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Em 2005, a Agência Nacional de Saúde Suplementar (ANS) estabelece o padrão TISS (Troca de Informação na Saúde Suplementar), intercâmbio eletrônico obrigatório entre as operadoras de planos de saúde (cerca de 1500 registradas na ANS) e prestadores de serviços (cerca de 200 mil) sobre os eventos de assistência prestados aos beneficiários. O padrão TISS foi desenvolvido seguindo a estrutura do Comitê ISO/TC215 de padrões para informática em saúde e se divide em quatro partes: conteúdo e estrutura, que compreende a estrutura das guias em papel; representação de conceitos em saúde, que se refere às tabelas de domínio e vocabulários em saúde; comunicação, que contempla as mensagens eletrônicas; e segurança e privacidade, seguindo recomendação do Conselho Federal de Medicina (CFM). Para aprimorar sua metodologia de evolução, essa presente tese analisou o grau de interoperabilidade do padrão TISS segundo a norma ISO 20514 (ISO 20514, 2005) e a luz do modelo dual da Fundação openEHR, que propõe padrões abertos para arquitetura e estrutura do Registro Eletrônico de Saúde (RES). O modelo dual da Fundação openEHR é composto, no primeiro nível, por um modelo de referência genérico e, no segundo, por um modelo de arquétipos, onde se detalham os conceitos e atributos. Dois estudos foram realizados: o primeiro se refere a um conjunto de arquétipos demográficos elaborados como proposta de representação da informação demográfica em saúde, baseado no modelo de referência da Fundação openEHR. O segundo estudo propõe um modelo de referência genérico, como aprimoramento das especificações da Fundação openEHR, para representar o conceito de submissão de autorização e contas na saúde, assim como um conjunto de arquétipos. Por fim, uma nova arquitetura para construção do padrão TISS é proposta, tendo como base o modelo dual da Fundação openEHR e como horizonte a evolução para o RES centrado no paciente / In 2005 the Brazilian National Healthcare Agency (Agência Nacional de Saúde Suplementar (ANS), in Portuguese) published the TISS standard, a mandatory electronic exchange claims between the health insurance (approximately 1500 registered at ANS) and healthcare providers (approximately 200 000) about the healthcare events provided to the beneficiaries. The TISS standard was developed following the structure of the ISO/TC215 Committee for Health Informatics and is divided into four parts: data structure that encompasses the forms; semantic content that refers to the vocabularies and terminologies; data interchange that includes the electronic messages; and security issues in healthcare information following a recommendation of the Federal Council of Medicine (Conselho Federal de Medicina (CFM), in Portuguese). To improve the TISS standards evolution, this study analyses the levels of interoperability in accordance with ISO 20514 (ISO 20514, 2005) and the dual model of the openEHR Foundation, which proposes open standards for Electronic Health Records (EHR) architecture and healthcare information. The dual model of the openEHR Foundation specifications is composed, on the first level, by a generic reference model and on the second by an archetype model that details the concepts and attributes. Two studies were conducted in this thesis: the first one refers to a set of demographic archetypes developed as a proposal representation of the demographic information, based on the reference model of the openEHR Foundation. The second study proposes a generic reference model, as an improvement of the openEHR specifications, to represent the concept of submission of claims, as well as a set of archetypes. Finally, a new architecture for building the TISS standard is proposed based on the dual model of the openEHR Foundation and envisioning a patient-centered EHR

