Healthcare in Sweden is in need of eHealth innovations to meet the requirements a highlydeveloped society. However to develop and implement eHealth in the healthcare system ischallenging because the system is experienced as complex, conservative and fragmented.In this thesis a qualitative single case study has been conducted to further investigate thechallenges of development and implementation of eHealth. This study demonstrates that itis challenging to understand the complexity of the healthcare system and this has animpact on eHealth development. Involvement of potential users and collaborationbetween stakeholders are seen as a suggested solution to understand this problem. Thisthesis has also shown that to involve users and collaborators is challenging as well.Further the study has shown that there are technological challenges in realizing eHealthin the healthcare system and there is a challenge to develop and implement informationsystems because of regulatory limitations. Despite years of experience in healthcare or ITdevelopmentmany of the respondents find that these factors challenge innovation efforts.

Access to Personal Health Information (PHI) is a valuable part of the modern health care model. Timely access to relevant PHI assists care providers in making clinical decisions and ensure that patients receive the highest quality of care. PHI is highly sensitive and unauthorized disclosure of PHI has potential to lead to social, economic, or even physical harm to the patient. Traditional electronic health (eHealth) tools are designed for the needs of care providers and are insufficient for the needs of patients. Our research goal is to investigate the requirements of electronic health care systems which place patient health and privacy above all other concerns. Control of secure resources is a well established area of research in which many techniques such as cryptography, access control, authentication, and organizational policy can be combined to maintain the confidentiality and integrity of data. Access control is the dominant data owner facing privacy control. To better understand this domain we conducted a scoping literature review to rapidly map the key concepts underpinning patient facing access controls in eHealth systems. We present the analysis of that corpus as well as a set of identified requirements. Based on the identified requirements we developed Circle of Health based Access Control (CoHBAC), a patient centered access control model. We then performed a second scoping review to extend our research beyond just access controls, which are insufficient to provide reasonable privacy alone. The second review yielded a larger, more comprehensive, set of sixty five requirements for patient centered privacy systems. We refined CoHBAC into Privacy Centered Access Control (PCAC) to meet the needs of our second set of requirements. Using the conceptual model of accountability that emerged from the reviewed literature we present the identified requirements organized into the Patient Centered Privacy Framework. We applied our framework to the Canadian health care context to demonstrate its applicability. / Graduate

Approximately half a million people in Canada suffer from heart failure (HF), a leading cause of hospital admission. HF outcomes can be improved by self-care behaviors, to which patients often show low adherence. This study focuses on the co-design of an online self-care application and community intervention, called HFApp, which patients with HF and their informal caregivers could use to potentially improve HF outcomes. The intended users for HFApp are older adults with HF and their informal caregivers. The primary objective of this study is to identify themes for the development of HFApp. The secondary objective is to apply these findings to identify user needs and preferences for HFApp. Persona-scenario discussion sessions were conducted with 4 older patients with HF (≥ 60 years) and 4 informal caregivers from the Hamilton Health Sciences Heart Function Clinic. One persona-scenario discussion session was held for each participant type (i.e. patients with HF or informal caregivers). Participants were divided into pairs and participant pairs created personas and scenarios together. Scenarios included: (1) how they learn about HFApp, (2) how they might access HFApp, (3) where they are when they use HFApp, (4) who might help them with HFApp, and (5) how often they use HFApp. All discussions were audio recorded. Data analysis, using NVivo 10 , provided six categories of design themes which were used to develop a list of user requirements for HFApp. Some of these requirements help users perceive HFApp to be more useful and give a sense of self-care confidence. However, some requirements may be excluded due to low feasibility. It is recommended that a larger persona-scenario group session be conducted in the future to support the requirements gathered in this study as well as identify any new requirements. / Thesis / Master of Science (MSc) / Approximately half a million Canadians suffer from heart failure (HF), a leading cause of hospitalization. This study focuses on the involvement of potential users in the design of HFApp, an online HF self-care application (“app”). These users include older patients with HF and their family and close friends. One of HFApp’s objectives is to potentially decrease hospital visits for older patients with HF. A design based on patient preferences called persona-scenarios was used to conduct this study. Participants were asked to create pretend individuals that were similar to themselves and describe scenarios in which these individuals would interact with HFApp. These could include: (1) how they learn about HFApp, (2) how they might access HFApp, (3) where they are when using HFApp, (4) who might help them with HFApp, and (5) how often they use HFApp. These interactions will be used to identify user requirements and preferences for HFApp’s design.

