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1.
BMJ ; 367: l5725, 2019 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578180
2.
Stud Health Technol Inform ; 264: 843-847, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438043

RESUMO

The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered "Collaborative Care and Cure-system" for the management of elderly with multimorbidity, enabling continuous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal caregivers (ICG). In this study various components of the infrastructure were tested to fulfill the functional requirements and the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate a high level of satisfaction with all components. Early testing also provided feedback for technical improvement of the entire system, and the paper points out useful evaluation methods.


Assuntos
Computação em Nuvem , Multimorbidade , Idoso , Humanos , Assistência Centrada no Paciente
3.
Stud Health Technol Inform ; 264: 1126-1130, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438100

RESUMO

"Journalen" is a patient accessible electronic health record (PAEHR) and the national eHealth service for Sweden's citizens to gain access to their EHR. The Swedish national eHealth organization Inera, responsible for Journalen, created an inbox to receive voluntary user feedback about Journalen in order to improve the service from the user perspective. Based on voluntary user feedback via email. This study explored patients' experiences of using the national eHealth service and identified pros and cons. A mixed method content analysis was performed. In total, 1084 emails from 2016-2017 have been analyzed. 9 categories were identified, the most frequent ones related to questions about why some information was not accessible (due to regional differencies), feedback (including only positive or negative comments as well as constructive improvement suggestions), and emails about errors that user found in their record. These data can be successfully used to continuously improve an already implemented eHealth service.


Assuntos
Registros de Saúde Pessoal , Telemedicina , Registros Eletrônicos de Saúde , Retroalimentação , Humanos , Suécia
4.
J Med Internet Res ; 20(11): e278, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30389647

RESUMO

BACKGROUND: Internationally, there is a movement toward providing patients a Web-based access to their electronic health records (EHRs). In Sweden, Region Uppsala was the first to introduce patient-accessible EHRs (PAEHRs) in 2012. By the summer of 2016, 17 of 21 county councils had given citizens Web-based access to their medical information. Studies on the effect of PAEHRs on the work environment of health care professionals have been conducted, but up until now, few extensive studies have been conducted regarding patients' experiences of using PAEHRs in Sweden or Europe, more generally. OBJECTIVE: The objective of our study was to investigate patients' experiences of accessing their EHRs through the Swedish national patient portal. In this study, we have focused on describing user characteristics, usage, and attitudes toward the system. METHODS: A national patient survey was designed, based on previous interview and survey studies with patients and health care professionals. Data were collected during a 5-month period in 2016. The survey was made available through the PAEHR system, called Journalen, in Sweden. The total number of patients that logged in and could access the survey during the study period was 423,141. In addition to descriptive statistics reporting response frequencies on Likert scale questions, Mann-Whitney tests, Kruskal-Wallis tests, and chi-square tests were used to compare answers between different county councils as well as between respondents working in health care and all other respondents. RESULTS: Overall, 2587 users completed the survey with a response rate of 0.61% (2587/423,141). Two participants were excluded from the analysis because they had only received care in a county council that did not yet show any information in Journalen. The results showed that 62.97% (1629/2587) of respondents were women and 39.81% (1030/2587) were working or had been working in health care. In addition, 72.08% (1794/2489) of respondents used Journalen about once a month, and the main reason for use was to gain an overview of one's health status. Furthermore, respondents reported that lab results were the most important information for them to access; 68.41% (1737/2539) of respondents wanted access to new information within a day, and 96.58% (2454/2541) of users reported that they are positive toward Journalen. CONCLUSIONS: In this study, respondents provided several important reasons for why they use Journalen and why it is important for them to be able to access information in this way-several related to patient empowerment, involvement, and security. Considering the overall positive attitude, PAEHRs seem to fill important needs for patients.