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2017-04-19T16:23:48Z No. of bitstreams: 1 Vitor Secretti Bertoncello_.pdf: 8707879 bytes, checksum: 8c444504769b11f83390c5d057d72e7c (MD5) / Made available in DSpace on 2017-04-19T16:23:48Z (GMT). No. of bitstreams: 1 Vitor Secretti Bertoncello_.pdf: 8707879 bytes, checksum: 8c444504769b11f83390c5d057d72e7c (MD5) Previous issue date: 2017-02-21 / Nenhuma / O crescimento constante da expectativa de vida no Brasil trouxe à tona um desafio para a rede de atendimento de saúde. A maior longevidade da população resulta diretamente no aumento do registro de doenças crônicas, elevando a procura por atendimento médico. A superação desse desafio passa pela mudança no modelo de atendimento de saúde, cujo objetivo é inserir o paciente como membro ativo no cuidado ao próprio bem-estar. Esse novo modelo gerou demanda por novas soluções de tecnologia de informação e comunicação capazes de atender satisfatoriamente ao paciente, como soluções em computação móvel e ubíqua. Assim, o presente trabalho propõe o modelo chamado AllHealthcare, consistindo em uma solução de registro de saúde pessoal (PHR), em que o próprio paciente é capaz de construir um Perfil de Acompanhamento Dinâmico (PAD) para seus cuidados de saúde, de acordo com suas necessidades, e alterá-lo conforme novas demandas ou focos venham a ser considerados. Tal dinamismo na construção de um perfil personalizado é alcançado devido ao modelo proposto se basear em arquétipos do padrão OpenEHR, o que também atribui a característica de interoperabilidade semântica à presente proposta. Em revisão de pesquisas com foco em PHR, grande parte das soluções encontradas são concebidas e focadas para tratamento de determinada doença, ou seus modelos não atendem a um conjunto de requisitos operacionais importantes e atuais, como a mobilidade do cuidado de saúde e a interoperabilidade semântica das informações de saúde. Do modelo proposto, foi implementado um protótipo funcional, o qual passou por três etapas de avaliação. Nas três etapas de avaliação os resultados foram positivos e e os participantes apontaram um conjunto de possíveis melhorias, mesmo assim, aplicando-se o modelo de aceitação de tecnologia (TAM) a 22 usuários do protótipo, obteve uma aceitação média de 86,6%. / The constant growth of life expectancy in Brazil brought to the focus a challenge for the healthcare systems. The increased longevity of the population directly results in increased registration of chronic diseases, increasing the demand for healthcare. Overcoming this challenge is to change the health care model, whose goal is to insert the patient as an active member in the care of own welness. This new model has generated demand for new information and communication technologies solutions able to satisfactorily meet the patient, as solutions in mobile and ubiquitous computing. Thus, this paper proposes the model called AllHealthcare, consisting of a personal health record (PHR) solution that the patient is able to build a Dynamic Accompanying Profile (PAD) for their health care, according to their needs, and change it as new demands or focus may be considered. This dynamism in building a custom profile is achieved due to the proposed model is based on openEHR standard archetypes, which also provides the feature of semantic interoperability to this proposal. In a review research focusing on PHR, most of the solutions founded are designed and focused for treatment of a particular disease or their models do not fulfill a number of important and current operational requirements, such as healthcare mobility and semantic interoperability of health information. From the proposed model, a functional prototype was implemented, underwent through three stages of evaluation. In the three evaluation stages, the results were positive and the participants pointed out a set of possible improvements, even though applying the technology acceptance model (TAM) to 22 prototype users, obtained an average acceptance of 86.6%.

