The majority of patients with a distal radius fracture (DRF) are elderly, a group known to experience difficulties with new technology, partly due to a low level of digital literacy. At the beginning of the coronavirus disease 2019 pandemic, during the spring 2020, patients that underwent DRF surgery had regular follow-ups replaced by video calls from their surgeon and physiotherapist. Afterward, patients answered questionnaires regarding health and digital literacy and took part in semistructured interviews regarding the experience of the virtual follow-up. By systemic text condensation, 2 major categories were identified: (1) The video call—new, but surprisingly simple: All but 1 found it easier than expected, and (2) Video calls—the patient's choice: All but 1 patient preferred video calls to physical visits for follow-up. This is the first mixed methods study to assess patients’ experiences of digital follow-up after DRF surgery. This study indicates that digital follow-up was highly appreciated, even among patients with low levels of digital literacy. Digital technologies must be made suitable even for patients with inadequate levels of digital literacy. © The Author(s) 2023.

A growing and aging population provides challenges for the healthcare sector, generating higher healthcare costs, and ineffective work process that results in long patient queues and problems with recruiting and retaining healthcare professionals. Artificial intelligence (AI) is considered as one means to provide efficient processes for healthcare professionals, e.g. in diagnostics and treatment recommendations. However, research has shown that there are many obstacles to successfully introducing and using AI applications in healthcare, especially by focusing on the organizational level. However, individual healthcare professionals have an important role to play in the transition towards information driven healthcare. 

Therefore, we address the healthcare professionals' perception of the usefulness and value of AI applications, as well as challenges and considerations of this new technology. 

The study is based on an exploratory approach with more than 350 healthcare professionals in Sweden, carried out beginning of 2024. The questionnaire includes perceptions of the use of AI and identifies potential challenges that need to be addressed. The respondents include doctors (92%) and nurses (8%). The sample consists of answers from 221 (62%) male and 136 (38%) female respondents. Most of the respondents work in public hospitals (54%) and health centers (20% public and 14% private). Several AI applications are used by healthcare professionals, spanning from administrative work reduction to new insights in the analysis of complex cases.

Thematic analysis is conducted to create a model of perception of usefulness, values and problems (barriers). The analysis includes a stepwise analysis to identify patterns and themes.

The  results from the project provide insights into how the introduction of AI applications in healthcare changes the work of healthcare professionals and the perceived challenges that need to be addressed to improve their work by using AI. To some extent, implementation and use is based on healthcare professionals’ interest in using new advanced technology but for others the decision to adopt AI is primarily based on formal decisions within the organization. Respondents that have been using AI for at least six months, indicate AI supports decision making, with the main benefit consisting of a more effective and faster work process, while other respondents do not perceive any changes. A surprising result is that healthcare professionals have identified the possibility to test and evaluate new ideas and more complex cases. One interpretation is that AI has made the workload easier, which may allow for more innovative work. Another interpretation is that their experience-based knowledge is augmented by AI, and this makes it possible for them to handle more complex cases.   However, others experience a learning paradox – challenging to find time and learn how to use the technology, while at the same time adopting by testing AI applications.

Conclusions drawn from the ongoing study provide insights on the transformation phase towards implementing and using AI applications in healthcare.

Allt fler så kallade e-tjänster, exempelvis journaler på nätet, införs i vården. De kan dock leda till nya problem för personalen, inte minst när det gäller arbetsbelastning och yrkesroller. Projektet har tagit fram kunskap som förebygger arbetsmiljöproblem vid införandet av e-hälsotjänster.

This paper is based on an interview study examining the implementation of the eHealth service patient online access to electronic health records in two county councils in Sweden. Our aim is to present and discuss the two councils’ implementation processes and the differences between them, with particular focus on the implementers’ consideration of caregivers’ work environment. A theoretical aim is to shed light on the complicated situation that arises when a county council is responsible for both the implementation of an eHealth service and the effects it has on the work environment of the employees (professionals). The results from the total of 16 semi-structured indepth interviews show that the two county councils differ in the following areas: 1) whether the implementation is interpreted as a threat for the work environment; 2) who the interviewees consider as responsible for the work environment; and 3) if it was considered important to build trust between the implementers (the county councils) and the professionals – and how this trustbuilding was accomplished. It is concluded that the differences between the two implementation processes was due in part to the difference in how the service was framed and labelled in the two respective county councils, and that one of the county councils has encountered difficulties in taking dual responsibility towards both patients and the work environment of the employees. This implies, according to Bovens’ (1998) classification, that one of the county councils takes active responsibility for the work environment while the other takes passive responsibility for the work environment. 

Introduction: Government and public agencies in Sweden have promoted the expansion of eHealth. The strategy behind many of the eHealth services is to increase quality of care, enhance efficiency, patient empowerment and patient safety. Patient online access to their electronic health record (EHR) is one of the most important civic eHealth services. By 2017, all patients in Sweden will be able to access their EHR online. In Mars 2014, Region Skåne (RS) introduced the service in somatic care and in September 2015 RS introduced the service in adult psychiatry. The aim of this presentation is to discuss 1) how the employees in somatic care experience the service in terms of effects on work environment and patient safety. 2) How the employees in psychiatric care anticipated that the service would affect their work environment and patient safety.

Material and methods: The material presented derives from two surveys: 1) A full population web survey distributed to employees in somatic care in RS approximately two years after the introduction of the service (post implementation). Response rate: 20% (n = 2376). 2) A full population web survey that was distributed to employees in adult psychiatry in RS just before the introduction of the service (ante implementation). Response rate: 29% (n = 871).

Results: The results show that the experience in somatic care and the expectation in adult psychiatric care correspond to a large degree. Respondents in both groups are sceptical to the anticipated positive effects of the service. The comparison between the two surveys further show that the employees with experience of the service (somatic care) are even more negative then the employees without experience (psychiatric care).

Conclusions: The results from the two surveys indicate that there is a large difference between the aimes of the national eHealth strategy and the expectations and experiences of the healthcare personell and that little attention is given to the negative effects that civic eHealth services may have on the work environment of healthcare personell. There is thus a need for more research about how eHealth services affect work environment, patient safety and quality of care.

Background: The New Public Management movement strove for transparency so that policy makers and citizens could gain insight into the work and performance of health care. As the use of the electronic health record (EHR) started to diffuse, a foundation was laid for enhanced transparency within and between health care organizations. Now we appear to be experiencing a new kind of transparency in the health care sector. Many health care providers offer their patients online access to their EHRs (here referred to as Open Notes). The Open Notes system enables and strives for transparency between the health care organization and the patient. Hence, this study investigates health care professional (HCP) perceptions of Open Notes and deepens the understanding of the transparency that Open Notes implies.