5.
Stud Health Technol Inform ; 247: 336-340, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29677978

RESUMO

In Sweden, and internationally, there is an ongoing debate about the effects of national implementations of Patient Accessible Electronic Health Records (PAEHRs). The purpose of this paper was to describe the current situation in Sweden and compare this with the expectations on reasonable waiting time for information access of users of the Swedish PAEHR. Data were collected from publicly available resources regarding current implementation in the 21 county councils, contrasted with patient experiences, gathered from a national online survey. The results indicate that patients have high expectations on immediate access to information, while this varies greatly in implementation across Sweden.


Assuntos
Acesso à Informação , Registros Eletrônicos de Saúde , Internet , Registros de Saúde Pessoal , Humanos , Suécia
6.
Artigo em Inglês | MEDLINE | ID: mdl-29039366

RESUMO

In Sweden, and internationally, there is a movement towards increased transparency in healthcare including giving patients online access to their electronic health records (EHR). The purpose of this paper is to analyze the Swedish patient accessible EHR (PAEHR) service using a socio-technical framework, to increase the understanding of factors that influence the design, implementation, adoption and use of the service. Using the Sitting and Singh socio-technical framework as a basis for analyzing the Swedish PAEHR system and its context indicated that there are many stakeholders engaged in these types of services, with different driving forces and incentives that may influence the adoption and usefulness of PAEHR services. The analysis was useful in highlighting important areas that need to be further explored in evaluations of PAEHR services, and can act as a guide when planning evaluations of any PAEHR service.


Assuntos
Registros Eletrônicos de Saúde , Registros de Saúde Pessoal , Acesso à Informação , Assistência à Saúde , Humanos , Suécia
7.
Stud Health Technol Inform ; 245: 723-727, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29295193

RESUMO

The number of eHealth services for patients is rapidly increasing worldwide. This paper describes the status of a very important eHealth service for patients in Sweden, the Patient Accessible Electronic Health Record (PAEHR). As many countries are facing an introduction of national eHealth services providing health information to the patients, lessons learned from Sweden may improve the deployment and use of PAEHRs and similar eHealth services. Challenges that remain in Sweden relate to local differences in the implementation that lead to fragmentation and unequal access to information. Initiatives have been taken to reconcile some of the problems, e.g. an updated national regulatory framework for PAEHR. To date, evaluations are often performed from a healthcare provider perspective, focusing on aspects that are considered important by healthcare professionals and decision makers. Based on experiences of this nation-wide implementation we argue for the need to also base evaluations of eHealth on the perspective of the patients.


Assuntos
Registros Eletrônicos de Saúde , Registros de Saúde Pessoal , Atitude do Pessoal de Saúde , Humanos , Suécia , Telemedicina
8.
Stud Health Technol Inform ; 245: 798-802, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29295208

RESUMO

In Sweden, all citizens can (in 2017) access their health data online from all county councils using one national eHealth service. However, depending on where the patient lives, different information is provided as care providers have assessed differently how to apply the National Regulatory Framework (NRF). The NRF recently was updated and this paper analyses version 2.0 should now serve as the guideline for all county councils. Potential improvements are analyzed in relation to patient experiences of using the service, and the rationale for each change in the NRF is discussed. Two real case quotations are used to illustrate potential implications for the patient when the new version is placed into operation. Results indicate that this NRF allows for opportunities to create a national eHealth service that better supports patient-centered care and improves health information outcome.


Assuntos
Registros Eletrônicos de Saúde , Assistência Centrada no Paciente , Acesso à Informação , Registros de Saúde Pessoal , Humanos , Suécia , Telemedicina
9.
Stud Health Technol Inform ; 228: 695-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27577474

RESUMO

Online access to your own electronic health record is a controversial issue. In a Swedish county such eHealth service has been in operation since 2012 and it is now being widely deployed in the other counties. This first review presents work regarding current National Regulatory Framework (NRF) related to the public eHealth service Patient Accessible Electronic Health Record (PAEHR) and points out how electable paragraphs have been applied in different counties. Potential implications due to the different decisions made are discussed in terms of patient centricity and health information outcome. In current PAEHR, care providers have assessed differently how to apply the NRF. For the patients, this means that information gathered from the health record may be displayed differently, depending on where, when and why they seek treatment. When a patient visits different care providers such solution may cause confusion and its purpose may go lost. Consequently a revised NRF with less electable paragraphs is recommended, as well as adherence to the next NRF by all county councils.


