but also research and development projects with focus on eHealth at Linnæus University.  

During her talk she discussed the professional identity of being a good nurse that is not the same thing as being good at IT systems. That working with IT was not seen as a part of the core professional nursing profession, and that previous bad experiences of implementations affect future ones.

Suspicions based on previous experiences of implementations, attitudes along the lines of “it didn’t go that well last time, why should we trust this one to be any better?” are challenging for an implementation project in health care. eHealth can provide tools that are appreciated by health care professionals, but also affect their work in ways that they do not. For example by affecting traditional power structures between professions.

Today Lina Nilsson has focused her research on nursing. One thing that she has found is that ICT implementations solve certain problems related to work, but that it also introduces new problems. She is also working in a project, ePATH, directed at supporting patients and empowering patients in care at home. In another project, she is involved in researching how small and medium sized enterprises can compete more fairly with larger actors on the market for providing HIT to health care organisations.

Working in the HTO group for a week

My name is Edvin Cajander and I am 15 years old and come from 8th grade in Heby skola. I have been doing a work experience programme with the HTO group for one week.

I have updated the Project DOME page, including updating the pictures, some dates and information about the researchers. After that I updated the activities with some conference, presentations and meetings. I also worked on putting in some Journal papers and conference contributions and sorted them all out from the new at the top and the old ones at the bottom. When I was done with the Journal papers and the conference contributions I upgraded the Project DOME WordPress site to a subscription for 30 Skr a month, which gave me the ability to change the theme on the site and sorting everything out again.

Working as a Researcher was a tough ride with a lot of thinking trying to learn so much new thinks, at the start I felt like it would take years to do everything i was supposed to do but when I got into the instructions I ended up finishing all the things in a couple off hours. My Mother, Åsa Cajander, believed I would not finish everything in the length of my whole week, so she did not really believe me in that case. Then I got the other task to change the theme of the the project DOME site and I also finished that so now I am here got a new thing to do and write a blog about what I have done the last week.It felt like a very long week because I did so many new things and that was very exiting. It felt good doing something new this week and being around new people. I actually got stuck at my “missions” from mom and it actually was very fun working as a researcher.



Uppsala SciFest 2019

This is the second time visiting the Uppsala SciFest 2019, and it was an intense first day. School class after school class visited the booth in which I demonstrated the use of EEG-equipment as a simple Brain-Computer interface. The challenge is to focus your attention on one of two small circles on the screen in such a way that it starts to move. This is difficult since we are not used to using our brains in this way.

Full concentration, focusing on moving things on the screen, just by thinking hard.

However, after training for a couple of minutes, many of the visitors actually managed to make the desired circle move more than the circle not focused on. The problem is that it is not possible to describe how you do this since the learning is made in the brain, rather than as a conscious activity. This was a continuous source of slightly embarrassed comments: “I don’t know how I do it, but it just happens…!“. And that is a very good observation. This skill is actually very much like keeping the balance on a bicycle, you know when you get it right, but no one can tell you how to do it.

All in all, the first day at SciFest was a success, so I will just keep my fingers crossed that the rest of the SciFest will continue just as well, including on Saturday, when it is open to the public.

What could a digitalized primary healthcare look like in 2030? IT in Society Class of 2018 presenting at Vitalis

This years’ IT in Society Class got the task from Region Uppsala to look into primary care. Students in this class come from Uppsala University and the highly prestigious Rose-Hulman Institute of Technology. Anne Peters, Mats Daniels and Åsa Cajander are teachers in Uppsala, and Cary Laxer is the teacher in Indiana.

By the end of the semester they submitted an abstract to the peer-reviewed industry conference VITALIS – and they were accepted! The Vitalis conference is the leading eHealth conferences in the Nordic countries with more than 5000 participants who now have the opportunity to meet our students. See you at Vitalis!

Below is the abstract: 

What could a digitalized primary healthcare look like in 2030? This was the question addressed by a group of around 25 computer science students from Uppsala University and Rose-Hulman Institute of Technology in the US. To examine this question, they collaborated with healthcare professionals in Region Uppsala. In their semester long project, they researched the current primary healthcare system in order to find digitally related improvements that can impact how healthcare could look like in 2030. The research conducted is human-centered and seeks to define modernization methods that would improve the working situation for the medical professionals, as well as the patients’ experience. To grasp the current workflow in Region Uppsala we conducted a holistic overview from two perspectives: the patient perspective and the healthcare professional’s perspective. We found that the current primary care system has areas of improvement in the fields of User experience and Graphical User interfaces for computer systems that patients and staff members use. We also found that digitized self-assessment and triage is an area that can reduce the workload of the staff and enhance the patient experience.

Our research has also highlighted the need to find new digital tools and adapt the existing digital solutions to provide a better working environment for workers in primary care. This would imply moving away from “pen and papper” analog systems towards a more digitally integrated, cohesive system.

The suggestions that we provide in this presentation are based on sound scientific studies previously conducted and on extensive field interviews with more than 20 involved specialists and data gathering on the current system. We have also conducted two surveys in order to understand how patients feel in regards to the current primary care system and participated in observations to see how primary care professionals operate on a daily basis.

Some of the solutions we propose are:

– the smart, easy to use design of graphical interfaces that also adapt and learn the user’s behaviour to provide ease of access

– adding more real time alternatives to get in touch with medical professionals such as live chat messaging

– using wearable devices to monitor frequent patients’ clinical measurements

– modernizing the analog areas of the current system with the help of new technologies.

Looking forward into the future, we have ideas of how a future system could look like in 2030. The areas of improvement are relying on the continuous development of artificial intelligence and machine learning, all integrated to reiterate our objective: an efficient, human-centered primary care. We hope that these improvements would lead to a better medical system and change society for the better.

Three Key Note Speakers at the Next SuniWeb Conference

Join the HTO research group at the next SuniWeb Conference in Uppsala the 29 and 30th of April 2019! Three people from our research group will be keynote speakers.

All three researchers will be presenting on the 29th of April. First Diane Golay and Åsa Cajander will be talking in the morning about the latest research in the area of digitalisation and the work environment. This includes really interesting results from Diane Golay’s licentiate thesis related to invisible work and IT (from the DISA project). They will also touch upon fragmentation of time, changes in work tasks and the problems related to always being online.

Lars Oestreicher will be talking as the final keynote of the conference. His topic will be “How do you create communication systems for people with severe disabilities?”. In his talk, he will talk about web applications and non-excluding design.  In this way of doing design you focus on how to isolate the excluding factors already in the design process. He will also talk about his exciting research on young people with disabilities and music as a concrete example of to focus on abilities instead of disabilities.

Welcome to an International Summer School in User Centred Design and Health & Wellbeing in Finland

Welcome to an international course on interaction design!

This Nordplus funded class brings together practitioners, students, and teachers from Iceland, Finland, Estonia, Denmark, and Sweden to gain a higher level of digital literacy. The course provides the basic skills in user-centred, hands-on interaction design during two intensive weeks, including Google Design Sprint.

Experimental Interaction Design
29 July – 9 August, 2019
Aalto University, Finland (

Applications deadline: 31 March
Acceptance notifications: 19 April
More information:

For questions, please contact:
Ilja Šmorgun, Lecturer of Interaction Design, Tallinn University