Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.

Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.

The published literature indicates that large information system implementations are often expensive failures with costs to human safety largely because of missing or corrupt information. This has generated the overall research question of “What do Key Informants think about Information Quality in Acute Care?” This dissertation research examined information quality using a Grounded Theory analytic method for coding and analyzing semi structured interview responses from ten clinical (nurses, physicians, pharmacist) and ten non-clinical (IT support) interviewees in several public sector health organizations across Canada. The semi structured interview questions focused on five key areas: information quality, acute care setting, information systems, risk (as a function of poor information quality) and patient safety. A key finding from the interview data is that information is missing and unstable within the two key health care information systems: the paper chart, the main repository of narrative unstructured data, and the electronic health record system, of structured data. The interviewees mentioned pressure to information standardization such as fixed patient identity information anchoring patient data in the rest of the patient record. However, there is resistance to standardizing other information because the users, nurses and physicians, resist fettering in order to be able to tell the patient’s story in narrative unstructured data form. A descriptive socio-technical model, the Systems Engineering Initiative for Patient Safety (SEIPS) Model that organizes elements for analysis under the headings of person, task, technology and tools, organization, external environment and patient outcomes, was considered for further discussion in the context of the study. The SEIPS Model analysis also helps to identify gaps in the Model including what missing and uncertain information might mean. Key points from this discussion include how the information system maps to the real world, the patient, and to the user’s perception of the real world. This mapping can never be totally accurate and complete so gaps exist. The discussion of information and information flow lead to enhancements of the SEIPS Model, placing information and information quality in its rightful place as a “glue” for the acute care system. This is an important contribution to knowledge that can lead to future research so there can be a better fit between the real world, information, information systems and people to provide safer care. / Graduate

Over 4 million avoidable hospital admissions result from medication errors (IMS Insitute for Healthcare Informatics, 2013). Human error accounts for 80% of all medical errors (Palmieri, DeLucia, Peterson, Ott, & Green, 2008). Medication administration is a complex process. It is important to understand the cognitive load (CL) of Registered Nurses (RNs) working in an electronic health record environment to identify the risk factors of medication errors. The purpose of this study is to investigate the factors that influence the CL of RNs during medication administration who are working in an electronic health record environment. Simulated medication administration scenarios with varying degrees of multi-tasking were completed with 30 participants. When RNs multi-task during medication administration their CL increases. Furthermore, RNs who have poor sleep quality cannot process high-level tasks as well as those RNs who report a good sleep quality. Future work can limit EEG lead placement to the frontal channels of the EEG. Furthermore, replication of this study with a larger sample and a broader range of competing tasks is indicated.

Magister Curationis - MCur / The implementation, adoption and the use of EHR globally has been proven a challenge, despite the numerous advantages that have been noted with the use of an electronic health recording system to improve health care services. Among some of the challenges that have been reported is lack of knowledge and staff attitudes towards this new technology. It has also been noted that the success or failure of an EHR system is dependent on nurses’ or individual user acceptance, as they are pivotal in the healthcare team; therefore, their attitude towards an EHR system is crucial.

>Magister Scientiae - MSc / With the development of information and network technologies, Electronic Health Records (EHRs) management system has gained wide spread application in managing medical records. One of the major challenges of EHRs is the independent nature of medical institutions. This non-collaborative nature puts a significant barrier between patients, doctors, medical researchers and medical data. Moreover, unlike the unique and strong anti-tampering nature of traditional paper-based records, electronic health records stored in centralization database are vulnerable to risks from network attacks, forgery and tampering. In view of the data sharing difficulties and information security problems commonly found in existing EHRs, this dissertation designs and develops a credible Blockchain-based electronic health records (CB-EHRs) management system.

This master’s thesis project began at the Karolinska University Hospital. This thesis discusses how to design an authorization schema focused on ensuring each patient’s data privacy within a hospital information system. It begins with an overview of the current problem, followed by a review of related work. The overall project’s goal is to create and evaluate an authorization schema that can ensure each patient’s data confidentiality. Authorization has currently become a very important aspect in information systems, to the point of being a necessity when implementing a complete system for managing access control in certain complex environments. This requirement lead to the approach that this master thesis takes for effectively reasoning about authorization requests in situations where a great number of parameters could affect the access control assessment. This study is part of the ICT4MPOWER project developed in Sweden by both public and private organizations with the objective of improving health-care aid in Uganda through the use of information and communication technologies.  More concretely, this work defines an authorization schema that can cope with the increasing needs of sophisticated access control methods where a complex environment exists and policies require certain flexibility. / Detta examensarbete projektet startade vid Karolinska Universitetssjukhuset. Denna avhandling diskuterar hur man designar ett tillstånd schema fokuserat på att säkerställa varje patients dataskydd inom ett sjukhus informationssystem. Det börjar med en översikt över det aktuella problemet, följt av en genomgång av arbete. Projektets övergripande mål är att skapa och utvärdera ett tillstånd schema som kan garantera varje patient data sekretess. Bemyndigande har för närvarande blivit en mycket viktig aspekt i informationssystem, till den grad att vara nödvändigt att genomföra komplett system för hantering av åtkomstkontroll i vissa komplexa miljöer. Detta är i själva verket den strategi som detta examensarbete tar för att effektivt resonemang om en ansökan om godkännande i situationer där ett stort antal parametrar kan påverka i åtkomstkontroll bedömningen. Denna studie är en del av ICT4MPOWER projektet utvecklades i Sverige av både offentliga och privata organisationer i syfte att förbättra stödet sjukvård i Uganda med användning av informations-och kommunikationsteknik.<p> Mer konkret definierar detta arbete ett tillstånd schema som kan hantera de ökande behoven av sofistikerade metoder för åtkomstkontroll där en komplex miljö finns och politik kräver en viss flexibilitet.

The design and development of “e-Vaccination” applications are not extensively researched within developing economies, in part because of the difficulty in gaining access to government officials and medical experts. Vaccination cards have been used to keep track of minors’ immunisation records in South Africa for over 30 years. The South African government is moving towards the use of electronic systems for the storage of such information. South Africa has a clearly defined electronic health strategy, which is to utilise information and communications technologies in healthcare to inter alia, engage in medical research, promote health education, monitoring of diseases and tracking public health. Supporting this strategy means digitising current paper-based systems. The result would be information that can be stored safely, backed up and analysed more easily than paper-based journals, documents and vaccination cards. The purpose of this research is to develop a better understanding of key stakeholders’ perceptions to the replacement of paper-based vaccination cards with an electronic system. This is important because digital records can be considered as a more effective method of storing vaccination data. This study is quantitative in nature and primary data in the form of Likert scale questionnaires were collected from 118 key stakeholders being nurses, doctors, parents and school administration staff. The Likert scale questionnaire data was analysed using the following statistical techniques: Cronbach Alpha Test, Chi-Square Test, Analysis of Variance Test and Principle Component Analysis. The analysis provided a deeper understanding of the key stakeholder’s perceptions to the use of e-Vaccination applications. e-Vaccination applications are affected by user friendliness of the application, the graphical design of the application, practicality of the application, user experience of the application as well as the usability of the application. The practical implications of this research on e-Vaccination applications is that designers, developers, policymakers and government have a deeper understanding of nurses, doctors, parents and school administration staff perceptions to the use of e-Vaccination. / School of Computing

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