The diploma thesis is focused on the analysis of national strategies in the area of eHealth. The main aim of this thesis is to analyse the foreign national eHealth strategies and subsequent draft concept for the Czech Republic based on achieved results. The first chapter contains theoretical introduction into the field of eHealth, the main sources of research, history and definition of eHealth. The second part is devoted to the analysis, comparison and critical assessment of national eHealth strategies based on criteria in the countries of Denmark, New Zealand and the Slovak Republic. Third and final chapter is focused on the assessment of the current state of eHealth in the Czech Republic and the draft concept of eHealth strategy in the Czech Republic, which is based on the conclusions reached in the second chapter. The main contribution of this work is the analysis of selected national strategies and draft concept for eHealth strategy in the Czech Republic.

The ability to interoperate between systems, people, and organizations is considered an important issue within eHealth in order to deliver patient centered care. The achieving and improving of interoperability is a complex undertaking involving the evolution of an information infrastructure, sharing of knowledge and resources, governance of the interoperation between organizations, people and work practices, and handling of economic and legal matters. This thesis contributes with practical knowledge on improving interoperability, based on active participation in and empirical studies of improving interoperability in ePrescribing. A case study describes and analyzes the evolution of ePrescribing in Sweden since the early pioneering years in 1980s, its growth and consolidation before the reregulation of the pharmacy market in 2009. Apractical theory on ePrescribing is presented. A unique field experimental study measuring improvement of interoperability in ePrescribing, before and after a major intervention to improve the quality of ePrescriptions between 2004 and 2009 is presented. Furthermore, a practical theory on interoperation and interoperability is presented. Interoperability is seen as the exercised capability of organizations through their agents to interoperate in a shared work practice in an effective, efficient, and satisfactory manner based on a common ground in a mediated, prescriptive, and non-personal communicative setting using an information infrastructure for mediating interoperation.

Background and objectives: Information and communication technologies (ICTs) have been in use in the health setting since the time of the first telephones. However, the advent of computers, personal-computers (PCs) and, more recently, mobile information and communication technologies (mICTs) such as mobile phones, smartphones, tablet-pcs and laptops, has seen technology become increasingly integrated into how care is delivered and received. No research has yet explored how people with mood disorders use mICTs in their everyday lives and, more specifically, how they might use mICTs to look after themselves. This oversight has led to technology redundancy and high attrition rates in the use of this type of technology. Further research was therefore required to understand the meaning that this type of technology holds for people with mood disorders. This qualitative study aimed to explore the views and experiences of people with mood disorders, and their mental health and social care professionals, in using mICTs. Design and methods: A meta-synthesis was completed, guided by the work of Sandelowski and Barroso, using thematic synthesis an approach, as designed by Thomas and Harden. An exploratory qualitative approach, using in-depth, semi-structured interviews with 26 patients with mood disorders in secondary and specialist mental health services, and ten mental health and social care professionals, was subsequently employed. Participants’ datasets were analysed using Constructivist Grounded Theory (CGT). Grounded theory (GT) involves the gradual identification and integration of categories of meaning from the data, and the identification of relationships between them. Results: The rigorous and systematic nature of the meta-synthesis identified shortcomings in current research and clearly identified a gap in the research literature regarding mICTs and mood disorders. The in-depth primary study created a theory explaining how mobile technology was used in daily life, and also, more specifically, how it was used to manage recovery from mood disorders. The core category and participants’ main concern that emerged from the data, forming theory, was ‘Centrality; through praxis of interconnectivity’. Patients with mood disorders used their mICTs to stay central within their on-and-offline worlds and held them central in their importance of attachment. Health and social care professionals worked around their provision of basic mICTs and lack of informational support when using them with their patients. Centrality was achieved through the ‘Praxis of interconnectivity’; the act of managing their connectedness using mICTs. This interconnectivity was not fixed; instead, it offered fluidity for participants to manage their continuums of use through their ‘Outsourcing of needs’, ‘Management of needs’, and ‘Disconnection of needs’. Conclusions and future implications: This study refocused the attention of ICT research onto arguably the most important person, the end-user, and, in this instance, the people recovering from mood disorders, and their health and social care professionals. The CGT provided, for the first time, a theory that explained how people made use of their mICTs. Additional research is warranted to further understand the transferability of the theory to other client groups, and, in so doing, whether it can be transformed into a formal theory. Also, further research is recommended to translate the theory into practical tools for clinicians; for example, the creation of an mICT self-management questionnaire or a digital hygiene support package. Both patients recovering from mood disorders, and health and social care professionals, can utilise the findings of this study to help make sense of their mICT use. The study findings can also help inform and encourage the further incorporation of mICTs into the health and social care settings; spanning the therapeutic to systemic levels so that the full potential of these ubiquitous technologies can be harnessed to improve care and care delivery.

