Digital interventions in healthcare have the potential to act as a positive approach to the demographical and social dilemmas existing in sparsely populated regions. Much emphasis lies on designing implementations that are beneficial and used to a large extent. The impact of responsible stakeholders in designing and implementing those interventions is vital to successful outcomes, but research about their perspective on the topic is lacking. The role of voluntariness in eHealth is unclear, and management’s view on determining factors that impact user adoption can contribute to the Information Systems literature. This study aimed to investigate healthcare management’s perspective regarding eHealth. A qualitative study was performed by conducting semi-structured interviews with management and decision-makers in Swedish healthcare on the regional and municipal levels. Their attitude towards the digitalization of healthcare is generally positive, and its benefits for the future are evident. Digitalizing the health sector is seen as necessary as long as equal care and high quality in healthcare can be maintained. Much work lies in increasing adherence to use eHealth solutions, and there is a desire to improve national coordination. Factors that influence adoption are generally compatible with existing technology acceptance literature, but the impact of some determinants differs. The results indicate that social influence has a more important impact in the voluntary context of eHealth than previous literature suggests. An introduction of mandatory elements in healthcare may have benefits for continuous use. Future research about the differences between voluntary and mandated contexts can give rich insight into how to view factors that affect technology adoption and adherence to eHealth solutions.

The importance that physical movement holds for people’s health is not up for debate. Staying active can alleviate a lot of symptoms, both physical and mental, that occur in both young and old, due to a sedentary lifestyle or to aging. Because of the way the society is developing, more and more people suffer from a sedentary lifestyle. Among all age groups, the older people have an especially high risk for negative side effects of too much sedentary time. The World Health Organization encourages countries to help combat the sedentary lifestyles and motivate people to exercise more. In their efforts to make sure people across countries have access to health information they also encourage the development of digital health tools and the use of eHealth, which falls under the umbrella term digital health. To create the lifestyle changes needed to become and stay more physically active there can be a need for motivational factors such as triggers, reminders and other motivators. Persuasive design in general and nudges in particular have the function where they will nudge people towards making a behavior change without removing the autonomy of the person. As the older people in Sweden are generally both digital and eHealth literate and are able to handle health related matters such as booking appointments and reading their health journal online, we see a possibility to examine the area of nudging the older towards a behavior change that leads to increased physical activity. Thus, in this study we examine to what extent digital nudges impact physical activities and related conditions, we chose a within subject design experiment which had two conditions – with and without a mobile application that offers digital nudges during two weeks of time period. In our study the test subjects are people above 65 years old as this group of people would greatly benefit from more physical activity and the study of how digital nudges would affect the older population in Sweden is an understudied area. The participants in one of the groups were nudged, using nudges such as the position effects, social norm and framing effects. A dependent t test was conducted and depending on the alpha level used, there was a statistical significance shown. Overall the amount of physical activity in older adults having a prototype with nudges was significantly higher. The results for this study are relevant to some degree since this is not something that has been studied before.

Background: Patient-reported outcomes (PRO) assess disease burden and indicate unmet needs. Home-based electronic PRO measures (ePROMs) can support tumor aftercare (TAC). Creating an ePROM is the next step after implementing the software “OncoFunction” to assess PROs during TAC of head- and neck-cancer patients (HNC). Therefore, internet use and perception on ePROMs of ENT and TAC patients were evaluated. Methods: From May–July 2020, ENT patients at a high- volume outpatient department aged >18 without need for emergency treatment were invited to complete a questionnaire concerning internet use and access, hardware, and opinion on the chances, requirements, and designs of ePROMs. Results: 415 questionnaires were evaluated; 46.3% of the respondents visited the common consultation hour (CCH) and 44.3% TAC; 71.9% were internet users, being younger than non-internet users; and 36.4% of TAC patients were non-internet users and 16.3% of them were without a web-enabled device. Significant differences existed in age and assessment of future perspectives between internet-/non-internet users and TAC/CCH patients, respectively. Regarding the design of ePROMs, patients preferred quarterly and short surveys. Data safety and feedback were important. Conclusions: ePROMs are not suitable for everyone because of missing internet access and experience. A tailored approach to implement ePROMs in TAC is needed