Objective: Based on two survey studies of HCP perceptions of Open Notes, this paper aims to deepen the academic writing on the type of transparency that is connected to Open Notes.

Methods: HCPs in adult psychiatry in Region Skåne, Sweden, were surveyed before and after implementation of Open Notes. The empirical material presented consists of 1554 free-text answers from two Web surveys. A qualitative content analysis was performed.

Results: The theoretically informed analysis pivots around the following factors connected to transparency: effectiveness; trust; accountability; autonomy and control; confidentiality, privacy, and anonymity; fairness; and legitimacy. The results show that free-text answers can be sorted under these factors as trade-offs with transparency. According to HCPs, trade-offs affect their work, their relationship with patients, and not least, their work tool, the EHR. However, since many HCPs also state that they have not met many patients, and in some cases none, who have read their EHRs, these effects seem to be more connected to the possibility (or threat) of transparency than to the actual effectuated transparency.

Conclusions: The implementation (or reform) of Open Notes is policy driven while demanding real-time transparency on behalf of citizens/patients and not the authorities, which makes this particular form of transparency quite unique and interesting. We have chosen to call it governed individual real-time transparency. The effects of Open Notes may vary between different medical specialties relative to their sensitivity to both total and real-time transparency. When HCPs react by changing their ways of writing notes, Open Notes can affect the efficiency of the work of HCPs and the service itself in a negative manner. HCP reactions are aimed primarily at protecting patients and their relatives as well as their own relationship with the patients and secondly at protecting themselves. Thus, governed individual real-time transparency that provides full transparency of an actual practice in health care may have the intended positive effects but can also result in negative trade-offs between transparency and efficiency of the actual practice. This may imply that full transparency is not always most desirable but that other options can be considered on a scale between none and full transparency.

© Gudbjörg Erlingsdóttir, Lena Petersson, Karin Jonnergård. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.09.2019.

This presentation brings light on how the materialityof three eHealth solutions affects care and carework. We conducted 92 semi-structured interviewswith healthcare workers from the south of Sweden.The analysis of the data was interpretive with focuson the participants’ experiences. By exploring thelived experiences of the participants, we found thatall the three solutions (1) changed the boundariesbetween patients and colleagues; (2) enabledaugmented information- and knowledge processes;and (3) reconfigured professional control.

Background: eHealth applications are considered a technological fix that can potentially address some of the grand challenges in healthcare, including burnout among healthcare professionals, the growing burden of patients with chronic conditions, and retaining and recruiting healthcare professionals. However, as the deployment of eHealth applications in healthcare is relatively novel, there is a lack of research on how they affect the work environment of healthcare professionals. This study explores how work evolves—particularly for nurses—during the utilisation of three eHealth applications.

Methods: The study is a qualitative case study with an interpretive approach. The utilisation of three different eHealth applications was studied. Seventy-five healthcare professionals were interviewed, most of whom were nurses (n = 47). Interviews were transcribed verbatim and qualitative content analysis was used to analyse the text.

Results: Three main themes were identified: work that is ignored and overlooked; actions needed to complete visible work; and more sedentary work activities. The findings suggest that work surrounding the utilisation of eHealth applications in care practices is mostly performed by nurses. While the promise of more efficient workflows resulting from healthcare’s digital transformation may be realised to different degrees, the utilisation of eHealth applications creates additional invisible labour for nurses.

Conclusion:We identified through our analysis that the extra work created by eHealth applications is invisible at the organisational level. Most of the invisible labour was performed by nurses, who were engaged in utilising the eHealth applications. This needs to be recognised when implementing eHealth applications in care practices. © 2023, The Author(s).

Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance. © The Author(s) 2022.

Background: The literature on how to communicate reform in organizations has mainly focused on levels of hierarchy and has largely ignored the variety of professions that may be found within an organization. In this study, we focus on the relationship between media type and professional responses.

Objective: The objective of this study was to investigate whether and how belonging to a profession influences the choice of communication media and the perception of information when a technical innovation is implemented in a health care setting.

Methods: This study followed a mixed methods design based on observations and participant studies, as well as a survey of professionals in psychiatric health care in Sweden. The χ2 test was used to detect differences in perceptions between professional groups.

Results: The use of available communication media differed among professions. These differences seem to be related to the status attached to each profession. The sense-making of the information appears to be similar among the professions, but is based on their traditional professional norms rather than on reflection on the reform at hand.

Conclusions: When communicating about the implementation of a new technology, the choice of media and the message need to be attuned to the employees in both hierarchical and professional terms. This also applies to situations where professional employees are only indirectly affected by the implementation. A differentiated communication strategy is preferred over a downward cascade of information. © Karin Jonnergård, Lena Petersson, Gudbjörg Erlingsdóttir. 

Background

The implementation of e-health is transforming healthcare. The acknowledged benefits of digitalization are quality improvement, patient empowerment, and increased efficiency. The mobility of e-health makes it especially suitable for home healthcare. eMar is a common e-health technology used in Swedish home healthcare. Decisions about technology design are governed by developers’ perceptions of intended users. These perceptions can be identified in the description and promotion of a specific product.

Purpose

The purpose of the presentation is to contribute to increased knowledge about the values entailed in a specific eMar used in Swedish home healthcare, and furthermore to discuss how these values conform with existing national missions such as people-centered care.

Method

Information consisting of sales materials about a specific eMar used in several Swedish municipalities has been analyzed through critical discourse analysis to visualize values embedded in the eMar.

Findings

Preliminary results show that the provider of the specific eMar describes care in terms borrowed from the industrial sector, such as shift changes and production of care. Good and safe care is defined as the right person receiving the right medicine at the right time. Furthermore, the app is advertised as a tool for monitoring assuming that the performance of tasks can be influenced through the remote control of the employee. The eMar is described as representing new and modern technologies that are expected to raise the status of healthcare professions and facilitate the recruitment of employees.

Increased use of digital technologies in healthcare offers healthcare professionals multiple ways to perform tasks and interact with patients and colleagues. We used the JDCS model to identify employee´s well-being in relation to the use of an eMar. The analysis indicated that the specific technology influenced the work environment for registered nurses and nursing assistants in different ways.

