Insights from the Implementation of Open Notes in Sweden.

The implementation of Open Notes in Sweden, granting patients access to their clinical records, has been a complex and nuanced endeavor, marked by regional variations in strategy and challenges arising from the diverging needs of healthcare providers and patients. This paper presents an interview study with managers about the implementation process in five of the 21 regions in Sweden. The aim of this study is to explore the experiences and strategies of these managers in navigating the implementation challenges.

The Role of Health Informatics Research: A Case of a Large-Scale Implementation in Norway.

Many see the role of health informatics research as informing the development and implementation of information technology in clinical practice. The aim of this study is to see if this role is realized in the ongoing implementation of a large-scale health information system in central Norway. By doing a document analysis of the planning documents for the implementation, we assess to what extend evidence from the scientific community is explicitly referenced and used in the implementation planning.

Predicting Patient No-Shows: Situated Machine Learning with Imperfect Data.

Patients who do not show up for scheduled appointments are a considerable cost and concern in healthcare. In this study, we predict patient no-shows for outpatient surgery at the endoscopy ward of a hospital in Denmark. The predictions are made by training machine leaning (ML) models on available data, which have been recorded for purposes other than ML, and by doing situated work in the hospital setting to understand local data practices and fine-tune the models.

Technostress in Nuclear Medicine: A Qualitative Study of Causes, Mitigators, and Resolution Levels.

Background: In contemporary healthcare, information and communication technology enables specialized treatment and efficient information sharing. However, it also causes stress and frustration, so-called technostress, among healthcare staff.

Purpose: To investigate the day-to-day occurrence of technostress, we ask the research question: What causes the stressful situations with technology, how are they mitigated, and to what extent are they resolved?

Method: We interviewed 15 healthcare providers in the department of nuclear medicine at a Danish hospital about their experiences with technology-induced stress in their daily work.

Assessing metabolic risk factors for psychiatric patients: An IT-supported task shift from physician to pharmacist.

Background: Psychiatric medication can have adverse effects such as weight gain, which is a metabolic risk factor for the development of cardiovascular disease and diabetes. This study aimed to assess whether an IT-supported task shift from physicians to pharmacists could improve clinical guideline compliance in assessing metabolic risk factors for psychiatric patients.

Method: An IT tool was designed and implemented in the electronic health record to enable pharmacists to efficiently screen patients for metabolic risk factors.

Medication Reconciliation as Repair Work.

In Norway, the process of developing a national shared medication list has been underway for several years. The shared medication list provides an overview of all the medications used by a patient. However, its proper use requires that it be maintained regularly through so-called medication reconciliation processes in which health personnel clarify - and ask patients - what and how much medication they use.

Configuring Secretarial Workflows in the Epic EHR Suite.

The primary goal of large-scale electronic health record (EHR) suites is to meet the needs of a broad range of users in healthcare institutions. EHR suites are extensively configurable, which makes it possible to tailor them to diverse professional practices and users. However, while users such as physicians and nurses may have clearly defined responsibilities, clerical personnel (i.

Me-to-We Design: A Blueprint for Enriching Welfare Technologies.

Current technologies for ambient assisted living leave underexploited that social interaction is key to human wellbeing. Me-to-we design provides a blueprint for enriching such welfare technologies with social interaction. We present the five stages of me-to-we design, illustrate how it may transform a common class of welfare technologies, and discuss the distinguishing features of me-to-we design.

Implementing Large-Scale Electronic Health Records: Experiences from implementations of Epic in Denmark and Finland.

Background: With the still larger scale of electronic health records (EHRs), their implementation has become increasingly complex. In this study, we focus on one large-scale EHR - Epic.

Purpose: We analyze the Epic implementations in Denmark and Finland to understand how healthcare professionals experience this large-scale EHR.

Large-Scale EHR Suites and Path-Dependence.

Large-scale electronic health record (EHR) suites are expected to cover a broad range of use scenarios for healthcare workers in hospitals, nursing homes, home-care services, and general practitioner (GP) clinics. However, preparation for the implementation of EHR suites requires years of detailed planning and consumes considerable financial and human resources. A key problem, then, is that there is less room for decision-makers to consider promising alternative solutions both before and after the implementation of EHR suites.

National Integration Components Challenge the Epic Implementation in Central Norway.

Electronic health record (EHR) suites cover a broad range of cross-sectoral use scenarios. Thereby, they streamline information flows but also require that healthcare professionals with diverse responsibilities must adapt to one and the same system. In the region of Central Norway, the EHR suite from Epic is being implemented at hospitals as well as in municipal healthcare.

The Tension between National and Local Concerns in Preparing for Large-Scale Generic Systems in Healthcare.

Large-scale generic systems are typically adapted to local practice through configuration. This is especially important in healthcare, which involves a plurality of institutions and users. However, the decision to acquire a generic system in public healthcare is typically founded on regional and national health policy goals, which often are translated into various forms of standardization.

How Demanding Is Healthcare Work? A Meta-Analytic Review of TLX Scores.