Assuntos
Registros Eletrônicos de Saúde , Registros de Saúde Pessoal , Telemedicina , Humanos , Suécia
10.
Stud Health Technol Inform ; 225: 227-31, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27332196

RESUMO

Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.


Assuntos
Ocupações Relacionadas com Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Uso Significativo/estatística & dados numéricos , Assistentes Sociais/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Suécia
11.
Stud Health Technol Inform ; 216: 153-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26262029

RESUMO

Patients' increasing demands for medical information, the digitization of health records and the fast spread of Internet access form a basis of introducing new eHealth services. An international trend is to provide access for patients to health information of various kind. In Sweden, access by patients to their proper electronic health record (EHR) has been provided in a pilot county since November 2012. This eHealth service is controversial and criticism has arised from the clinical professions, mainly physicians. Two web surveys were conducted to discover whether the opinions of healthcare professionals differ; between staff that have had experience with patients accessing their own EHR and those who have no such expericence. Experienced nurses found the EHR more important for the patients and a better reform, compared to unexperienced nurses in the rest of the country. Similarly, physicians with their own experience had a more positive attitude compared to non-experienced physicians. The conclusion of this study is that healthcare professionals must be involved in the implementation of public eHealth services such as EHRs and that real experiences of the professionals should be better disseminated to their inexperienced peers.


Assuntos
Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Sistemas On-Line , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Acesso à Informação , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Suécia
12.
Artigo em Inglês | MEDLINE | ID: mdl-26262210

RESUMO

Sweden has had significant progress with the the introduction of electronic health records. A pilot county deployed in an eHealth service in 2012, giving access to health records for all of its patients. This eHealth service is, however, a controversial issue. Two surveys were conducted to discover whether healthcare professionals' opinions differ between professionals, and between staff who have had experience with patients using eHealth records and those, to date, who have had none. Experienced nurses found this eHealth service more important for the patients compared to unexperienced nurses outside the pilot county, as well as both semi-experienced physicians.


Assuntos
Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Prioridades em Saúde/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Suécia
13.
Stud Health Technol Inform ; 205: 221-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25160178

RESUMO

As many evaluations show, healthcare organizations do not accomplish the intended effects of their eHealth systems due to inadequate usability. On behalf of the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish healthcare have been analysed from the perspective of healthcare and social service professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, seven workshops were held where researchers within health informatics collaborated with staff from different care providers, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents a foundation for further development of eHealth systems, condensed into 10 issues that the Swedish health and social care professionals find imperative to improve. The study emphasizes that the development of eHealth systems is always a matter of organizational and process development and must be integrated into the care practice improvement process. Further, based on the findings, some identified challenges are discussed.


Assuntos
Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde , Uso Significativo , Informática Médica , Telemedicina , Revisão da Utilização de Recursos de Saúde , Suécia
14.
Med 2 0 ; 2(2): e12, 2013 Jul-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25075235