Background: The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. Aim: The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. Method: We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. Results: NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. Conclusion: Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare. © 2024 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

Svensk primärvård står inför stora utmaningar med en åldrande befolkning och ett ökat antal personer som vårdas i hemmet (Landers et al., 2016). Digital teknik implementeras med förhoppning om att förbättra kommunikationen mellan vårdpersonal och underlätta möjligheterna till egenvård och tillgänglighet för patienter (Socialstyrelsen, 2021). Tidigare studier visar att användningen av digital teknik kan förändra det professionella landskapet (Petersson, 2020) och påverka arbetsmiljö och arbetets innehåll (Ertner, 2019). Trots att teknik som implementeras inom vården bör vara anpassad till hälso- och sjukvårdspersonalens arbete och värderingar (Palmer et al., 2019; Reed et al., 2019) är sjuksköterskor sällan involverade i beslut kring utformning eller implementering av ny teknik (von Gerich et al., 2022). Det behövs mer kunskap om hur digitaliseringen kan ske i samproduktion med sjuksköterskor och utformas så att en god arbetsmiljö bibehålls.

Presentationen syftar till att beskriva sjuksköterskors arbete och arbetsmiljö inom hemsjukvården och hur dessa kunskaper kan användas vid utvecklingen och implementeringen av framtida digital teknik.

Individuella semi-strukturerade intervjuer har genomförts med 20 sjuksköterskor som arbetar på vårdcentral och inom hemsjukvård i två halländska kommuner. Intervjuerna har analyserats genom kvalitativ innehållsanalys (Hsieh & Shannon, 2005). Implementeringsteoretiska ramverk används för att undersöka hur kunskapen kan inkorporeras vid innovation och implementering av digitala tekniker inom vårdverksamheter (Nilsen, 2015).

Preliminära resultat kommer att presenteras vid konferensen.

Referenser

Ertner, S. M. (2019). Enchanting, evoking, and affecting: the invisible work of technology implementation in homecare. Nordic Journal of Working Life Studies, 9(S5), 33-47.

Hsieh, H.-F., & Shannon, S. E. (2005). Three Approaches to Qualitative Content Analysis. Qualitative health research, 15(9), 1277-1288.

Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., MacMillan, R., Jones, K., Bowles, K., Dowding, D., Lee, T., Moorhead, T., Rodriguez, S., & Breese, E. (2016). The Future of Home Health Care: A Strategic Framework for Optimizing Value. Home Health Care Management & Practice, 28(4), 262-278.

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation science : IS, 10(1), 53-53.

Palmer, V. J., Weavell, W., Callander, R., Piper, D., Richard, L., Maher, L., Boyd, H., Herrman, H., Furler, J., & Gunn, J. (2019). The Participatory Zeitgeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. Medical humanities, 45(3), 247-257.

Petersson, L. (2020). Paving the way for transparency: How eHealth technology can change boundaries in healthcare Lund University].

Reed, J. E., Howe, C., Doyle, C., & Bell, D. (2019). Successful healthcare improvements from translating evidence in complex systems (SHIFT-Evidence): simple rules to guide practice and research. International journal for quality in health care, 31(3), 238-244.

Socialstyrelsen. (2021). E-hälsa och välfärdsteknik i kommunerna 2021. Uppföljning av den digitala utvecklingen i socialtjänsten och den kommunala hälso-och sjukvården.

von Gerich, H., Moen, H., Block, L. J., Chu, C. H., DeForest, H., Hobensack, M., Michalowski, M., Mitchell, J., Nibber, R., & Olalia, M. A. (2022). Artificial Intelligence-based technologies in nursing: A scoping literature review of the evidence. International Journal of Nursing Studies, 127, 104153.

Background: Despite the extensive hopes and expectations for value creation resulting from the implementation of artificial intelligence (AI) applications in healthcare, research has predominantly been technology-centric rather than focused on the many changes that are required in clinical practice for the technology to be successfully implemented. The importance of leaders in the successful implementation of innovations in healthcare is well recognised, yet their perspectives on the specific innovation characteristics of AI are still unknown. The aim of this study was therefore to explore the perceptions of leaders in healthcare concerning the innovation characteristics of AI intended to be implemented into their organisation.

Methods: The study had a deductive qualitative design, using constructs from the innovation domain in the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with 26 leaders in healthcare.

Results: Participants perceived that AI could provide relative advantages when it came to care management, supporting clinical decisions, and the early detection of disease and risk of disease. The development of AI in the organisation itself was perceived as the main current innovation source. The evidence base behind AI technology was questioned, in relation to its transparency, potential quality improvement, and safety risks. Although the participants acknowledged AI to be superior to human action in terms of effectiveness and precision in some situations, they also expressed uncertainty about the adaptability and trialability of AI. Complexities such as the characteristics of the technology, the lack of conceptual consensus about AI, and the need for a variety of implementation strategies to accomplish transformative change in practice were identified, as were uncertainties about the costs involved in AI implementation.

Conclusion: Healthcare leaders not only saw potential in the technology and its use in practice, but also felt that AI’s opacity limits its evidence strength and that complexities in relation to AI itself and its implementation influence its current use in healthcare practice. More research is needed based on actual experiences using AI applications in real-world situations and their impact on clinical practice. New theories, models, and frameworks may need to be developed to meet challenges related to the implementation of AI in healthcare. © 2023, The Author(s).

Background: Evidence-based practice (EBP) involves making clinical decisions based on three sources of information: evidence, clinical experience and patient preferences. Despite popularization of EBP, research has shown that there are many barriers to achieving the goals of the EBP model. The use of artificial intelligence (AI) in healthcare has been proposed as a means to improve clinical decision-making. The aim of this paper was to pinpoint key challenges pertaining to the three pillars of EBP and to investigate the potential of AI in surmounting these challenges and contributing to a more evidence-based healthcare practice. We conducted a selective review of the literature on EBP and the integration of AI in healthcare to achieve this.

Challenges with the three components of EBP: Clinical decision-making in line with the EBP model presents several challenges. The availability and existence of robust evidence sometimes pose limitations due to slow generation and dissemination processes, as well as the scarcity of high-quality evidence. Direct application of evidence is not always viable because studies often involve patient groups distinct from those encountered in routine healthcare. Clinicians need to rely on their clinical experience to interpret the relevance of evidence and contextualize it within the unique needs of their patients. Moreover, clinical decision-making might be influenced by cognitive and implicit biases. Achieving patient involvement and shared decision-making between clinicians and patients remains challenging in routine healthcare practice due to factors such as low levels of health literacy among patients and their reluctance to actively participate, barriers rooted in clinicians' attitudes, scepticism towards patient knowledge and ineffective communication strategies, busy healthcare environments and limited resources.

AI assistance for the three components of EBP: AI presents a promising solution to address several challenges inherent in the research process, from conducting studies, generating evidence, synthesizing findings, and disseminating crucial information to clinicians to implementing these findings into routine practice. AI systems have a distinct advantage over human clinicians in processing specific types of data and information. The use of AI has shown great promise in areas such as image analysis. AI presents promising avenues to enhance patient engagement by saving time for clinicians and has the potential to increase patient autonomy although there is a lack of research on this issue.