Purpose:The thesis will shed light on the overall need of CDSSs in the Swedish health care system,  and  it  will  also  present  a  specific  efficiency  problem  that  could  be  solved  by implementing a CDSS. The need for a CDSS is where an implementation would improve patient outcome, by delivering the right care at the right time, and where the CDSS could reduce the cost of the delivered care. A better understanding of the current need could help eliminate the existing empirical gap and ultimately lead to better and more efficient health care in Sweden. The research question was formulated as: Where within Swedish health care can a need for increased efficiency be met through the implementation of a realistic CDSS system? Design and methodology: The  thesis  is  a  case  study  where qualitative data, collected through a literature review and interviews, was used to answer the research question. The methodology used was tailored to the unique setting of the research and in accordance to the purpose of the study. The method was divided into five phases. (1) Finding an area of focus, such as a specific diagnosis, within the health care system where the need for a CDSS system is deemed high. (2) Mapping the care chain of the identified area of interest. (3) Developing hypotheses concerning where in the care chain challenges could be solved using a clinical decision support system. (4) Confirming or rejecting the proposed hypotheses through interviews with relevant experts. (5) Presenting the specific efficiency problem that could be solved using a CDSS and a presentation of the design of said CDSS. Findings: The efficiency problem that could be solved using a CDSS was identified to be within the area of heart failure treatment. There were a multitude of areas of improvement found along the care chain and a number of them could be solved by developing and using specific CDSSs. A CDSS that could help physicians, within the primary care system, to identify patients that  could benefit from  being  assessed  by  cardiology specialist was  proposed  as  the  most beneficial  CDSS  system.  The  proposed  CDSS  would  be  both  beneficial  and  realistically implementable. / Syftet med uppsatsen är att belysa det övergripande behovet av kliniska beslutsstödssystem inom den svenska vården och slutligen finna det mest trängande behovet. En bättre förståelse för detta behov kan hjälpa att minska det existerande empiriska gapet och slutligen leda till en bättre och mer effektiv vård i Sverige. Forskarfrågan formulerades som uppdraget att finna ett behov för ökad effektivitet inom svensk sjukvård, som kan lösas genom implementering av ett realistiskt kliniskt beslutsstöd. Design och metodologi: Uppsatsen är en casestudie där kvalitativ data, samlad genom en litteraturstudie samt intervjuer, användes för att besvara forskningsfrågan. Metodologin som brukades var anpassad efter den unika naturen för forskningen, samt i enighet med syftet av studien. Metoden delades in i fem faser. (1) Finna ett fokusområde, exempelvis en specifik diagnos, där behovet av ett kliniskt beslutsstöd bedömdes högt. (2) Kartlägga vårdkedjan för den identifierade diagnosen. (3) Utveckla hypoteser angående var inom vårdkedjan som  utmaningar skulle kunna lösas med ett kliniskt beslutsstöd. (4) Bekräfta eller förkasta ypoteserna genom intervjuer med relevanta experter. (5) Presentera problemet med det mest trängande behovet efter ett kliniskt beslutsstöd och hur ett sådans skulle utformas. Fynd: Effektivitetsproblemet som kunde lösas bäst via ett kliniskt beslutsstöd identifierades att vara inom området hjärtsviktsbehandling. Det fanns flertalet områden med utvecklingspotential som urskiljdes ur vårdkedjan för hjärtsviktspatienter, och vissa av dessa utmaningar kunde lösas genom utveckling och implementering av specifika kliniska beslutsstöd. Det kliniska beslutsstöd som skulle lösa det mest trängande behovet inom vården idag föreslås vara ett system som hjälper läkare inom vårdcentralerna att identifiera patienter som skulle gagnas av en remiss till en kardiolog. Det föreslagna kliniska beslutsstödet skulle vara både fördelaktigt för vårdpersonal samt patienter samt är realistiskt implementerbart.

SWEPPE is a mobile application for employees returning to work after sick leave and a web application for their employer. Employees can update the application with data regarding their return-to-work process and choose what to share with their employers. When SWEPPE was tested in real contexts, the researchers developing the application found that employers were not using the application to its full potential, and there was a need for further development. This master's thesis identified requirements for employers in their web application to support their employee's return-to-work process caused by chronic pain. Additionally, prototypes were designed in an iterative human-centered design process, focusing on usability in terms of satisfaction. In each iteration, prototypes were first designed and modified, and afterward, evaluations with stakeholders participating took place. The study revealed that contributing further knowledge to the employers, showing employees data efficiently, designing in line with the employer's workflow, and considering the integrity aspect were essential for usability. The design process resulted in a high-fidelity prototype, and the last evaluation showed that the designed prototype was usable in terms of satisfaction.