<p>Dagens elektroniska patientjournalsystem har begränsade möjligheter att på likartat sätt strukturera och lagra patientinformation. Det är en anledning till att det är problem med att utbyta patientjournaldata mellan olika system. Detta försvårar bland annat forskning och tillgänglighet till patientinformation. Brist på tillgänglighet minskar i sin tur möjligheten att ge en god vård oberoende av var patienten befinner sig.</p><p>Inom projektet openEHR har en idé med så kallade arketyper tagits fram som ett enhetligt sätt att strukturera utbytbar patientjournaldata för att möta framtida krav på patientjournaler och patientjournalsystem. Arketyper är formella modeller av kliniska informationsentiteter, exempelvis blodtryck. De byggs upp av restriktioner, struktur och termer med eventuella bindningar till medicinska terminologisystem. Dessutom kopplas medicinsk kunskap i arketyperna fri från journalsystemen.</p><p>Syftet med examensarbetet har varit att utveckla ett verktyg, en så kallad arketypeditor, som kan användas för att skapa och redigera arketyper. Utöver detta skulle möjligheterna undersökas att i verktyget implementera en koppling till medicinska terminologisystem. Utvecklingen har skett i en iterativ process med fokus på användbarhet och stabilitet. Det har även ingått att ta reda på syftet med en arketypeditor.</p><p>Resultatet är ett plattformsoberoende och stabilt verktyg som är utvecklat enligt användbarhetsprinciper med koppling till terminologisystemet Unified Medical Language System (UMLS). En arketypeditors syfte i ett bredare perspektiv är att lösa brister i dagens medicinska informationssystem som tas upp i denna rapport. Trots att openEHR-projektet är nytt finns det många tekniskt gångbara idéer, men det finns även problem som beror på för lite praktisk testning och tillämpning.</p> / <p>Present-day electronic health record systems have limited possibilities to structure and store patient information in a similarly manner. This causes problems with exchanging patient record data between different systems and it gives rise to problems with, among other things, research and patient information availability. Lack of availability will in turn decrease the possibility of giving good care irrespective of where the patient is located.</p><p>Within the openEHR project an idea with so called archetypes has been introduced as a uniform way to structure exchangeable patient record data in order to meet future requirements on electronic health records and systems. Archetypes are formal models of clinical information entities, for example blood pressure. They are constructed from constraints, structure and terms which may have bindings to medical terminology systems. Furthermore, medical knowledge in the archetypes is separated from the patient record systems.</p><p>The purpose of the thesis has been to develop a tool, a so called archetype editor, that can be used to create and edit archetypes. In addition, the possibilities of implementing a connection to medical terminology systems should be explored. The development has followed an iterative process with focus on stability and usability. Another task has also been to find out the purpose with an archetype editor.</p><p>The result is a platform-independent and stable tool, developed according to usability principles with a connection to the terminology system Unified Medical Language System (UMLS). An archetype editor’s purpose in a wider perspective is to solve shortcomings in medical information systems of today, which are brought up in this thesis. Although the openEHR project is new, there are many technically applicable ideas but also problems because of insufficient practical testing and application.</p>

Dagens elektroniska patientjournalsystem har begränsade möjligheter att på likartat sätt strukturera och lagra patientinformation. Det är en anledning till att det är problem med att utbyta patientjournaldata mellan olika system. Detta försvårar bland annat forskning och tillgänglighet till patientinformation. Brist på tillgänglighet minskar i sin tur möjligheten att ge en god vård oberoende av var patienten befinner sig. Inom projektet openEHR har en idé med så kallade arketyper tagits fram som ett enhetligt sätt att strukturera utbytbar patientjournaldata för att möta framtida krav på patientjournaler och patientjournalsystem. Arketyper är formella modeller av kliniska informationsentiteter, exempelvis blodtryck. De byggs upp av restriktioner, struktur och termer med eventuella bindningar till medicinska terminologisystem. Dessutom kopplas medicinsk kunskap i arketyperna fri från journalsystemen. Syftet med examensarbetet har varit att utveckla ett verktyg, en så kallad arketypeditor, som kan användas för att skapa och redigera arketyper. Utöver detta skulle möjligheterna undersökas att i verktyget implementera en koppling till medicinska terminologisystem. Utvecklingen har skett i en iterativ process med fokus på användbarhet och stabilitet. Det har även ingått att ta reda på syftet med en arketypeditor. Resultatet är ett plattformsoberoende och stabilt verktyg som är utvecklat enligt användbarhetsprinciper med koppling till terminologisystemet Unified Medical Language System (UMLS). En arketypeditors syfte i ett bredare perspektiv är att lösa brister i dagens medicinska informationssystem som tas upp i denna rapport. Trots att openEHR-projektet är nytt finns det många tekniskt gångbara idéer, men det finns även problem som beror på för lite praktisk testning och tillämpning. / Present-day electronic health record systems have limited possibilities to structure and store patient information in a similarly manner. This causes problems with exchanging patient record data between different systems and it gives rise to problems with, among other things, research and patient information availability. Lack of availability will in turn decrease the possibility of giving good care irrespective of where the patient is located. Within the openEHR project an idea with so called archetypes has been introduced as a uniform way to structure exchangeable patient record data in order to meet future requirements on electronic health records and systems. Archetypes are formal models of clinical information entities, for example blood pressure. They are constructed from constraints, structure and terms which may have bindings to medical terminology systems. Furthermore, medical knowledge in the archetypes is separated from the patient record systems. The purpose of the thesis has been to develop a tool, a so called archetype editor, that can be used to create and edit archetypes. In addition, the possibilities of implementing a connection to medical terminology systems should be explored. The development has followed an iterative process with focus on stability and usability. Another task has also been to find out the purpose with an archetype editor. The result is a platform-independent and stable tool, developed according to usability principles with a connection to the terminology system Unified Medical Language System (UMLS). An archetype editor’s purpose in a wider perspective is to solve shortcomings in medical information systems of today, which are brought up in this thesis. Although the openEHR project is new, there are many technically applicable ideas but also problems because of insufficient practical testing and application.