Conclusion: This review underscores AI's potential to augment evidence-based healthcare practices, potentially marking the emergence of EBP 2.0. However, there are also uncertainties regarding how AI will contribute to a more evidence-based healthcare. Hence, empirical research is essential to validate and substantiate various aspects of AI use in healthcare. 

©2024 The Authors

Background: Artificial intelligence (AI) has the potential in health care to transform patient care and administrative processes, yet health care has been slow to adopt AI due to many types of barriers. Implementation science has shown the importance of structured implementation processes to overcome implementation barriers. However, there is a lack of knowledge and tools to guide such processes when implementing AI-based applications in health care.

Objective: The aim of this protocol is to describe the development, testing, and evaluation of a framework, “Artificial Intelligence-Quality Implementation Framework” (AI-QIF), intended to guide decisions and activities related to the implementation of various AI-based applications in health care.

Methods: The paper outlines the development of an AI implementation framework for broad use in health care based on the Quality Implementation Framework (QIF). QIF is a process model developed in implementation science. The model guides the user to consider implementation-related issues in a step-by-step design and plan and perform activities that support implementation. This framework was chosen for its adaptability, usability, broad scope, and detailed guidance concerning important activities and considerations for successful implementation. The development will proceed in 5 phases with primarily qualitative methods being used. The process starts with phase I, in which an AI-adapted version of QIF is created (AI-QIF). Phase II will produce a digital mockup of the AI-QIF. Phase III will involve the development of a prototype of the AI-QIF with an intuitive user interface. Phase IV is dedicated to usability testing of the prototype in health care environments. Phase V will focus on evaluating the usability and effectiveness of the AI-QIF. Cocreation is a guiding principle for the project and is an important aspect in 4 of the 5 development phases. The cocreation process will enable the use of both on research-based and practice-based knowledge.

Results: The project is being conducted within the frame of a larger research program, with the overall objective of developing theoretically and empirically informed frameworks to support AI implementation in routine health care. The program was launched in 2021 and has carried out numerous research activities. The development of AI-QIF as a tool to guide the implementation of AI-based applications in health care will draw on knowledge and experience acquired from these activities. The framework is being developed over 2 years, from January 2023 to December 2024. It is under continuous development and refinement.

Conclusions: The development of the AI implementation framework, AI-QIF, described in this study protocol aims to facilitate the implementation of AI-based applications in health care based on the premise that implementation processes benefit from being well-prepared and structured. The framework will be coproduced to enhance its relevance, validity, usefulness, and potential value for application in practice. © 2023 The Author(s).

This manuscript delineates the pathway from in-house research on Artificial Intelligence (AI) to the development of a medical device, addressing critical phases including conceptualization, development, validation, and regulatory compliance. Key stages in the transformation process involve identifying clinical needs, data management, model training, and rigorous validation to ensure AI models are both robust and clinically relevant. Continuous post-deployment surveillance is essential to maintain performance and adapt to changes in clinical practice. The regulatory landscape is complex, encompassing stringent certification processes under the EU Medical Device Regulation (MDR) and the upcoming EU AI Act, which imposes additional compliance requirements aimed at mitigating AI-specific risks. Ethical considerations such as, emphasizing transparency, patient privacy, and equitable access to AI technologies, are paramount. The manuscript underscores the importance of interdisciplinary collaboration, between healthcare institutions and industry partners, and navigation of commercialization and market entry of AI devices. This overview provides a strategic framework for radiologists and healthcare leaders to effectively integrate AI into clinical practice, while adhering to regulatory and ethical standards, ultimately enhancing patient care and operational efficiency. © 2024 Elsevier B.V.

Introduktion

Hälsa har blivit ett av de mest centrala begreppen i välfärdssamhället och den digitalisering som sker ställer både nya krav och öppnar nya möjligheter för den enskilde individen, hälso- och sjukvården samt övrigaaktörer i samhället. Den tekniska utvecklingen beskrivs som ett paradigmskifte inom hälso- och sjukvården (Socialdepartementet, 2010 & Cehis, 2013). Hur kommer dessa förändringar att påverka vårdprofessionernasarbetsmiljö? I både vardagliga och kliniska sammanhang ökar förväntningarna på att människor ska kunna fatta självständiga beslut inom hälsoområdet, med stöd av teknik som är ansluten till Internet. EU-kommissionen harantagit eHealth som en paraplyterm för tillämpningar av digital teknik för att förbättra och utveckla hälsa påbåde individ och samhällsnivå (EU, 2014). Det finns ett ökat intresse från individer att söka information ochatt bli delaktiga i frågor som rör den egna och anhörigas hälsa, vilket aktualiserar begreppet eHealth literacy. eHealth literacy avser individens förmåga att leta, hitta, förstå och bedöma hälsoinformation i digitala medieroch omsätta dessa kunskaper till sin egen situation (Norman & Skinner, 2006). Hälso- och sjukvården står inför stora förändringar i och med införandet av nya e- hälsotjänster (SKL, Sveriges Kommuner och Landsting,2010). Förändringar inom hälso- och sjukvården innebär att vårdprofessionernas arbete kommer att förändras. En viktig aspekt vid vårdarbete är förtroende och tillit till de professionella och deras kompetens. Fransson(2012) menar att förtroende är riktat mot system och organisation och att tillit är en relation mellan enskilda människor. Syftet med detta paper är att beskriva och analysera i vilken utsträckning Vårdförbundets medlemmar upplever att patienter hämtar medicinsk information själva via Internet samt att analysera vilka konsekvenser denna utveckling kan få för professionernas arbetsmiljö.

Metod

Respondenterna i denna undersökning är medlemmar i Vårdförbundet. Populationen är 84 640 yrkesverksamma sjuksköterskor och barnmorskor. Urvalet är 8464 slumpvis utvalda medlemmar i hela landet som har e-postadresser i Vårdförbundets medlemsregister. Datainsamlingen skedde mellan den 7 mars-5 april 2014. 8464 webbenkäter skickades, 356 respondenter var inte kontaktbara. 2867 respondenter svarade, vilket ger ensvarsfrekvens på 35,4 %.

Resultat

Vårdpersonal möter ofta patienter som har sökt information på Internet. Fritextsvaren vittnar om att patienter missförstår och feltolkar den information de har tagit del av på olika Internetsajter, vilket kan påverka förtroendet och tilliten för hälso- och sjukvården och dess professioner. Resultatet av studien visar att det behövs mer kunskap om hur patienters eHealth literacy och informationssökning på internet förändrar och påverkar vårdpersonalens arbetsmiljö.