Health care systems still focus on single disease management and ignore the complexities of multiple conditions management. Though self-management is the focus of chronic disease management, patients with comorbidities face challenges in meeting their self-management goals. The purpose of this study was to explore the perspectives of patients with comorbid conditions on the use of eHealth technology to promote self-management. The research was grounded on the technology acceptance model. I sought to explore the participants' understanding of self-management, the challenges to self-management and their perspectives on the use of eHealth for self-management. In this phenomenological study, 10 interviews were conducted from a purposeful sample of those with two or more comorbid conditions. The collected data were audio recorded and transcribed verbatim. Prolonged engagement, member checks, and triangulation were used to ensure trustworthiness. Self-reports and observation augmented the interviews. Data collection continued until saturation was reached, then analyzed iteratively and organized according to themes. The results showed that the participants managed their conditions at home by taking prescribed drugs, attending clinics, and following a special diet. However, they faced financial constraints, struggled with symptom control, and took too many drugs. The results also showed that technology could be used for people living with comorbidity as a source of information, to remind patients to take drugs or attend clinics, to increase awareness of symptoms, and to assist in the management of the disease. This study is expected to help in understanding (a) the challenges faced by patients with comorbidities, and (b) how the use of technology promotes self-management in this growing group.

Around the globe the number of older people in relation to the rest is constantly growing. As a result, medical and care facilities cannot handle the growing number of patients. Therefore, elderly in-home assistance gets more attention an importance. Due to issues regarding memory, physical strength and reduced self-assessment, old people face a lot of challenges in accomplishing their activities of daily living. This thesis is meant to address these problems by analysing the required infrastructure of a home-care facility as well as the arising issues regarding used components, especially wireless sensors. After the analysis, a prototype of a home-care system is designed and implemented. Furthermore, the issue of energy consumption of the used wireless sensor node is addressed by modifying the intelligence of the used sensor. After that, the design and components of the prototype used for the energy consumption analysis is explained, together with the programming structure of the sensor nodes used in this thesis. Thereupon, the results are of the simulations are discussed and compared with the authors ‘expectations. Finally the overall outcomes of the thesis are analysed and summed up, followed by a short outlook of further possible improvements and developments.