This work aims to propose a recommendation model of prescription items for Pediatric Oncology based on data extraction from Electronic Patient Record. These data are used as indexed cases to aid providers of medical service based on the similarity of prescriptions, according to the patient's history. From the viewpoint of aid medical education, the modeling objective support the student or health professional in understanding the decision-making process during the prescription items oncological medical treatment, for example drugs, laboratory exams or images exams, diet, gases, care, chemotherapy, radiotherapy. To develop the model, was used the approach of Case Based Reasoning (CBR), through the representation of prescription medical base-case, indexed by their treatment items. During the recovery phase of cases, we used the tool. Data Mining by applying the model of association rule, together with the algorithm "apriori" for obtaining the similarity between cases. To update the case base, a procedure database for performing the process of Extraction, Transformation and Load of the database was developed. The developed model was applied in the database of the Electronic Patient Record of the Santa Casa de Misericordia de Maceio, based on Hospital Management Systems “MV Sistemas”, deployed in the unit since 2005. For the presentation of results, was used the Oracle Data Miner tool, which allowed access to the database and analysis of selected cases by identifying key words contained in the evolution of the clinical condition of the patient. The application of the experiments validate the occurrence of allowed combined application of items of treatment according to the keywords, which can be used as input in the process of making medical decision and tutoring. / Este trabalho tem como objetivo propor um Modelo de Recomendação de itens de prescrição para Oncologia Pediátrica baseado na extração de dados do Prontuário Eletrônico do Paciente. Esses dados são utilizados como casos indexados, para auxiliar os prestadores de serviço médico baseados na similaridade de prescrições, de acordo com o histórico do paciente. Do ponto de vista do apoio a educação médica, a modelagem objetiva apoiar o estudante ou o profissional de saúde no entendimento do processo de tomada de decisão durante a fase de prescrição de itens de tratamento médico oncológico, como, por exemplo: medicamentos, exames de laboratório ou de imagens, dieta, gases, cuidados, quimioterapia, radioterapia. Para o desenvolvimento do modelo, utilizou-se a abordagem de Raciocínio Baseado em Casos (RBC), através da representação de uma base de casos de prescrição médica, indexada por seus itens de tratamento. Durante a fase de recuperação de casos, utilizou-se a ferramenta de Mineração de Dados aplicando-se o modelo de regra de associação, em conjunto com o algoritmo “apriori” visando a obtenção da similaridade entre casos. Para a atualização da base de casos, foi desenvolvido um procedimento de banco de dados para execução do processo de Extração, Transformação e Carga da base de dados. O modelo desenvolvido foi aplicado na base de dados do Prontuário Eletrônico do Paciente da Santa Casa de Misericórdia de Maceió, baseado no sistema de gestão hospitalar MV Sistemas, implantado na unidade desde 2005. Para a apresentação dos resultados, utilizou-se a ferramenta Oracle Data Miner, que possibilitou o acesso ao banco de dados e a análise dos casos selecionados pela identificação de palavras chaves contidas na evolução do estado clínico do paciente. A aplicação dos experimentos permitiu validar a ocorrência de aplicação conjunta de itens de tratamento de acordo com as palavras chaves, o que pode ser utilizado como elemento para o processo de tomada de decisão médica e tutoria.