Referenser

Cehis (2013) Handlingsplan 2013-2018. Landstings, regioners och kommuners samarbeteinom eHälsoområdet, Centrum för eHälsa i samverkan. http://www.inera.se/Documents/OM_OSS/handlingsplan_2013_2018.pdf

Fransson, O. (2012). Förtroende för professioner. I C. Björngren Cuadra & O. Fransson (red.), Tillit och förtroende. Ständiga utmaningar för professionella (s 11-24). Malmö: Gleerups.

EU (2014). Policy för e-hälsa. http://ec.europa.eu/health/ehealth/policy/index_en.htm

Norman, D.C. & Skinner, A.H. (2006). eHealth Literacy. Essential skills for consumer health in a networkedworld. Journal of Medical Internet Research, 8(2), e9.

SKL, Sveriges Kommuner och Landsting (2010). Från sjukhussäng till e-hälsa. Utvecklingstendenser inomHälso- och sjukvården. www.skl.se

Socialdepartementet (2010). Nationell eHälsa – strategin för tillgänglig och säker information inom vård ochomsorg. http://www.nationellehalsa.se/Content/Cms/img/temp/b38c1b84.pdf

The digitalization that currently is taking place in healthcare raises questions about how this development, with visions of more patient participation and patient empowerment, changes this sector and what role eHealth can play in these changes. The term civic health technologies (Invånartjänster) is used in Sweden to describe eHealth in the healthcare sector that is developed and deployed by the authorities for the citizens. Open Notes (Journalen) is a civic health technology that enables patients to access their electronic health records online. The system is an innovation in healthcare that changes when and where patients can read the content of their health records. Psychiatric care was initially exempt from the service because the content of the records was considered too sensitive and the psychiatric patients too vulnerable. In October 2015, Region Skåne became the first region in Sweden to include adult psychiatry in the service. It is thus of interest to gain more knowledge about how the healthcare professionals in this setting describe how their work changed when the eHealth solution, aimed to support and empower patients, was implemented in their practice.

The overall aim of the thesis is to explore and analyze how the transparency that is afforded to patients by eHealth technology changes the boundaries in healthcare. By analyzing these issues with the support of a theoretical framework, we can increase our knowledge of how the transparency afforded by the materiality of technologies changes the boundaries around the work of healthcare professionals. The thesis presents three studies that have a mixed methods approach.

The results show that although civic health technologies, such as the Open Notes service, are aimed at the patients, they also change healthcare practice and the relations between professionals and patients. These changes are reported regardless of whether the patient uses the service or not. The idea of Open Notes is to create a transparent healthcare practice that empowers patients and enables them to be more involved in their care. The results show that the professionals do not experience that all of their patients in adult psychiatry meet these expectations. This indicates that governed individual real-time transparency may not always be the best choice either for the patients or for the healthcare professionals’ work. The work of healthcare professions, by tradition, is surrounded by boundaries. The results show that key actors behind the Open Notes service, through what is referred to as configurational boundary work, have the power to transform these boundaries. Such a development could result in actions from the professions to regain control over the boundaries, referred to as competitive boundary work. The professionals reported that they had changed their behavior and conducted competitive boundary work in order to deal with the transparency in the Open Notes service because it makes their professional work visible. The professionals did this primarily to protect the patients and their relatives, and secondly to protect themselves. The results from adult psychiatry show that doctors and psychologists in many cases seem more negative to the visibility than other groups of healthcare professionals. The materiality of Open Notes thus seems to challenge professional values, and the reactions are strongest from these two professions. Their primary reason for being sceptical to the transparency that is afforded by Open Notes is that they believe that it may not always be the best and safest solution for all of their patients.

In 2015 Region Skåne was the first county council in Sweden to add adult psychiatry patients to the civic service of patient online access to their EHR (electronic health records). The initial implementation of the service in somatic care had previously raised both questions and resistance amongst the healthcare professionals. It was thus considered important to inform the professionals involved about the planned introduction in psychiatry well in advance. This paper presents and discusses how well the management was able to do this. The material presented derives from a survey that was distributed to employees in adult psychiatry in Region Skåne just before the introduction of the service. Overall, the results show that different professions receive information through different channels. This indicates that it is important for an employer to use many information and communication channels to reach employees. It is also important to use both interpersonal and mediated communication channels as they serve different purposes.

Government and public agencies in Sweden have promoted the expansion of eHealth. The strategy behind this effort is to increase quality of care, efficiency, patient empowerment and patient safety, and one of the most important civic eHealth services is patient online access to electronic health records (EHR). By 2017, all of Sweden's inhabitants will be able to access their EHR from somatic care through the Internet and thus read clinical notes. In 2015 Region Skåne was the first county council in Sweden to implement patient online access to their EHR as a civic service, for adult psychiatric care patients. Earlier research shows that initial implementation of the service in somatic care raised both questions and resistance among involved healthcare professionals. Thus, for an implementer, there are many factors to consider and it may be difficult to choose and prioritize among them; on the other hand, there is little knowledge about what healthcare professionals think is important when implementing a civic service in healthcare. The aim of this study is to present and discuss what healthcare professionals think is important to consider when Region Skåne implements patient online access to EHR in psychiatric care.

The material presented derives from a full-population web survey, distributed to employees in adult psychiatry in Region Skåne just before the introduction of the service. The response rate was 29% (n = 871). In one of the question in the survey, respondents were asked to choose five out of eleven factors that they thought might affect the implementation of the service. Thereafter they were asked to rank these five factors and assign the most important factor five points, the second most important factor four points and so on.

Overall, the results show that the most frequently chosen factor was Evaluation of patient online access to their EHR, but Patient safety was the factor with the highest total score and also the highest mean value. Furthermore, it is interesting to note that the factor receiving the lowest score was a support line for the employees; this factor has the lowest total score and lowest mean value. The results also show that different professional groups consider different factors to be important in the implementation process.

The conclusions are firstly; that healthcare professionals care about the implementation of civic services even though the technology does not change towards them. Secondly; that the healthcare professionals consider not only factors that affect their own work to be important but also factors that are related to patient's interests. Thirdly; it is important for implementers to be aware of that civic services can affect the healthcare professionals work even if the service is only aimed at patients. It is thus important to consider factors related to both patients and professionals when implementing a civic eHealth service, even if the service is aimed at only one of these groups.