RESUMO

BACKGROUND: There is an increasing social isolation among the elderly today. This will be an even larger issue in the future with growing numbers of elderly and less resources, for example, in terms of economy and staff. Loneliness and social isolation can, however, be addressed in several ways using different interactive eHealth services. OBJECTIVE: This case study investigated novel eHealth services for the elderly, and their usage of a social interactive device designed especially for them. METHODS: In this work, we used an innovative mobile communication device connected to the television (TV), which worked as a remotely controlled large interactive screen. The device was tested by 8 volunteers who visited a senior center. They were between 65 and 80 years of age and lived in their own homes. Throughout the 1.5 year-long project, 7 design workshops were held with the seniors and the staff at the center. During these workshops, demands and preferences regarding existing and new services were gathered. At the end of the project the participants' experience of the device and of the services was elaborated in 3 workshops to get ideas for improved or new meaningful services. During the data analyses and development process, what seniors thought would be useful in relation to what was feasible was prioritized by the development company. RESULTS: Regarding daily usage, the seniors reported that they mainly used the service for receiving information from the senior center and for communication with other participants in the group or with younger relatives. They also read information about events at the senior center and they liked to perform a weekly sent out workout exercise. Further, they played games such as Memory and Sudoku using the device. The service development focused on three categories of services: cognitive activities, social activities, and physical activities. A cognitive activity service that would be meaningful to develop was a game for practicing working memory. In the social activities category, the seniors wanted different quizzes and multi-player games. For physical activities, the seniors desired more workout exercises and suggestions for guided walking routes. A new category, "information and news", was suggested since they lacked services like senior-customized global and local news. CONCLUSIONS: This study showed the importance of input from a group of seniors when designing new services for elderly citizens. Besides input to interactive eHealth service development for seniors, this study showed the importance of a social context around such work. The seniors were very engaged throughout the project and workshops were frequently visited and the seniors became friends. The high amount of input from the seniors could be explained in terms of social inclusion; they belonged to a group and each member was considered important for the work. The friendly workshop atmosphere facilitated new ideas and redesign of the services.

15.
Stud Health Technol Inform ; 160(Pt 1): 639-43, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20841765

RESUMO

There are numerous advantages described of how imaging technology can support forensic examinations. However, postmortem examinations of bodies are mainly performed to address demands which differ from those of traditional clinical image processing. This needs to be kept in mind when gathering information from image data sets for forensic purposes. To support radiologists and forensic clinicians using Virtual Autopsy technologies, an initial workflow study regarding post-mortem imaging has been performed, aiming to receive an improved understanding of how Virtual Autopsy workstations, image data sets and processes can be adjusted to support and improve conventional autopsies. This paper presents potential impacts and a current forensic Virtual Autopsy workflow aiming to form a foundation for collaborative procedures that increase the value of Virtual Autopsy. The workflow study will provide an increased and mutual understanding of involved professionals. In addition, insight into future forensic workflows based on demands from both forensic and radiologist perspectives bring visualization and medical informatics researchers together to develop and improve the technology and software needed.


Assuntos
Autopsia/métodos , Previsões , Modelos Biológicos , Interface Usuário-Computador , Fluxo de Trabalho , Simulação por Computador , Suécia
16.
Int J Med Inform ; 79(6): e126-34, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18762445

RESUMO

BACKGROUND: Shared homecare is increasingly common, and in order to develop ICT that support such complex cooperative and interdisciplinary work it is crucial to obtain an understanding of work processes at the clinical level before the development is initiated. It is also crucial, but difficult, to correctly transfer this insight to the development team. METHOD: User-centered scenario building in interdisciplinary working groups is applied for capturing cooperative work routines, information demands, and other central preconditions in shared homecare. RESULTS: Use of scenarios for analysis of cooperative work and as information carrier is described via a case from the multi-disciplinary OLD@HOME project. Both current and future work scenarios were elicited. To illustrate the process of transforming scenarios into more technical descriptions (use cases), and finally into an application, examples showing the transparency in resulting use cases and in the implemented system are provided. CONCLUSION: In this case study, scenarios proved to be useful not only in initial system development phases but throughout the entire development process, improving accessibility and assessment of end user needs. For the development team, scenarios assisted in solving usability issues, and served as a basis for describing use cases and for further system development. More importantly, the shared care scenarios ensured the provision of different perspectives on common work processes, which are often neglected in conventional requirements specifications. This also improved understanding between different clinical groups and between clinicians and developers.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Sistemas de Informação/organização & administração , Comunicação Interdisciplinar , Análise e Desempenho de Tarefas , Protocolos Clínicos , Comportamento Cooperativo , Humanos
17.
Telemed J E Health ; 15(1): 53-61, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19199848

