Research in risk awareness has been relatively neglected in the health informatics literature, which tends largely to examine project managers’ perspectives of risk awareness; very few studies explicitly address the perspectives held by senior executives such as directors. Another limitation evident in the current risk literature is that studies are often based on American data and/or they are restricted to American culture. Both factors highlight the need to examine how senior executives (i.e., directors) who oversee or direct eHealth projects in Canada perceive risk awareness. This research explores and discusses the perspectives of risk awareness (i.e., identification, analysis, and prioritization) held by directors and project managers who implement Canadian eHealth projects. Semi-structured interviews with nine directors and project managers uncovered six key distinctions in these two groups’ awareness of risk. First, all project managers valued transparency over anonymity, whereas directors believed that an anonymous reporting system for communicating risks had merit. Secondly, most directors emphasized the importance of evidence-based planning and decision making when balancing risks and opportunities, an aspect none of the project managers voiced. Thirdly, while project managers noted that the level of risk tolerance may evolve from being risk-averse to risk-neutral, directors believed that risk tolerance evolved toward risk-seeking. Directors also noted the importance of employing risk officers, a view that was not shared by project managers. Directors also believed the risk of too little end-user engagement and change management was the most important risk, whereas project managers ranked it as the least important. Finally, when directors and project managers were asked to identify and define the root cause(s) of eHealth risks, directors identified the complexity of health care industry, while project managers attributed it to political pressure and a lack of resources where eHealth projects are concerned. This research proposes that the varied perspectives of risk awareness held by directors and project managers must be considered and integrated to properly align expectations and build partnerships for successful eHealth project outcomes. Understanding risk awareness offers a means to systematically identify and analyze the complex nature of eHealth projects by embracing uncertainties, thereby enabling forward thinking (i.e., staying one step ahead of risks) and the ability to prevent avoidable risks and seize opportunities. / Graduate / 0723 / 0489 / 0454 / randbpark@gmail.com

Bakgrund: I Sverige pågår för närvarande stora projekt för att utforma och införa framtidens vårdinformationssystem. Dessa system utvecklas för att effektivisera hälso- och sjukvårdens processer och IT-miljöer. Elektroniska patientjournalsystem är den mest använda typen av vårdinformationssystem. Andra exempel är system för prover och svar, patientadministration och läkemedelsförskrivning. Trots att vårdinformationssystem har visat sig kunna bidra till ökad patientsäkerhet och kvalitet har implementering av nya system i hälso- och sjukvården en historia av att ofta misslyckas. Enligt ramverket Technology, People, Organizations and Macroenvironmental factors (TPOM), påverkar ett antal områden hur väl implementering av vårdinformationssystem faller ut.  Sjuksköterskor är den största legitimerade yrkeskåren inom hälso- och sjukvård. De ansvarar för omvårdnaden av en individ och hela dennes situation vilket bidrar till att sjuksköterskor är de som använder vårdinformationssystem mest frekvent. För att bidra till lyckad utveckling, implementering och förvaltning av vårdinformationssystem behöver sjuksköterskors upplevelser av utmaningar och möjligheter med vårdinformationssystem och vårddokumentation beskrivas.   Syfte: Studiens syfte är att beskriva sjuksköterskors upplevelser av utmaningar och möjligheter med vårdinformationssystem och vårddokumentation utifrån tekniska, personliga, organisatoriska och samhälleliga områden.  Metod: Kvalitativa semistrukturerade intervjuer genomfördes med tio legitimerade sjuksköterskor från olika verksamheter. Analys av insamlad data skedde genom kvalitativ innehållsanalys med deduktiv ansats utifrån huvudkategorierna i ramverket TPOM.  Resultat: Utmaningar och möjligheter inom områdena teknik, person, organisation och samhälle identifierades och beskrevs. Totalt tio subkategorier identifierades under huvudkategorierna. Respondenternas upplevelser av liknande utmaningar och möjligheter oavsett arbetsplats och vårdinformationssystem tyder på att resultatet kan appliceras och tas i beaktande vid utveckling, implementering och förvaltning oavsett vårdinformationssystem. / Background: Currently in Sweden, there are a number of ongoing extensive projects aiming towards development and adoption of futures’ health information technology (HIT). These systems are formed to make the processes and IT environment of health care more effective. Electronic health records are the most used type of health information technology. Other examples are systems for laboratory testing, patient administration and prescription of medications. Even though HIT has proven to contribute to effectiveness and quality of care, the implementations of such systems has a history of failing. According to the Technology, People, Organizations and Macroenvironmental factors framework (TPOM), a number of dimensions has an impact to determine the success of HIT implementation.  Nurses are the largest group of registered health care practitioners in Sweden. Nursing care include caring for the individual in whole, which leads to nurses extensive, and frequent use of HIT. To contribute to successful development, implementation and continuous management of HIT, nurses’ experiences of challenges and possibilities in HIT and documentation must be described further.  Aim: This study aims to describe nurses’ experiences of challenges and possibilities in Health information technology and documentation in the perspective of Technology, People, Organizations and Macroenvironmental factors.  Method: Qualitative, semistructured interviews was conducted with ten registered nurses coming from different types of care. Data was analyzed based on deductive approached qualitative content analysis, using the TPOM framework.  Results: Challenges and possibilites within technology, people, organizations and macroenvironmental domains were identified and described. A total of ten subcategories were identified. The respondendts experienced similar challenges and possibilites, regardless of workplace and health information technology. This implicates that the result of this study might be considered in development, implementation and management of HIT.