Magister Commercii - MCom / This study aimed to understand the readiness and perceptions of Electronic Health Record (EHR) adoption among dentists in the public service of the Western Cape. A qualitative study design was chosen due to a lack of understanding of the phenomena. Additionally, the research sought to identify the factors that would potentially influence readiness and perceptions in order to identify how these factors could potentially influence EHR adoption among dentists.

Health care leaders lack the strategies to implement cloud security for electronic medical records to prevent a breach of patient data. The purpose of this qualitative case study was to explore strategies senior information technology leaders in the healthcare industry use to implement cloud security to minimize electronic health record cyberattacks. The theory supporting this study was routine activities theory. Routine activities theory is a theory of criminal events that can be applied to technology. The study's population consisted of senior information technology leaders from a medical facility in a large northeastern city. Data collection included semistructured interviews, phone interviews, and analysis of organizational documents. The use of member checking and methodological triangulation increased the validity of this study's findings among all participants. There were 5 major themes that emerged from the study (a) requirement of coordination with the electronic health record vendor and the private cloud vendor, (b) protection of the organization, (c) requirements based on government and organizational regulations, (d) access management, (e) a focus on continuous improvement. The results of this study may create awareness of the necessity to secure electronic health records in the cloud to minimize cyberattacks. Cloud security is essential because of its social impact on the ability to protect confidential data and information. The results of this study will further serve as a foundation for positive social change by increasing awareness in support of the implementation of electronic health record cloud security.

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.

Rates of immune-mediated diseases (IMDs) have rapidly increased. Although the exact etiology has not yet been fully elucidated, disruptions to the microbiome has been proposed as a potential mechanism. We conducted a retrospective, longitudinal, birth cohort study utilizing electronic health records (EHR) to investigate the association between early life antibiotic exposure and the risk of developing juvenile idiopathic arthritis (JIA), pediatric psoriasis, or type 1 diabetes. Incident rate ratios (IRR) were estimated using modified Poisson regression models and adjusted for significant confounders. Children exposed to two or more antibiotics prior to 12 months of age had a 69% increased risk of developing JIA (1.69 IRR, 95% CI [1.04-2.73]), which rose to 97% when exposed prior to 6 months (1.97 IRR, 95% CI [1.11-3.49]). Children exposed to a penicillin antibiotic had a 62% increase in risk for psoriasis (1.62 IRR, 95% CI [1.06-2.49]), which rose slightly to 64% when exposure occurred between 6 and 12 months of age [(1.64 IRR, 95% CI [1.04-2.59]). We found a moderate to strong association between early antibiotic exposure and risk for JIA and psoriasis when exposure was examined by age, frequency, and type of antibiotic, but not for type 1 diabetes. Potential interactions effects between infection and antibiotics with an increased susceptibility to early life infections among children with an IMD was also observed. Overall, children exposed to antibiotics at an early age have an increased probability of developing an IMD after 12 months of age. However, alternative explanations for this association should be considered. / Public Health

Digital transformation is evolving, and it is driving at the helm of the digital evolution. The amount of information accessible to us has revolutionized the way we gather information. Mobile technology and the immediate and ubiquitous access to information has changed how we engage with services including healthcare. Digital technology and digital transformation have afforded people the ability to self-manage in different ways than face-to-face and paper-based methods through different technologies. This study focuses on exploring the use of the most commonly used digital health technologies in the healthcare sector and how it affects physicians’ daily routine practice. The study presents findings from a qualitative methodology involving semi-structured, personal interviews with physicians from Sweden and a physician from Spain. The interviews capture what physicians feel towards digital transformation, digital health technologies and how it affects their work. In a field where a lack of information regarding how physicians work is affected by digital health technologies, this study reveals a general aspect of how reality looks for physicians. A new way of conducting medicine and the changed role of the physician is presented along with the societal implications for physicians and the healthcare sector. The findings demonstrate that physicians’ role, work and the digital transformation in healthcare on a societal level are important in shaping the future for the healthcare industry and the role of the physician in this future. / Den digitala transformationen växer och den drivs vid rodret för den digitala utvecklingen. Mängden information som är tillgänglig för oss har revolutionerat hur vi samlar in information. Mobila tekniker och den omedelbara och allmänt förekommande tillgången till information har förändrat hur vi tillhandahåller oss tjänster inklusive inom vården. Digital teknik och digital transformation har gett människor möjlighet att kontrollera sig själv och sin egen hälsa på olika sätt än ansikte mot ansikte och pappersbaserade metoder genom olika tekniker. Denna studie fokuserar på att utforska användningen av de vanligaste digitala hälsoteknologierna inom hälso- och sjukvårdssektorn och hur det påverkar läkarnas dagliga rutin. Studien presenterar resultat från en kvalitativ metod som involverar semistrukturerade, personliga intervjuer med läkare från Sverige och en läkare från Spanien. Intervjuerna fångar vad läkare tycker om digital transformation, digital hälsoteknik och hur det påverkar deras arbete. I ett fält där brist på information om hur läkare arbetar påverkas av digital hälsoteknik avslöjar denna studie en allmän aspekt av hur verkligheten ser ut för läkare. Ett nytt sätt att bedriva medicin och läkarens förändrade roll presenteras tillsammans med de samhälleliga konsekvenserna för läkare och vårdsektorn. Resultaten visar att läkarnas roll, arbete och den digitala transformationen inom hälso- och sjukvården på samhällsnivå är viktiga för att utforma framtiden för vårdindustrin och läkarens roll i framtiden.