Hösten 2015 var Region Skåne först i Sverige med att lägga till patientjournaler från psykiatrin till invånartjänsten eJournal. Genom tjänsten, har alla patienter i den vuxenpsykiatriska vården i Region Skåne tillgång till sin journal via nätet. Det finns lite kunskap om hur professioner na inom den psykiatriska vården förväntar sig att deras arbete kommer att påverkas av den ökade transparens som patienternas tillgång till sin journal via internet innebär. Syftet med detta paper är att undersöka hur socionomer, läkare, psykologer och sjuksköterskor i vuxenpsykiatrin i Region Skåne förväntar sig att patienternas tillgång till eJournal kommer att förändra villkore n för det egna professionella arbetet. Empirin som presenteras härrör från en webbenkät som skickades till samtliga anställda inom vuxenpsykiatrin i Region Skåne strax före införandet av tjänsten. Svarsfrekvensen på enkäten var 29% och fördelningen mellan de olika personalkategorierna överensstämmer väl med andelen anställda i varje personalgrupp. Analysen visar dels att förväntningarna skiljersigmellan de olika professionerna och dels att professionerna förväntar sig att eJournal kommer att påverka deras legitimitet, makten över journalen som arbetsverktyg samt patienternas förtroende för dem.

Bakgrund Teknikutvecklingen inom hälso- och sjukvårdsområdet möjliggör ständigt nya och mer avancerade sätt att distansmonitorera och vårda patienter digitalt. Digitaliseringen inom hälso- och sjukvårdsområdet i form av till exempel hälsoapplikationer gör det möjligt för patienter och personal att ha kontakt och kommunicera digitalt med varandra (WHO, 2011). itACiH är ett digitalt system där patienter med hemdialys distansmonitoreras och kommunicerar med vårdpersonalen via videosamtal, chatt-meddelanden och foton. Behandlingen i hemmet följs genom att behandlingsparametrar registreras och mätvärden, som till exempel vikt och blodtryck, förmedlas automatiskt från våg och blodtrycksmätare till vårdpersonalen. Genom processen där analog information transformeras till digital information sker en informationsdigitalisering, vilket innebär att informationen blir strukturerad, sökbar och tillgänglig via digitala kanaler. Digitalisering inom hälso- och sjukvårdsområdet erbjuder nya förutsättningarna för både patienter och vårdpersonal vilket kan ändra både arbete och kommunikation runt de gränser som finns kring etablerade vårdprocesser. Implementering av e-hälsolösningar som riktar sig till patienter kan förändra gränserna runt personalens arbete vilket kan skapa förutsättningar för ett samarbetsinriktat gränsarbete mellan personal och patienter (Petersson, 2020). Digitala system kan i dessa fall beskrivas som ett gränsobjekt som kan skapa förutsättningar för samarbete och lärande mellan olika grupper (Carlile, 2002, 2004).SyfteSyftet med presentationen är att beskriva preliminära resultat från ett pågående forskningsprojekt som visar hur digitalisering av information och implementering av ett digitalt system förändrar personalens arbete och på vilket sätt ett digitalt system kan skapa ett gränsobjekt mellan olika personalgrupper och patienter. MetodI studien genomför vi intervjuer med vårdpersonal på fem sjukvårdsmottagningar i Region Skåne där itACiH används i vården av patienter med hemdialys. Hittills har vi genomfört 18 semistrukturerade intervjuer och vi planerar att genomföra ytterligare ca 10 intervjuer under våren. Materialet analyseras med utgångspunkt i teorier om gränsobjekt (Carlile, 2002, 2004; Star & Griesemer, 1989).ResultatResultatet visar att hur personalens arbete förändras när vården för patienter med hemdialys digitaliseras genom att den rapportering som tidigare skedde med papper och penna istället sker via en digital hälsoapplikation. Det digitala systemet kan beskrivas som ett gränsobjekt som möjliggör för patienter och olika professioner att dela information och därmed arbeta tillsammans. De hälsoparametrar som finns tillgängliga i det digitala systemet är strukturerade och visualiseras genom olika kurvor som visar patientens hälsoutveckling över tid, vilket skapar förutsättningar för samverkan och lärande. Systemet gör det också möjligt för vårdpersonal från olika huvudmän att kommunicera med varandra beträffande de gemsamma patienternas hälsoutveckling. 

Kontaktinformation: Lena.Petersson@design.lth.se

Carlile, P.R. (2002). 'A pragmatic view of knowledge and boundaries: Boundary objects in new product development', Organization Science, vol. 13, no. 4, pp. 442;455.

Carlile, P.R. (2004). 'Transferring, translating, and transforming: An integrative framework for managing knowledge across boundaries', Organization Science, vol. 15, no. 5, pp. 555;568.

Petersson, L. (2020). Paving the way for transparency: How eHealth technology can change boundaries in healthcare. (1 ed.). Department of Design Sciences, Faculty of Engineering, Lund University.

Star SL, Griesemer JR. (1989). Institutional ecology, ‘translations’ and boundary objects: amateurs and professionals in Berkeley’s Museum of Vertebrate Zoology, 1907-39. Soc Stud Sci. 19: 387–420.

WHO (2011). mHealth: New Horizons for Health through Mobile Technologies: Based on the Findings of the Second Global Survey on eHealth (Global Observatory for eHealth Series, Volume 3). http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf

BACKGROUND: When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne.

OBJECTIVE: The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice.

METHODS: A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service.

RESULTS: The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future.

CONCLUSIONS: Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients. © Lena Petersson, Gudbjörg Erlingsdóttir.

Background: This is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively.

Objective: The objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Skåne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study.

Methods: We distributed a full population Web-based questionnaire to psychiatric care professionals in Region Skåne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service.

Results: A total of 41.5% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients' questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62%) and doctors (36/94, 38%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40% of the health care professionals (239/650, 36.8%) reported that the Open Notes Service in psychiatry was a good idea.

Conclusions: Most health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive. ©Lena Petersson, Gudbjörg Erlingsdóttir. Originally published in JMIR Mental Health (http://mental.jmir.org), 21.06.2018.

There have been large changes in the area of healthcare in the past decades concerning patient participation, patient empowerment and the development of knowledge in healthcare. This has consequences for, amongst other things, the relationship between patients and caregivers. Web. 2.0 made different types of online communities for patients possible and the concept Medicine 2.0 was developed for health issues on the Internet. This paper addresses one such community, namely PatiensLikeMe.com (PLM). PLM is designed for patients’ independent use to get information and knowledge about their disease, and to get in contact with other patients with the same diagnosis to share experiences. Our aim is to analyse the online community PatientLikeMe.com from the perspective of how the type of information it allows for, can be used by patients and what consequences it may have for the doctor-patient relationship and thereby on the work environment of the doctors. Traditionally the doctor’s knowledge base has been seen as specific and difficult to gain for actors outside the profession. This might now change due to the patients’ opportunity to build their own knowledge base on PLM and other similar sights. This may enhance patient empowerment and literacy but also lead to impairment of the doctor-patient relationship and ultimately the working conditions of the medical profession through loss of control over their knowledge base.