Allt fler blir allt äldre i Sverige och äldreomsorgen står inför en stor utmaning när resurser i form av ekonomiska medel och rätt personal blir allt svårare att konkurrera om. I eHälsans tidsålder utvecklas det på många håll smarta tekniska lösningar för att effektivisera och kvalitetshöja omsorgsinsatser, något som allt fler aktörer får upp ögonen för. Denna uppsats utreder behovsbilden för att kunna skapa en ny kontaktyta mellan omsorgstagare, närstående och utförare inom äldreomsorg. Uppsatsens resultat är en del av det Vinnova-finansierade projektet BoNUS VO som undersöker förutsättningarna för en sådan kontaktyta. IKT-stödet ska underlätta delaktighet i den egna omsorgen såväl som stödja yrkesutövare i arbetsuppgifter. Data samlades in genom en observationsstudie av hemtjänstarbete, deltagande i gruppsamtal med närstående till omsorgstagare samt kvalitativa intervjuer med 13 informanter som hade erfarenhet av äldreomsorg. Resultatet av dataanalysen visar på att det i dagsläget finns problem som skulle kunna undvikas genom att underlätta kommunikation och informationsdelning mellan användargrupperna. Resultaten visar också på att det finns många diskussionspunkter vad gäller nytta, motsättningar i behov och avvägningen mellan ett översiktligt eller komplext system. Studien konstaterar att det finns utrymme för vidare forskning inom området. / Sweden’s population is steadily growing older and while the demand for care of senior citizens is increasing, care givers are forced to cope with diminishing resources in terms of money and qualified staff. Many put hope in new eHealth technology, as a means of raising efficiency and quality in the every day working situation. This thesis aims to study needs regarding communication, information and interaction between care takers, dependants and caregivers in geriatric care, in order to create a foundation upon which an ICT system may be built to fulfill those needs. The results presented are part of a research project focusing on future ICT systems in healthcare. Data was collected through an observational study, group discussions with informants related to care takers, and qualitative interviews with 13 informants who have extensive experience of geriatric care. The results imply there are existing problems that may be avoided by facilitating information sharing between the aforementioned groups. The study also presents some important points of discussion regarding usefulness, clashing needs of different users, and the balance between simplicity of use and system size.

Läkare, sjuksköterskor, farmaceuter, patienter och patienters anhöriga är alla delar av den kedja som ska se till så att läkemedelsanvändning sker på ett säkert sätt. Så många inblandade och i så många olika sammanhang gör att läkemedelsanvändning kan vara svårt att hantera. 2014 skrevs det ut 102 913 130 recept i Sverige (1). Fram till 2014 hade ca 850 000 felaktiga recept korrigerats av farmaceuter varje år (2). Att korrigera recept är en nödvändig del som ingår i farmaceutens skyldighet och ansvar vilket regleras i svensk lagstiftning (3). Farmaceuten är en del av vårdkedjan som skall tillse att patienten har en korrekt och säker behandling med läkemedel (4). Tillgång till en nationell gemensam läkemedelslista för alla berörda parter, förskrivare, farmaceut, patient och övrig vårdpersonal skulle kanske kunna komma tillrätta med felaktigheter i förskrivningar och därmed öka patientsäkerheten (4). Tidigare studier har genomförts som behandlar läkarens syn på en gemensam lista och även patientens syn på eHälsoarbete vilket till viss del belyser en gemensam lista (5)(6) men inga studier har hittats om hur en gemensam lista kommer att påverka farmaceuternas vardag vilket ett av syftena med detta arbete har varit. För att uppnå syftet genomfördes en enkätundersökning med farmaceuter verksamma på ett antal apotek där de fick delge sina tankar både kring den information om patienters aktuella läkemedel som finns tillgänglig idag, bland annat genom receptdepån och sina tankar kring en nationell gemensam läkemedelslista. Resultat av undersökning gör gällande att det förekommer fel i receptdepån både med avseende på saknad information, felaktigheter i recept och att recept förekommer mer än en gång och att de finns med trots att patienten inte skall använda dem mer. Majoriteten av farmaceuterna var eniga om att en nationell gemensam läkemedelslista skulle hjälpa dem i deras arbete för att öka patientsäkerheten men huruvida den kommer att lösa alla problem som förekommer i receptdepån får framtiden utvisa. / Doctors, nurses, pharmacists, patients and next of kin are all parts of the chain that is needed to make sure that the use of medication is safe and appropriate for the patient. That many people involved and in many different settings can make the use of medication difficult to manage. In the year 2014 there were 102 913 130 prescriptions made out to patients in Sweden. Up to the year 2014 850 000 corrections had been made to prescriptions with faults in them by pharmacists each year. To correct prescriptions is an essential part of the pharmacist’s obligations and responsibility, a responsibility that is regulated in Swedish law. The pharmacist is the last part of the chain that has the possibility to adjust anything that is wrong with medications and the use of it before it is in the patient’s own hands. The access to a nationally shared medication list for all involved parties might solve some of the problems that faces the responsible parties when it comes to dealing with patients and their new and ongoing medications and in that way be able to increase the safety around mediation for the patient in need. Although the survey conducted as part of this paper focuses on pharmacists the background tries to explain in what way the different professions come in contact with medicines and how they would perhaps benefit from a shared list. The paper also tries to give a little insight to what kind of problems there could be related to prescriptions. In Sweden we have come a rather long way in the use of computers and the use of internet in the field of eHealth compared to other countries. The paper tries to show how the problem surrounding prescription of medicine is handled in the other countries of Scandinavia. Earlier studies have been conducted that looks at shared lists from the doctors view and also studies have been conducted that looks upon eHealth for patients partly in view of shared medication lists. No studies have been found that looks specifically at how pharmacists feel about it and how such a list would benefit them in their work to secure patient safety, hence this paper. In order to reach the papers purpose a survey was performed with pharmacists employed at different pharmacies in the southern part of Sweden. The result of the survey showed that there are indeed problems with prescriptions in the prescription repository and the majority of the pharmacists agreed that a shared medication list could help them in their work to secure patient safety when releasing prescribed medication. Although the pharmacist agreed for the most part in the benefits of such a list they did not know if it would solve all problems, which is for the future to decide.