RESUMO

The aim of the present research was to study outcomes of use of the OLD@HOME Virtual Health Record with regard to staff opinions about information, communication technology, and satisfaction with work. A quasi-experimental design was used. Staff opinions about the information and communication technology were assessed using a study-specific questionnaire at the test site (n =22) and at other settings in the municipality (n =172). Staff (n =22) job satisfaction, perceived quality of care, and psychosomatic health were assessed using the Satisfaction with Work Questionnaires before and after a 5-month period of testing the technology in an intervention and a comparison group. Staff opinions about the information and communication technology were significantly more positive at the test site compared to other settings in the municipality. For the total scale of quality of care and the factor documentation, there were significant differences in change scores between intervention and comparison groups, with improvements for the comparison group. For job satisfaction and psychosomatic health, there were no differences in change scores between the groups. Participatory design enhances staff opinions about information and communication technology. However, a 5-month test period showed no benefits regarding staff satisfaction with work when compared to a comparison group. On the contrary, the comparison group improved in documentation, and for the intervention group, there was a trend toward deterioration, which may be due to their knowing how to document, but not having time when using both paper-based and electronic systems.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Serviços de Assistência Domiciliar , Satisfação no Emprego , Telemedicina/organização & administração , Interface Usuário-Computador , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Sistemas de Informação Hospitalar , Humanos , Masculino , Sistemas Computadorizados de Registros Médicos/normas , Psicometria , Qualidade da Assistência à Saúde , Inquéritos e Questionários
18.
Health Informatics J ; 14(3): 195-210, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18775826

RESUMO

The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users' involvement and commitment, stimulating them to test and improve the prototype until the final version.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Sistemas de Informação/organização & administração , Telemedicina/organização & administração , Idoso , Idoso de 80 Anos ou mais , Comunicação , Pessoal de Saúde/organização & administração , Humanos , Sistemas Computadorizados de Registros Médicos/organização & administração , Estudos de Casos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração
19.
Stud Health Technol Inform ; 136: 597-602, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18487796

RESUMO

UNLABELLED: A significant problem with current health information technologies is that they poorly support collaborative work of healthcare professionals, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. OBJECTIVE: This paper presents two homecare cases, both applying multi-disciplinary thematic seminars (MdTS) as a collaborative method for user needs elicitation and requirements specification. METHODS: This study describes the MdTS application to elicit user needs from different perspectives to coincide with collaborative professions' work practices in two cases. RESULTS: Despite different objectives, the two cases validated that MdTS emphasized the "points of intersection" in cooperative work. Different user groups with similar, yet distinct needs reached a common understanding of the entire work process, agreed upon requirements and participated in the design of prototypes supporting cooperative work. CONCLUSION: MdTS was applicable in both exploratory and normative studies aiming to elicit the specific requirements in a cooperative environment.


Assuntos
Comportamento Cooperativo , Serviços de Assistência Domiciliar , Sistemas de Informação , Equipe de Assistência ao Paciente , Interface Usuário-Computador , Necessidades e Demandas de Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Planejamento de Assistência ao Paciente , Linguagens de Programação , Software
20.
Stud Health Technol Inform ; 130: 205-16, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17917194

RESUMO

Heuristic evaluation is a usability testing method aiming to improve the user interface design. Traditionally, a panel of experts in usability and human factor issues evaluate and judge the compliance of computer software according to recognized usability principles, the heuristics. In this paper, we investigate clinicians' attitudes towards learning and performing a heuristic evaluation and present the procedure of educating the healthcare staff and their accomplishment of the evaluation. 18 clinicians were recruited for a 2-hours education and filled in a post-education questionnaire regarding their opinions of the evaluation method when applied by clinicians. Six of the clinicians participated later in a heuristic evaluation of a web-based virtual health record,Their time spent for evaluation and analysis of results was approximately four hours each. Opinions from the six "clinical evaluators" were gathered in an post-evaluation form and compared to the post-education questionnaire. The results of 18 clinicians indicate that there is an interest in learning and participating in such evaluations. Our interpretation is that it is feasible to educate healthcare staff to perform rapid usability inspections to locate usability defects and additionally emphasize the domain specific problems residing in health information systems.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Sistemas de Informação/organização & administração , Interface Usuário-Computador , Adulto , Educação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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