Submitted by Clebson Anjos (clebson.leandro54@gmail.com) on 2016-02-11T19:57:13Z No. of bitstreams: 1 arquivototal.pdf: 4682448 bytes, checksum: 9f9a7a72b4132cb9d61c8cc0c1591ea3 (MD5) / Made available in DSpace on 2016-02-11T19:57:13Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 4682448 bytes, checksum: 9f9a7a72b4132cb9d61c8cc0c1591ea3 (MD5) Previous issue date: 2014-05-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Health informatics is a domain that presents several challenges to be overcome. Electronic Health Records (EHR) are one of its most important subdomain, in charge of storage, exhibition, and manipulation of patient clinical information, among others. EHR systems require domain flexibility, which allows modifications in the structure of documents without application recompilation or redeployment, for instance, in a web server. Current approaches in the literature propose generic models to represent domain and presentation, without ontological definitions for user interface (UI) layout and style. These, when properly organized, improve the acceptance of the system by users. This work aims to develop a framework to layout and style generation for graphical user interface of EHR documents, based on Web Ontology Language (OWL) ontologies and using restrictions. By centralizing and combining metadata from biomedical and documents domains, it was possible to apply layout and style to EHR documents, with the use of grids, including additional ontological definition of presentation formats for the medical field, facilitating UI development and maintenance. / A informática em saúde apresenta muitos desafios a serem superados. Um de seus principais ramos de pesquisa são os Registros Eletrônicos em Saúde (RES), responsáveis, dentre outros, pelo armazenamento, exibição e manipulação de registros clínicos do paciente. Sistemas deste tipo requerem flexibilidade do domínio da aplicação, de modo que alterações nos documentos do RES sejam realizadas em tempo de execução, sem recompilação ou reimplantação da aplicação, por exemplo, em um servidor web. Abordagens da literatura propõem modelos genéricos de representação de domínio e apresentação, sem definições ontológicas de layout e estilo de interface com o usuário (UI). Estes, quando bem organizados, melhoram a aceitação do sistema pelos usuários. Este trabalho teve como objetivo o desenvolvimento de um framework para geração de layout e estilo de interface gráfica com o usuário para documentos do RES, baseado em ontologias Web Ontology Language (OWL), com uso de restrições. Através da centralização e combinação dos metadados biomédicos e de documentos para o RES, foi possível aplicar layout e estilo para os documentos do RES, com uso de grids, com definição ontológica adicional de formatos de apresentação para a área médica, facilitando o desenvolvimento da UI para o RES a manutenção da interface gráfica da aplicação.

Em 2005, a Agência Nacional de Saúde Suplementar (ANS) estabelece o padrão TISS (Troca de Informação na Saúde Suplementar), intercâmbio eletrônico obrigatório entre as operadoras de planos de saúde (cerca de 1500 registradas na ANS) e prestadores de serviços (cerca de 200 mil) sobre os eventos de assistência prestados aos beneficiários. O padrão TISS foi desenvolvido seguindo a estrutura do Comitê ISO/TC215 de padrões para informática em saúde e se divide em quatro partes: conteúdo e estrutura, que compreende a estrutura das guias em papel; representação de conceitos em saúde, que se refere às tabelas de domínio e vocabulários em saúde; comunicação, que contempla as mensagens eletrônicas; e segurança e privacidade, seguindo recomendação do Conselho Federal de Medicina (CFM). Para aprimorar sua metodologia de evolução, essa presente tese analisou o grau de interoperabilidade do padrão TISS segundo a norma ISO 20514 (ISO 20514, 2005) e a luz do modelo dual da Fundação openEHR, que propõe padrões abertos para arquitetura e estrutura do Registro Eletrônico de Saúde (RES). O modelo dual da Fundação openEHR é composto, no primeiro nível, por um modelo de referência genérico e, no segundo, por um modelo de arquétipos, onde se detalham os conceitos e atributos. Dois estudos foram realizados: o primeiro se refere a um conjunto de arquétipos demográficos elaborados como proposta de representação da informação demográfica em saúde, baseado no modelo de referência da Fundação openEHR. O segundo estudo propõe um modelo de referência genérico, como aprimoramento das especificações da Fundação openEHR, para representar o conceito de submissão de autorização e contas na saúde, assim como um conjunto de arquétipos. Por fim, uma nova arquitetura para construção do padrão TISS é proposta, tendo como base o modelo dual da Fundação openEHR e como horizonte a evolução para o RES centrado no paciente / In 2005 the Brazilian National Healthcare Agency (Agência Nacional de Saúde Suplementar (ANS), in Portuguese) published the TISS standard, a mandatory electronic exchange claims between the health insurance (approximately 1500 registered at ANS) and healthcare providers (approximately 200 000) about the healthcare events provided to the beneficiaries. The TISS standard was developed following the structure of the ISO/TC215 Committee for Health Informatics and is divided into four parts: data structure that encompasses the forms; semantic content that refers to the vocabularies and terminologies; data interchange that includes the electronic messages; and security issues in healthcare information following a recommendation of the Federal Council of Medicine (Conselho Federal de Medicina (CFM), in Portuguese). To improve the TISS standards evolution, this study analyses the levels of interoperability in accordance with ISO 20514 (ISO 20514, 2005) and the dual model of the openEHR Foundation, which proposes open standards for Electronic Health Records (EHR) architecture and healthcare information. The dual model of the openEHR Foundation specifications is composed, on the first level, by a generic reference model and on the second by an archetype model that details the concepts and attributes. Two studies were conducted in this thesis: the first one refers to a set of demographic archetypes developed as a proposal representation of the demographic information, based on the reference model of the openEHR Foundation. The second study proposes a generic reference model, as an improvement of the openEHR specifications, to represent the concept of submission of claims, as well as a set of archetypes. Finally, a new architecture for building the TISS standard is proposed based on the dual model of the openEHR Foundation and envisioning a patient-centered EHR

The first steps in the software development life cycle are crucial for a successful software product. In this scenario, modeling activities play an important role in the requirements specification and other activities throughout the Project. Although the modeling activities of business processes and activities related to Requirements Engineering are recognized as important individually, some approaches have considered the integration of these activities. In this context, this master thesis proposes an approach and corresponding guidelines for integration of modeling software requirements with SysML and modeling of business processes and workflows with the support of BPMN. This relationship is represented with both graphical models and tabular format. Therefore, software developers can track business processes and software requirements already during the initial activities of the software development process. The proposed approach has been presented to a group of systems analysts, university professors and master students. These participants answered to a questionnaire based on TAM theory mostly agreeing that integrating BPMN and SysML will contribute positively for documentation , validation and tracking requirements. Despite their interest in learning more about the two languages, they declared di culty in performing integration and the cost to use this proposal in projects in industry. This work has also presented a report of the experience in HU / UFS and a guide to integration of BPMN and SysML to assist the development of a patient’s Electronic Health Record in a public hospital. / Os primeiros passos no ciclo de vida de desenvolvimento de software são cruciais para um produto de software bem sucedido. Neste cenário, as atividades de modelagem desempenham um papel importante na especificação de requisitos e demais atividades em todo o projeto. Embora as atividades de modelagem de processos de negócio e as atividades relacionadas com a Engenharia de Requisitos sejam reconhecidas como importantes individualmente, algumas abordagens têm considerado a integração destas atividades. Neste contexto, este trabalho propõe uma abordagem e orientações correspondentes à integração dos modelos de processos de negócio elaborados com BPMN e modelos de requisitos de software com SysML. Essa relação é representada tanto com modelos gráficos como em formato tabular. Portanto, os desenvolvedores de software podem rastrear os processos de negócio e requisitos de software já durante as atividades iniciais do processo de desenvolvimento de software. A abordagem proposta foi apresentada a um grupo de analistas de sistemas, professores universitários que lecionam a disciplina Engenharia de Software e estudantes de mestrado do curso de Ciência da Computação da Universidade Federal de Sergipe, e respondendo a um questionário baseado na teoria TAM afirmaram que a integração BPMN e SysML irá contribuir positivamente nas atividades de documentação, validação e rastreamento de requisitos. Apesar do interesse em aprender mais sobre as duas linguagens, os participantes na pesquisa declararam a dificuldade em realizar a integração e o custo em utilizar esta proposta em projetos reais. Neste trabalho foi ainda apresentado um relato da experiência no Hospital Universitário da Universidade Federal de Sergipe (HU/UFS) e um guia para integração de modelos elaborados com BPMN e SysML, para auxiliar o desenvolvimento de um prontuário eletrônico do paciente em um hospital público.