Denna studie undersöker användarupplevelsen av utbildning i journalsystemet Cosmic i Region Jönköpings län. Utbildning är av största vikt för personalens välmående samt för optimal användning av systemet. Syftet med undersökningen är att utforma en enkät för kontinuerligt förbättringsarbete inom området. Enkäten undersöker både kvantitativa och kvalitativa element hos ett urval som stratifierats utifrån användarnas yrkesroller. Enkäten skickades till deltagarnas respektive arbetsmejl, och svaren samlades in och bearbetades med hjälp av enkätprogrammet EsMaker. Ordinalskalor användes som mätverktyg i många av enkätens kvantitativa frågor, medan de kvalitativa frågorna analyserades med hjälp av The constant comparative method.  Studiens resultat visar en godtycklighet gentemot det material som finns samt med kollegor som instruktörer. Dock framkommer starka önskemål om organiserade utbildningar. Ett tydligt mönster är att användarna föredrar utbildningsmetoder som bygger på synkron kommunikation, samt att metoder som bygger på demonstration av programvaran är mer uppskattade än andra. Resultaten visar dock att dessa metoder bör kombineras med övningar för bästa effekt.  Slutsatser som undersökningen genererat är att kommande utbildningsinsatser bör innebära organiserade utbildningar på arbetsplatsen. Vidare forskning kopplat till Ställföreträdande lärande och Aktivitetsbaserat lärande skulle kunna användas för att optimera utbildningens resultat samt användarnas nöjdhet. En djupare analys av enkätresultatet med avseende på yrkesrollernas respektive behov skulle ytterligare kunna höja kvalitén och effektivisera utbildningarna. Studiens absolut viktigaste fynd är vikten av att chefer avsätter tid för sina medarbetare att ta del av de utbildningsmöjligheter som finns. Detta är kärnan i allt, för utan tid till utbildning spelar utbildningsmaterialets kvalitet ingen som helst roll. / This study investigates the end-user experience of education in Cosmic, a system for electronic health records, in Region Jönköping County. Training is of paramount importance for the well-being of the staff and for optimal use of the system. The purpose of the survey is to design a questionnaire that can be used for continuous improvement of the end-user training in the county.  The survey examines both quantitative and qualitative elements of a sample that is stratified based on the end‑users' professions. The survey was sent to the participants' work emails, and the responses were collected and processed using the EsMaker survey program. Ordinal scales were used as a measurement tool in many of the survey's quantitative questions, while the qualitative questions were analyzed using The constant comparative method.  The results of the study show an arbitrary attitude towards the available training material as well as towards colleagues as instructors. However, there are strong desires for organized training. A clear pattern is that users prefer training methods based on synchronous communication, as well as methods based on demonstration of the software. However, the results show that these methods should be combined with individual tasks for the best effect.  Conclusions generated by the survey are that future training efforts should involve organized training at the workplace. Further research linked to vicarious modeling and enactive learning could be used to optimize the results of the education as well as end-user satisfaction. A deeper analysis of the survey results regarding the respective needs of the professional roles could further increase the quality and streamline the education. The study's most important finding is the importance of managers to dedicate time for their employees to use the training opportunities available. This is the essence of everything, because without time for training, the quality of the educational material does not matter whatsoever. / <p>Examensarbete i vårdadministration, YH-utbildning: 20 Yh-poäng.</p>

Disease subtyping has been a critical aim of precision and personalized medicine. With the potential to improve patient outcomes, unsupervised and semi-supervised methods for determining phenotypes of subtypes have emerged with a recent focus on matrix and tensor factorization. However, interpretability of proposed models is debatable. Principal component analysis (PCA), a traditional method of dimensionality reduction, does not impose non-negativity constraints. Thus coefficients of the principal components are, in cases, difficult to translate to real physical units. Non-negative matrix factorization (NMF) constrains the factorization to positive numbers such that representative types resulting from the factorization are additive. Archetypal analysis (AA) extends this idea and seeks to identify pure types, archetypes, at the extremes of the data from which all other data can be expressed as a convex combination, or by proportion, of the archetypes. Using AA, this study sought to evaluate the sufficiency of AKI staging criteria through unsupervised subtyping. Archetype analysis failed to find a direct 1:1 mapping of archetypes to physician staging and also did not provide additional insight into patient outcomes. Several factors of the analysis such as quality of the data source and the difficulty in selecting features contributed to the outcome. Additionally, after performing feature selection with lasso across data subsets, it was determined that current staging criteria is sufficient to determine patient phenotype with serum creatinine at time of diagnosis to be a necessary factor.