Information and communication technologies can be used to deliver healthcare services and improve the healthcare system. Any electronic healthcare system whose usage results in the efficient and enhanced quality of healthcare is an eHealth system and can be beneficial for medical enterprises. Despite the advantages that eHealth systems offer, medical enterprises are often reluctant to abandon their paper-based systems and embrace eHealth solutions. Through a review of existing eHealth literature, this study identified generic technologies used within South African medical enterprises. Fourteen (14) technologies, that represent a basket of eHealth systems for supporting the business management, professional clinical informatics, patient information storage and consumer health informatics functional areas, were identified. The study then aimed to determine the state of adoption of these technologies as well as the factors influencing adoption. The technological, organisational and environmental (TOE) factors that contributed to the current state of adoption were identified through a review of existing TOE literature. A model that explores the effects of these pre-determined TOE factors on the propensity to adopt eHealth was developed and tested. A cross-sectional, quantitative study was carried out and survey data was collected from a sample of 130 medical enterprises in South Africa. Data was collected using a structured questionnaire. Correlation analysis was used to test the model’s hypotheses and hierarchical regression was used to test the overall TOE model. By using the TOE framework, the study has provided a theoretical contribution and addressed a gap in the literature into the barriers and determinants of the adoption of information and communication technologies (ICTs) in healthcare. The results of the study show that South African medical enterprises use systems that range from simple electronic fund transfer systems to more complex electronic record and clinical decision support systems. Of the 14 technologies that were identified, business information systems such as medical aid claims submission systems and electronic record systems for patient and fee related information were the most adopted while a steady, but continued increase in the adoption of clinical health information systems was observed. Specifically, the study reveals that electronic fund transfer systems are the most adopted systems while ePrescription systems are the least used. Furthermore, the study shows that in addition to the enterprises’ operating period, perceived benefits, IT infrastructure, senior clinician involvement, resource commitment and external pressure are correlated with the propensity to adopt while system complexity is a barrier to technology adoption.

Thesis advisor: John J. Michalczyk / The internet is changing health care right under out very noses. In doing so, it may have great impact on the physician-patient relationship. This relationship exists along a continuum, with paternalism at one end and total patient autonomy at the other. Various aspects of web-based health care (eHealth) are pushing the equilibrium one way or the other. Aspects of eHealth considered include: general health information websites, internet pharmacies, health communication infrastructures (as in physician-patient email and electronic medical records), and finally web-brokered organ transplantation. While there is obviously much to be aware of in terms of quality on the internet, it is concluded that an integration of eHealth into traditional medicine (thus creating cybermedicine) may not only help to mitigate the managed care crisis, but may also change the physician-patient relationship—hopefully for the better. / Thesis (BS) — Boston College, 2005. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: College Honors Program.

The complex process of patient placement within a hospital is a big challenge. The main focus in the process is how to coordinate clinics to make sure that the patients get the best possible care. The rise of digital health has led to a greater use of technologies to facilitate the activities within the hospitals’ processes. This study has been focusing on how Internet of Things can be used in the patient placement process. Respondents to participate in the interviews were chosen with help from a coordinator based on their experience within the study area of interest. Observations were done in meetings where the staff discussed patient placements. From a perspective of problem based coordination, a thematic analysis was done on the collected data and from the themes that were created a solution was presented. The object of this study is to map the process of patient placement and to present an analytic approach on how to facilitate the patient placement process with the use of Internet of Things. Our proposed approach will contribute to a greater understanding of the patient placement process and how Internet of Things can be used within it.