Mobile applications (“apps”) are increasingly used in medical education and practice. However, many medical apps are of variable quality, lack supporting evidence and fall outside the remit of regulators. In this thesis, I explore how the quality and credibility of apps for healthcare practitioners could be improved. I argue that interdisciplinary collaboration throughout the app life-cycle is critical and discuss how this can be facilitated. My argument rests on prior work in eHealth and neighbouring disciplines, and on original research in transfusion medicine. Blood transfusion can be a life-saving medical treatment. However, it also carries risks. Failures to provide irradiated and cytomegalovirus-negative blood components according to guidelines are frequently reported in the UK. Such incidents put patients at risk of serious complications. Haemovigilance data indicates that enhancing practitioner knowledge may reduce mistakes. Thus, I worked with medical experts to develop and evaluate the Special Blood Components (SBC) mobile learning app. To facilitate this work, I created two tools: the Web App Editor (WAE) and the Web App Trial (WAT). The former is a collaborative editor for building apps in a web browser and the latter is a system for conducting online randomised controlled app trials. The results are reported in five studies. Studies 1 and 2, based on interviews with seven practitioners, revealed shortcomings in an existing transfusion app and the SBC prototype. Study 3 demonstrated how students using theWAE were able to collaborate on apps, including an app in stroke medicine. Study 4, an evaluation of the revised SBC app with 54 medical students, established the ease of use as acceptable. In study 5, a WAT pilot study with 61 practitioners, the SBC app doubled scores on a knowledge test and was rated more favourably than existing hospital guidelines. In conclusion, creating high quality medical apps that are supported by evidence is a considerable undertaking and depends on a mix of knowledges and skills. It requires that healthcare practitioners, software developers and otherswork together effectively. Hence, the WAE and WAT are key research outcomes. They enabled participants to contribute improvements and assess the usability and efficacy of the SBC app. The results suggest that the SBC app is easy to use and can improve practitioner knowledge. Further work remains to pilot and evaluate the SBC app in a hospital setting.

Introduction: The traditional IT investment evaluation methods and/or techniques tend to measure the quantitative value added by eHealth. However, there are contributions brought by innovation which are intangible and sundry, and thus are difficult to identify, measure and manage. A model presented by Vimarlund & Koch (2011) aims for identifying the benefits that IT investments bring to health and social care organizations. It could be used as a tool that identifies and classifies the effects and indicators of IT innovation in-vestments at different organizational levels for different stakeholders. Purpose and research questions: This is an evaluative study with the purpose to validate Vimarlund & Koch’s (2011) evaluation model through practical application. A care study of EIAS (ERAS Interactive Audit System) is conducted. ERAS stands for Enhanced Recovery After Surgery, which is an innovative process aims to enhance patient’s outcome after ma-jor surgery. EIAS is a system that supports the ERAS process. The aim is to achieve a deep understanding of IT investment evaluation. The model will be used in a real case as a guide to evaluate and identify impact that derives from the use and implementation of IT applica-tions. The process of evaluation could also be seen as a process of validation of the model in terms of comprehensiveness, practicality and applicability. Through this study, we aim to find out: 1) What are the possible contributions that EIAS brings to Jönköping County Council? 2) How is the performance of Vimarlund & Koch’s (2011) evaluation model in practical application, in terms of comprehensiveness, practicality and applicability? Method: The purpose of this study is evaluative and it is conducted by using adductive ap-proach. Single case study will be adopted as the research strategy. In this study, qualitative data will be collected through semi-structured interview with key respondents. The data collected will be analyzed qualitatively with a narrative approach. Conclusion: Guided by Vimarlund & Koch’s (2011) evaluation model, the innovations that have been brought into healthcare organizations by EARS are electronic information supply, internal integration of clinical information and possibilities to learn from the system. The model has been validated in terms of comprehensiveness, practicality and applicability. The evaluation model is a generic model to demonstrate the contribution of IT to innovation and change in health care. It could be used in both formative and summative assessment and as well as goal-free and goal-based evaluation. The issue of the productivity paradox has been noticed as some effects are not immediate after introducing of IT. User-participation or not could be considered as an important condition for the validity of the evaluation guided by the evaluation model.