Practitioner Summary: PatientsLikeMe.com is an example of an online community that enables patients to communicate, interact and share their information about their health conditions. Patients can thus build a knowledge base of their own on the site. Traditionally this type of knowledge base has been exclusive to the doctors. In the paper we discuss how this may change the doctor-patient relationship and the working conditions for the medical profession. Copyright © Petersson & Erlingsdóttir.

Introduction

The technological developments in the e-health sector are enabling new and more advanced methods to monitor and care for patients digitally. The general purpose of digital care is to dismantle the constraints of time and space between the provider and the patient. This in turn leads to a possible reallocation of resources to those parts of care where they are needed the most. For the healthcare professionals this transition may imply a shift from personal meetings with the patient to digital communication; from measuring various parameters themselves to receiving health data reported by the patients; from booked patient meetings to a more continuous monitoring of the patient's data and that an algorithm in the digital system suggests which patient(s) should be prioritized. This type of healthcare is a growing area of e-health and patient studies are currently performed to measure the medical effects of digital care systems.

One example of such a patient study is SMART HF II; a randomized controlled trial study that was conducted in Region Skåne, Sweden. The aim of the study was to investigate if the e-health solution LifePod^® increases patients’ knowledge, compliance and quality of life, and thereby affects readmission and care visits. LifePod^® is an e-health solution that enables the exchange of information and communication between healthcare professionals and patients. All patients have their unique care profile in the system where they report their health parameters. An algorithm creates visualizations of the patients' condition and makes an evaluation of which patients should be prioritized. However, the study does not include how healthcare professionals experience this transition from traditional care to digital care. As this is a new area within e-health there is limited knowledge about how systems such as LifePod^® affect healthcare professionals’ work environment. 

In the research project “Between Pod and Patient – what happens when care becomes digital?” we aim to investigate how the healthcare professionals’ work changes when care becomes digitalized. The objective of this paper is to present data from a pilot study that explores how the healthcare professionals’ experience the implementation of LifePod® using the demand, control model as a theoretical lens (Karasek, 1979).

Methodology

Interviews were conducted in three healthcare settings in Region Skåne. All three settings participated in the SMART HF II study. In total, we conducted 19 interviews, sixteen semi-structured in-depth interviews with practitioners and three additional interviews with other stakeholders, including the doctor that is responsible for the SMART HF II study, the nurse that operationalized the study and a representative from the company behind LifePod^®

The interview guide consisted of the following themes: an introduction about the role and duties of the healthcare professional and the organization of the work in the healthcare setting, the healthcare professionals work and communication with patients and colleagues, the use of LifePod^® and finally some concluding questions. The interviews were recorded, transcribed and analysed with support of the demand and control model.

Research outcomes

The results show that the professionals, generally, express themselves in positive terms about the shift towards digital care. This includes being able to provide care that is based on up-to-date information and the present needs of each patient. They also state that a major advantage of LifePod^® is the feeling of control that the system offers by its overview of the patient data. The professionals also describe that they, by looking at the data, can evaluate the medical status of the patients providing an increased sense of security to them.

The algorithm in LifePod^® creates visualizations of the individual patient’s condition and the system ranks different patients’ need for care. When the nurses log into the system they thus see an overview of their patients’ data and their needs screen through a colouring scheme. The signals indicate whether actions, ranging between no action to immediate actions, are needed. As the patients’ entries of data into the system are voluntary and not scheduled, the nurses neither know the number of patients who have reported data nor how much of the reported data will demand actions on their behalf, when they log in to the system. This, in turn, can make it problematic for them to plan their time schedule visavi other work routines as, for instance, planned patient visits.

Being responsible for the system and for responding to the patients’ data may, in turn, be interpreted as increased demands on the nurses. The results thus indicate that LifePod^® may change the work conditions of the professionals, mostly in a positive way but also in a more complicated way regarding both control and demands, in some dimensions. In the presentation we will analyse and discuss this complexity in more depth.

References

Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285–308.

Bakgrund

Framväxten av hälsoapplikationer som gör det möjligt för patienter att kontakta och kommunicera med vårdpersonal digitalt kan förändra hur patienter ser på sin vård och hur de kontaktar vårdpersonalen (WHO, 2011). Digitala system kan också, utifrån sin design, ge förutsättningar för relationscentrerad vård genom att patienterna ges möjlighet att, i samverkan med vårdpersonalen, vara aktiva i sin egen vård (Qudah & Luetsch, 2019). LifePod är ett digitalt system som möjliggör informationsutbyte och kommunikation mellan vårdpersonal och patient via en applikation. I applikationen registreras patientens hälsoutveckling över tid. LifePod ger möjlighet till monitorering av patientens hälsa via patientrapporterad data samt till att feedback och rekommendationer skräddarsys efter patientens behov och tillstånd. För vårdpersonalen betyder tekniken att deras arbete förändras och i idealfallet att vissa personliga mötena med patienten kan ersättas med digital kommunikation och monitorering. Denna typ av digital vård är ett växande fenomen och syftet med den är att minska avståndet i tid och rum mellan vårdpersonal och patient och att vården ska bli mer kontinuerlig och proaktiv.

Syfte

Syftet med presentationen är att beskriva resultat från ett pågående forskningsprojekt som undersöker på vilket sätt digital vård påverkar relationen och kommunikationen mellan vårdpersonal och patienter och hur dessa förändringar påverkar vården och personalens arbete.

Metod

Arton semistrukturerade intervjuer med vårdpersonal och andra intressenter genomfördes på tre sjukvårdsmottagningar som använder LifePod. Intervjuguiden var uppdelad i följande teman: en inledning som berör yrkesroll och arbetets organisering, en del som handlar om det egna arbetet och kommunikation/relation med patienter och kollegor, den sista delen berör användandet av LifePod och slutligen ett avsnitt med några avslutande frågor av mer övergripande karaktär. Det teoretiska ramverket, som används, tar sin utgångspunkt i det sociokulturella perspektivet (Säljö, 2005) samt relationscentrerad vård (Qudah & Luetsch, 2019).

