Escape to the future - a qualitative study of physicians' views on the work environment, education, and support in a digital context.

BACKGROUND: The use of remote services such as video consultations (VCs) has increased significantly in the wake of the COVID-19 pandemic. In Sweden, private healthcare providers offering VCs have grown substantially since 2016 and have been controversial. Few studies have focused on physicians' experiences providing care in this context. Our aim was to study physicians' experiences of VCs, focusing on the work environment, quality of care, and educational needs. METHODS: Twenty-two semi-structured interviews were performed with physicians working with VCs in Sweden, and analyzed through inductive content analysis. RESULTS: We identified five categories; flexibility, social work environment, impact on care and society, continuous learning and career development, and organizational support. Flexibility and accessibility were considered positive features of working digitally by giving physicians control over their time and workplace and increasing patients' timely access to healthcare. Regarding collegial contact and social activities in a digital context, the majority of the participants did not experience any significant difference compared to the physical context. Access to technical support services, educational support, and collegial support in decision-making, guidance, and consultations were described as well-functioning. Satisfied patients positively impacted the work environment, and participants felt that VCs have a positive socio-economic effect. Continuity of care was considered supported, but patients did not always prioritize this. Privacy risks were considered a challenge, as were poor development of clinical skills due to the low variation of patient cases. Working for an online healthcare provider was contributing to career advancements for junior clinicians. CONCLUSIONS: Physicians appreciate the flexibility of the digital context and seem satisfied with a work environment where they have a high level of control, but few consider this a full-time career option. The pandemic year 2020 has led to a significant increase in the implementation of VCs in traditional care systems. How this affects the work environment and continuous education needs and career development remains to be seen.

Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform - a case study.

BACKGROUND: Patients and citizens need access to their health information to get a retrospective as well as a prospective view on their care and rehabilitation processes. However, patients' health information is stored in several health information systems and interoperability problems often hamper accessibility. In Sweden a national health information exchange (HIE) platform has been developed that enables information exchange between different health information systems. The aim of this study is to explore the opportunities and limitations of accessing and interacting with important health information through the Swedish national HIE platform. METHODS: A single case study approach was used for this study as an in-depth understanding of the subject was needed. A fictive patient case with a pseudo-name was created based on an interview with a stroke coordinator in Stockholm County. Information access through the national health information exchange platform and available service contracts and application programming interfaces were studied using different scenarios. RESULTS: Based on the scenarios created in this study, patients would be able to access some health related information from their electronic health records using the national health information exchange platform. However, there is necessary information which is not retrievable as it is either stored in electronic health records and eHealth services which are not connected to the national health information exchange platform or there is no service contract developed for these types of information. In addition, patients are not able to share information with healthcare professionals. CONCLUSION: The national Swedish HIE platform provides the building blocks needed to allow patients online access to their health information in a fragmented and distributed health system. However, more complex interaction scenarios allowing patients to communicate with their health care providers or to update their health related information are not yet supported. Therefore it is of great importance to involve patients throughout the design and evaluation of eHealth services on both national and local levels to ensure that their needs for interoperability and information exchange are met.

Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services.

BACKGROUND: Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients' information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes. METHODS: Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients' information needs was explored using patient journey model. RESULTS: Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients' post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients' journeys. CONCLUSIONS: Patient journey models and qualitative analysis of patients' information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients' understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients' information needs, it is imperative to understand the current care and rehabilitation processes and identify patients' information needs throughout their journey.

User acceptance of neuroanatomy virtual reality course: Contrasting views between undergraduate and postgraduate students.

Virtual Reality (VR) offers cost-efficient and effective tools for spatial 3-dimensional neuroanatomy learning. Enhancing users-system relationship is necessary for successful adoption of the system. The current study aimed to evaluate students' acceptance of VR for neuroanatomy. An exploratory qualitative case study based on Unified Theory of Acceptance and Use of Technology (UTAUT) framework carried out at [details omitted for double-anonymized peer review]. Participants in this study were students participating in a VR session, followed by a semi-structured interview. Deductive framework analysis employed to retrieve students' perspective and experience. A total of six undergraduate and 13 postgraduate students participated in this study. The following UTAUT constructs validated to be significant: Performance Expectancy, Effort Expectancy and Facilitating Conditions. System usability, depth of lesson and hardware optimizations are among concern for further improvements. In conclusion, students are accepting VR as a neuroanatomy learning resource. The findings of this research highlight the importance of system performance and user-centred approach in technology development for educational purposes.

Exploring the Operational and Technical Changes in the Healthcare Sector During the COVID-19 Pandemic.

The COVID-19 pandemic has affected the healthcare sector globally including Sweden, creating subsequent operational and technical changes to the wide range of digital healthcare services utilized by healthcare professionals or end consumers. A qualitative study using a self-assessment survey based on the national health services digital maturity assessment was used to study these changes from the perspective of personnel working in Swedish healthcare-related organizations. The number of 30 respondents was selected using purposive sampling, out of them 11 responded. The study highlighted positively perceived changes such as boosting digitalization, improving the procurement process, and introducing crisis management teams. Improving the offered digital services, the tools' effectiveness, efficiency, and technical support were also some of the results. On the contrary, the negatively perceived changes were limiting access to the services, limiting technical support, and reprioritizing non-essential services and projects.

Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study.

BACKGROUND: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. OBJECTIVE: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. METHODS: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. RESULTS: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients' disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. CONCLUSIONS: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group.

The Future of Online Video Consultations in Primary Care: A Qualitative Study.

The COVID-19 pandemic has significantly increased the use of remote services such as video consultations (VCs). In Sweden, private healthcare providers offering VCs have grown substantially since 2016 and have been controversial. Few studies have focused on physicians' experiences of providing care in this context. Our overall aim was to study physicians' experiences of VCs, here focusing on their suggestions for future improvements. Twenty-two semi-structured interviews were performed with physicians working for an online healthcare provider in Sweden, and analyzed through inductive content analysis. Two themes emerged related to desired future improvements of VCs; blended care and technical innovation.

To connect or not connect: long-term adoption of video consultations, and reasons for discontinuing use.

INTRODUCTION: This study investigates factors related to long-term and short-term adoption of video consultations (VCs) and reasons for discontinuing use among primary care patients. METHODS: A sample of primary care patients using VCs with healthcare providers were invited to take a survey in a cross-sectional study. Participants were asked about their intention to continue to have video consultations in the future, and those indicating no intention to use VCs in the future (short-term adopters) were asked about their reasons for this. Prevalence and statistical differences between long-term and short-term adopters were investigated. RESULTS: There were several statistically significant differences between long-term and short-term adopters (76% vs. 24%). Long-term adopters consisted of more middle-aged individuals (35-54 years) and the majority worked full-time (56%). They had more positive opinions of VCs and used VCs and video meetings for other purposes to a larger extent. They chose VCs because of the lack of time to go to the healthcare centre and because their provider offered them. The most common reason for discontinuing use was a preference for face-to-face consultations, with the youngest age group (16-34 years) reporting this to a larger extent. DISCUSSION: Younger and older age groups may be less likely to continue the use of VCs, potentially preserving the digital divide. Additionally, disparities in using similar technologies might contribute to the digital divide. Moreover, convenience, positive opinions of VCs, and experience with VCs were related to long-term adoption. Further studies are needed to explore non-use, age's influence, and address usability issues.

Patients' Experiences of Initiating Video Consultations.

Implementation and adoption of video consultations (VCs) in healthcare are not straightforward. Experiences of initiating a VC could increase our understanding of adoption by patients. This study aims to report patients' experiences of installing and booking a VC in primary care. Most people found it easy to find and install the VC application. Those with a higher self-reported ability and habit of using digital services and the internet found it easier than those reporting lower ability and habit. About half of our respondents had booked their recent VC themselves, most of whom had done so through a telephone call or the application "Alltid Öppet". The booking process was perceived to be easy by most but more difficult compared to installation. The easy installation process might have led to higher adoption by older people. Nevertheless, during implementation more support should be provided to people with lower digital service and internet use abilities and habits as they might find VC set-up more difficult. More attention should be given to the booking process as it may be a barrier potentially influencing adoption.

Healthcare Professionals' Experience of Performing Digital Care Visits-A Scoping Review.

The use of digital care visits has been increasing during the COVID-19 pandemic. Learning more about healthcare professionals' technology experiences provides valuable insight and a basis for improving digital visits. This study aimed to explore the existing literature on healthcare professionals' experience performing digital care visits. A scoping review was performed following Arksey & O'Malley's proposed framework using the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The collected data were analyzed using thematic content analysis. Five main themes were identified in the literature: positive experiences/benefits, facilitators, negative experiences/challenges, barriers, and suggestions for improvement. Healthcare professionals mostly reported having an overall positive experience with digital visits and discovered benefits for themselves and the patients. However, opinions were mixed or negative regarding the complexity of decision making, workload and workflow, suitability of this type of care, and other challenges. The suggestions for improvement included training and education, improvements within the system and tools, along with support for professionals. Despite overall positive experiences and benefits for both professionals and patients, clinicians reported challenges such as physical barriers, technical issues, suitability concerns, and others. Digital care visits could not fully replace face-to-face visits.

Nurses' experience of using video consultation in a digital care setting and its impact on their workflow and communication.

Sweden as many other countries uses video consultation to increase patients' access to primary healthcare services particularly during the COVID-19 pandemic. Working in digital care settings and using new technologies, in this case video consultations, require learning new skills and adoption to new workflow. The aim of this study is to explore nurses' experience of using video consultation in a digital care setting and its impact on their workflow and communication. Fifteen semi-structured interviews were carried out with registered nurses recruited from a private digital healthcare provider. Interviews were recorded, transcribed, and analysed using an abductive approach. Nurses' workflow was modeled, and several categories and subcategories were identified: nurses' workflow (efficiency, flexibility, and information accessibility); communication (interaction with patients and interprofessional communication); user experience (change and development of the platform, challenges, and combining digital and physical care). Even though providing online care has its limitations, the nurses were positive towards using video consultations.