This study establishes how demanding healthcare work is experienced to be and whether nurses and physicians experience different levels of workload. A meta-analytic review was conducted of 87 studies that reported Task Load Index (TLX) scores for healthcare work. Of these studies, 37 were conducted in real-life settings and 50 in lab settings without real patients.

Persuasion Tactics in the Implementation of Large-Scale EHR Suites in Public Healthcare.

Large-scale electronic health record (EHR) suites have the potential to cover a broad range of use needs across various healthcare domains. However, a challenge that must be solved is the distributed governance structure of public healthcare: Regional health authorities regulate hospitals, municipalities are responsible for first-line healthcare services, and general practitioners (GPs) have an independent entrepreneurial role. In such settings, EHR program owners cannot enforce municipalities and GPs to come on board.

Reference values and subscale patterns for the task load index (TLX): a meta-analytic review.

The Task Load Index (TLX) is the predominant instrument for self-reporting workload. On the basis of a meta-analytic review of 556 studies, this paper supplies reference values for TLX and its six subscales across domains, technologies, regions, and real-life/lab settings. Across domains, TLX spans mean values from 35 for leisure to 56 for manual labour.

Electronic Health Records in Danish Home Care and Nursing Homes: Inadequate Documentation of Care, Medication, and Consent.

Background: Electronic health records (EHRs) are used in long-term care to document the patients' condition, medication, and care, thereby supporting communication among caregivers and counteracting adverse drug events. However, the use of EHRs in long-term care has lagged behind EHR use in hospitals. In addition, most EHR research focuses on hospitals.

Drivers of expectations: Why are Norwegian general practitioners skeptical of a prospective electronic health record?

While expectations are well-known drivers of electronic health record (EHR) adoption, the drivers of expectations are more elusive. On the basis of interviews with general practitioners (GPs), we investigate how the early implementation process drives their expectations of an EHR that is being implemented in Norway. The GPs' expectations of the prospective EHR are driven by (a) satisfying experiences with their current system, (b) the transfer of others' experiences with the prospective EHR, (c) a sense of alignment, or lack thereof, with those in charge of the implementation process, (d) uncertainty about the inclusion of GP needs, and (e) competing technological futures.

How Come Nothing Changed? Reflections on the Fasting-Time Project.

Many healthcare interventions fail to produce the intended effect. In this paper we look back at the fasting-time project, which aimed to shorten patients' preoperative fasting times. However, the project failed to achieve this effect, even though it had been identified and prioritized by the clinicians at the studied hospital.

User Requirements Meet Large-Scale EHR Suites: Norwegian Preparations for Epic.

Electronic health records (EHRs) are becoming the norm in healthcare. Typically, these EHRs are large-scale suite systems. The up-front presence of ready-for-use EHR suites changes the role of user requirements and the conditions for deciding which requirements to include in the final contract.

The implementation of an electronic health record: Comparing preparations for Epic in Norway with experiences from the UK and Denmark.

Background: The implementation of electronic health records (EHRs) requires careful preparations but may still cause trouble. In this study we focus on one EHR - Epic.

Purpose: We compare the experiences from implementing Epic in the UK and Denmark with the preparations for implementing it in Norway.

The Handover from Intensive Care Unit to General Ward: Baseline Performance and Participatory Design of an Electronic Follow-Up Plan.

The transfer of patients from intensive care unit (ICU) to general ward involves risk to patient health. To mitigate this risk the present study investigates the current use of follow-up plans in the handover from ICU to general ward and proposes a novel design of follow-up plans. On the basis of a record audit we find that follow-up plans exist for only 16% of the audited transfers, that these plans are rarely used, and that 25% of the patients with a plan die within 24 hours of their transfer.

How Do Experienced Physicians Access and Evaluate Laboratory Test Results for the Chronic Patient? A Qualitative Analysis.

Background: Electronic health records may present laboratory test results in a variety of ways. Little is known about how the usefulness of different visualizations of laboratory test results is influenced by the complex and varied process of clinical decision making.

Objective: The purpose of this study was to investigate how clinicians access and utilize laboratory test results when caring for patients with chronic illness.

Successful System, Incomplete Data: Caveats in Reusing Activity Data from Emergency Department Whiteboards.

During the daily treatment of patients large quantities of data are recorded in electronic health records (EHRs). Compared to data in paper records, these EHR data are easily available for reuse in research and quality improvement. However, the opportunities for reuse depend on the quality of the data.

Grappling with the future: The messiness of pilot implementation in information systems design.

Pilot implementation is a method for avoiding unintended consequences of healthcare information systems. This study investigates how learning from pilot implementations is situated, messy, and therefore difficult. We analyze two pilot implementations by means of observation and interviews.

Effects-Driven Participatory Design: Learning from Sampling Interruptions.

Participatory design (PD) can play an important role in obtaining benefits from healthcare information technologies, but we contend that to fulfil this role PD must incorporate feedback from real use of the technologies. In this paper we describe an effects-driven PD approach that revolves around a sustained focus on pursued effects and uses the experience sampling method (ESM) to collect real-use feedback. To illustrate the use of the method we analyze a case that involves the organizational implementation of electronic whiteboards at a Danish hospital to support the clinicians' intra- and interdepartmental coordination.