The European health care is facing challenges with an increasing ageing population, with a higher frequency of chronic diseases, which have resulted in rising health care costs. Meanwhile, the trend shows how patients and citizens are becoming more active in their personal health care, with the number of existing doctors and nurses subsiding furthermore entailing problems. The area of eHealth, which involves information and communication technologies with health care, is hence seen as a partial long-term solution and is considered being a rapidly growing market both in Sweden, but also in Europe. eHealth services further consider to promote increased access, mobility and interoperability in the health care, but the lack of wholehearted commitment, financial support and complex EHR-systems in Sweden's municipalities and county councils might partially impeding down the development. The purpose of this report is therefore targeting to explore, identify and analyze prominent aspects for the continued development of the Swedish health care and eHealth services. The study also examines what subsequent benefits an implementation of an eHealth service entails, which also has been related to the identified prominent aspects. This master thesis is based on a thorough literature review extracted from a theoretical framework including an interoperability-, security-, mobility- and business-modeling perspective, which are used as a foundation for the building of a set of hypotheses, which are subsequently verified with the aid of gathered empirics. The empirics are obtained from 10 semi-structured qualitative interviews, as well as two case studies, which together resulted in key-findings and conclusions. Firstly, in relation to the interoperability perspective, it became clear how there should exist both a technical and social interoperability that communicate with each other. The EHR-systems of today are often considered difficult to learn, non-intuitive and lacking interfaces that are user-friendly designed for the end-user. Increased interoperability was also seen as enabling and simplifying the access to the patient’s medical history, which the EHR-system TakeCare evidently demonstrated. Furthermore, it was acknowledged how there is no correlation between the increased time spent by health care professionals with administrative tasks and documentation with an increased interoperability. It also emerged that patients and the dominant part of the population had either no or very limited knowledge regarding the underlying security and overall management of personal health information in health care. Patients instead often blindly trust the Swedish health care system being secure, and prioritizing other things during medical appointments. The knowledge of security issues in the health care is predicted to increase among patients if they in the future would obtain full access to their own medical records. There is also a general opinion among health care professionals and related instances how new security risks will arise alongside the eHealth wave, with a particular concern for the increasing involvement of mobile devices. Relationships between an increased interoperability also seem to favor increased mobility in health care, but security aspects often prevent the mobility development. Finally, it was unanimously espoused how non-financial values must not be ignored, where the on-going debate argues whether what real impact these non-financial values have, where inter alia strict budgets and large gaps between the decision-makers and end-users appeared as issues. Similar arguments were encountered regarding the actual impact of the opinions of patients in relation to business modeling, where a tripartite-problem and the patients’ limited access to their medical records was partly seen as a primary issue. Secondly, the case studies demonstrated how a transition to the EHR-system TakeCare generally did result in cost- and resource savings in terms of local servers, IT-maintenance and inventory management. The TakeCare implementation also led to an increased visibility among health care centers by enabling and simplifying the access to patient medical history. Increased communication, awareness, and more effective internal processes due to integrated modules and direct connections to ePrescriptions could also be accessed from the TakeCare transition. Finally, it emerged that relations existed between simplified access to the patient’s medical