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content.

Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.

Students' Perceptions on Chatbots' Potential and Design Characteristics in Healthcare Education.

Chatbots may have the potential to support healthcare education by enabling personalized learning. Trust is a pre-requisite for the users to accept the chatbots. In this study we analyzed students' assignments of the MSc course "User Needs, Requirements Engineering and Evaluation" at Karolinska Institutet, aiming to explore the chatbots' potential in healthcare education and the design characteristics of chatbots that may enhance the trust. The students identified two courses: pharmacology and medical law, that have the potential to leverage chatbots' characteristics. Our analyses on the design characteristics they suggested resulted in: recognition; visibility of system status; anthropomorphism in communication; knowledge expertise, linguistic consistency; realistic interaction. Our results are in line with previous research. Future studies could investigate the educational impact on the learning outcomes and students' satisfaction when interacting with chatbots.

Care Professionals' Perceived Usefulness of eHealth for Post-Discharge Stroke Patients.

Despite many attempts to provide appropriate tools for supporting stroke patients in their care and rehabilitation processes, there is still room for improvement. We propose an online care and rehabilitation planning tool as a potential eHealth service for stroke patients. The aim is to study the care professionals' perceived usefulness of the planning tool. We developed and presented a functional prototype to a neurology team in Stockholm. Three focus groups were performed with the care professionals in the team and the data were analysed based on the unified theory of acceptance and use of technology. Although care professionals mentioned challenges such as time limitation for using the tool and issues related to the responsibility of the system, they were positive towards the tool and its potential usefulness in ease of understanding the rehabilitation process and support for collaboration.

Care Professionals' Perceived Usefulness Of A Rehabilitation Ehealth Service In Stroke Care.

Despite many attempts to support stroke patients, there is still room for improvement. The aim of this study is to gain insight into care professionals' perceived usefulness of an online care and rehabilitation planning tool. A functional prototype was developed and presented to a neurology team in a primary care centre in Stockholm. Three focus group meetings were conducted. The data were analysed based on the unified theory of acceptance and use of technology. The results indicate that the care professionals were positive towards the tool and described potential usefulness such as ease of understanding the rehabilitation process and support for collaboration among care providers and also cooperation between the patient and the team. They also identified challenges such as time limitation in daily care.

Collaborative interaction points in post-discharge stroke care.

INTRODUCTION: Lack of appropriate electronic tools for supporting patient involvement and collaboration with care professionals is a problem in health care. METHODS: Care and rehabilitation processes of post-discharge stroke patients were analysed using the concept of interaction points where patients, next-of-kin and care professionals interact and exchange information. Thirteen interviews with care professionals and five non-participatory observations were performed. Data were analysed using content analysis and modelling of interaction points in the patient journey. RESULTS: Patient participation and interaction patterns vary; patients requiring home care have a passive role and next-of-kin or nurses become advocates by coordinating care on behalf of the patient, whereas patients who are able to visit primary care coordinate their own care by initiating interactions. Important categories of participation include the following: participation in care planning, in monitoring risk factors and in rehabilitation planning. CONCLUSIONS: Designing a supportive electronic tool requires understanding the interactions and patients' activity levels at each interaction point. A tool for patients with higher activity level should support them to coordinate their own care, whereas for a less-active patient group, the tool could focus on supporting next-of-kin and care professionals in motivating, guiding and including passive patients in their care and rehabilitation processes.

Steps to consider for effective decision making when selecting and prioritizing eHealth services.

Making the best choice for an organization when selecting IT applications or eHealth services is not always easy as there are a lot of parameters to take into account. The aim of this paper is to explore some steps to support effective decision making when selecting and prioritizing eHealth services prior to implementation and/or procurement. The steps presented in this paper were identified by interviewing nine key stakeholders at Stockholm County Council. They are supposed to work as a guide for decision making and aim to identify objectives and expected effects, technical, organizational, and economic requirements, and opportunities important to consider before decisions are taken. The steps and their respective issues and variables are concretized in a number of templates to be filled in by decision makers when selecting and prioritizing eHealth services.

My care pathways - creating open innovation in healthcare.

In this paper we describe initial results from the Swedish innovation project "My Care Pathways" which envisions enabling citizens to track their own health by providing them with online access to their historical, current and prospective future events. We describe an information infrastructure and its base services as well as the use of this solution as an open source platform for open innovation in healthcare. This will facilitate the development of end-user e-services for citizens. We have technically enabled the information infrastructure in close collaboration with decision makers in three Swedish health care regions, and system vendors as well as with National eHealth projects. Close collaboration between heterogeneous actors made implementation in real practice possible. However, a number of challenges, mainly related to legal and business issues, persist when implementing our results. Future work should therefore target the development of business models for sustainable provision of end-user e-services in a public health care system such as the Swedish one. Also, a legal analysis of the development of third party provider (nonhealthcare based) personal health data e-services should be done.