history and how it subsequently resulted in an increased interoperability. A correlation was also seen as the health care become generally more mobile due to increased interoperability. / Hälso- och sjukvården i Europa står inför utmaningar i och med en stigande åldersgrupp med en större andel kroniska sjukdomar, vilket resulterat i stegrande sjukvårdskostnader. Samtidigt ses en trend i hur patienter och medborgare börjar bli mer aktiva i sin egen vård och efterfrågan på sjukvårdspersonal ökar, med ökande utmaningar som följd. eHälsa-området, vilket involverar informations- och kommunikationsteknik inom sjukvården, ses därför som en potentiell långsiktig del-lösning och anses samtidigt vara ett starkt växande område i Sverige, men också på den övriga europeiska marknaden. eHälsa betraktas vidare främja en ökad åtkomst, mobilitet och interoperabilitet inom sjukvården, men bristen på helhjärtat engagemang, finansiellt stöd och det stora antal komplexa journalsystem i Sveriges olika kommuner och landsting ses delvis ligga till grund för en bromsad utveckling. Syftet med denna rapport är därför att undersöka, kartlägga och analysera de mest centrala aspekterna för den fortsatta utvecklingen av svensk sjukvård och eHälso-tjänster. Studien undersöker även vad implement av en eHälso-tjänst praktiskt har medfört, med ett fokus på journalsystem där de enskilda förändringarna även har relaterats till de identifierade centrala aspekterna. Examensarbetet är baserat på en gedigen litteraturstudie som utifrån ett teoretiskt ramverk inkluderande ett interoperabilitets-, säkerhets-, mobilitets- och affärsmoduleringsperspektiv ligger till grund för framtagandet av hypoteser som sedan verifierats med hjälp av empiriskt insamlad information. Empirin är erhållen från tio semi-strukturerande kvalitativa intervjuer, samt två fallstudier, vilka tillsammans har resulterat i ett flertal slutsatser. Utifrån ett interoperabilitetsperspektiv framgick det hur det bör finnas både en teknisk och social interoperabilitet som kommunicerar med varandra, då journalsystem idag anses vara svåra att lära sig, icke intuitiva och ej användarvänligt utformade för slutanvändaren. Ökad interoperabilitet ses även möjliggöra och förenkla åtkomsten av patienthistorik, vilket journalsystemet TakeCare tydligt påvisat. Vidare kunde det konstateras att det inte finns en korrelation mellan den progressivt ökande avsatta tiden som sjukvårdspersonal idag tillbringar med administrativa uppgifter och dokumentation med en förhöjd interoperabilitet. Det framkom även att patienter har väldigt liten eller obefintlig kunskap rörande den underliggande säkerheten och hanteringen av personlig information i sjukvården, då de ofta blint litar på att svensk sjukvård anses vara säker samt att patienter prioriterar annat vid läkarbesök. Kunskaper om säkerheten i sjukvården bland patienterna anses dock öka ifall de i framtiden får tillgång till sin journal. Det finns även en allmän oro bland sjukvårdspersonal och närbesläktade instanser för att nya säkerhetsrisker kommer att uppstå i och med eHälsa-vågen, med ett särskilt orosmoln för den ökande användningen av mobila enheter. Relationer mellan hur ökad interoperabilitet även gynnar förhöjd mobilitet sågs även förekomma, men att det ofta samtidigt är säkerhetsaspekter som hindrar den mobila utvecklingen. Avslutningsvis förespråkades det hur icke-finansiella värden inte får bli ignorerade, men problemet kring hur verkningsfull dess faktiska påverkan är, relateras bland annat till strikta budgetar samt stora avstånd mellan beslutstagare och slutanvändare. Liknande argument påträffades angående den faktiska inverkan av åsikter från patienter vid affärsmodulering, där ett trepartsproblem och patienternas begränsade åtkomst till sina journaler delvis sågs ligga till grund. Fallstudierna påvisade hur övergången till journalsystemet TakeCare generellt har lett till resursbesparingar i form av lokala servrars underhåll och lageranvändning, samt en ökad synlighet i vården med förbättrad tillgång till patienthistorik jämfört med tidigare journalsystem. En ökad kommunikation och medvetenhet samt effektivare interna processer på grund av integrerade moduler och direktkoppling till eRecept kunde även påvisas. Slutligen framgick det att relationer förekom mellan den ökande åtkomsten av patienthistorik och andra journaler, och hur förhöjd interoperabilitet medfört detta. Samband kunde även ses hur ökad interoperabilitet positivt gynnar mobiliteten i sjukvården.