Resultat

Analysen av intervjuerna visar bland annat att LifePod upplevs som en social plattform som skapar kommunikation och bygger relationer mellan vårdpersonal och patienter. Systemet kan således beskrivas som ett medierat verktyg som utbildar patienterna och lär dem mer om sin hälsa. LifePod bidrar också till att skapa en relationscentrerad vård genom att medierar relationer och kommunikation mellan patienter och vårdpersonal, systemet erbjuder dessutom en enkel kontaktväg för kommunikation och interaktion mellan patienterna och vårdpersonalen. Samtidigt visar resultaten att personalen behöver förändra sitt arbetssätt när de har patienter som använder LifePod och att deras arbete styrs av när patienterna rapporterar och vilka värden som de rapporterar. Digitaliseringen av vården ger också en distansöverblick av patienterna som i vissa fall ökar personalens kontroll och i andra fall minskar deras kontroll över sitt arbete.

Kontaktinformation: Lena.Petersson@design.lth.se

Qudah, B & Luetsch, K (2019). The influence of mobile health applications on patient - healthcare provider relationships: A systematic, narrative review. Patient Education and Counseling. Volume 102, Issue 6, June 2019, Pages 1080-1089Säljö, R. (2005). Lärande och kulturella redskap: om lärprocesser och det kollektiva minnet. Stockholm: Norstedts akademiska förlag.WHO (2011). mHealth: New Horizons for Health through Mobile Technologies: Based on the Findings of the Second Global Survey on eHealth (Global Observatory for eHealth Series, Volume 3). http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf

Background: Artificial intelligence (AI) for healthcare presents potential solutions to some of the challenges faced by health systems around the world. However, it is well established in implementation and innovation research that novel technologies are often resisted by healthcare leaders, which contributes to their slow and variable uptake. Although research on various stakeholders’ perspectives on AI implementation has been undertaken, very few studies have investigated leaders’ perspectives on the issue of AI implementation in healthcare. It is essential to understand the perspectives of healthcare leaders, because they have a key role in the implementation process of new technologies in healthcare. The aim of this study was to explore challenges perceived by leaders in a regional Swedish healthcare setting concerning the implementation of AI in healthcare.

Methods: The study takes an explorative qualitative approach. Individual, semi-structured interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders. The analysis was performed using qualitative content analysis, with an inductive approach.

Results: The analysis yielded three categories, representing three types of challenge perceived to be linked with the implementation of AI in healthcare: 1) Conditions external to the healthcare system; 2) Capacity for strategic change management; 3) Transformation of healthcare professions and healthcare practice.

Conclusions: In conclusion, healthcare leaders highlighted several implementation challenges in relation to AI within and beyond the healthcare system in general and their organisations in particular. The challenges comprised conditions external to the healthcare system, internal capacity for strategic change management, along with transformation of healthcare professions and healthcare practice. The results point to the need to develop implementation strategies across healthcare organisations to address challenges to AI-specific capacity building. Laws and policies are needed to regulate the design and execution of effective AI implementation strategies. There is a need to invest time and resources in implementation processes, with collaboration across healthcare, county councils, and industry partnerships. © The Author(s) 2022.

Just nu pågår en digital transformation av svensk hälso- och sjukvård och artificiell intelligens (AI) är tänkt att vara lösningen på många av de utmaningar sjukvården står inför. I en kunskapssammanställning från Myndigheten för arbetsmiljökunskap (MYNAK) (2020) om digitalisering och arbetsmiljö påtalas att den snabba tekniska utvecklingen kommer att förändra arbetsmiljö och yrkesrollers karaktär. Professionellas arbete är traditionellt omgärdat av gränser och att upprätthålla gränserna kring det egna kunskapsområdet är en grundläggande del av professionens utveckling. Digitalisering och implementering av olika former av teknik kan förändra professionella gränser och därmed generera så kallat gränsarbete (Petersson, 2020) som kan indelas i tre former; konkurrenskraftigt gränsarbete, kollaborativt gränsarbete och konfigurativt gränsarbete (Langley et al. 2019). De tre formerna av gränsarbete är ofta sammanflätade i praktiken, men konfigurativt gränsarbete kan dock beskrivas som en kraft som driver de andra två kategorierna av gränsarbete, eftersom det riktar sig emot andras aktiviteter i syfte att utforma gränser för förändring mellan grupper (Langley et al., 2019). Denna studie fokuserar på hur gränserna kring vårdprofessionernas arbete kan förändras vid implementering av AI och på vilket konfigurativt gränsarbete som aktörer på ledningsnivån i ett sjukvårdssystem förutser kommer att ske när sjukvården blir mer datadriven genom användning av AI-analyser.Vi genomförde semistrukturerade intervjuer med 26 ledare som var i en position att potentiellt påverka implementeringen och användningen av AI i en svensk region. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Analysen i studien fokuserar på den konfigurativa formen av gränsarbete.Sammantaget visar resultatet att ledarna beskriver olika typer av konfigurativt gränsarbete. Ledarna har makten att bedriva gränsarbete som förändrar gränserna kring vårdpersonalens arbete och de beskriver att de, medvetet eller omedvetet, vill förändra gränserna kring i första hand läkarnas arbete vid implementeringen av AI i hälso- och sjukvården.

Referenser

Langley, A., Lindberg, K., Mork, B. E., Nicolini, D., Raviola, E., Walter, L. (2019). Boundary work among groups, occupations, and organization: From Cartography to process. Academy of Management Annals, 13(2): 704–736.

Mynak (2020). Framtidens arbetsmiljö – trender, digitalisering och anställningsformer. 2020:3. www.mynak.se.

Petersson, L. (2020). Paving the way for transparency: How eHealth technology can change boundaries in healthcare. Lund: Department of Design Sciences, Faculty of Engineering, Lund University.

A digital transformation of Swedish healthcare is currently taking place, and artificial intelligence (AI) is meant to solve many of the healthcare sector's challenges. We conducted 26 semi-structured interviews with healthcare leaders and 18 with healthcare managers and professionals. The result shows that the leaders, healthcare managers, and healthcare professionals describe different types of boundary work in regard to the implementation of AI.

Presentationen kommer att fokusera på hur implementeringen av itACiH och digitalisering av information förändrar personalens arbete och på vilket sätt ett digitalt system kan skapa ett gränsobjekt mellan olika personalgrupper och patienter.

Vi kommer att presentera ett nytt forskningsprojekt vid Högskolan i Halmstad med finansiering från Vetenskapsrådet, som förväntas bidra med kunskap om hur arbetets gränser i hälso- och sjukvården förändras vid implementering av artificiell intelligens (AI). Hälso- och sjukvården i Sverige brottas idag med utmaningar kring att klara av att fördela resurser där de gör mest nytta, säkerställa kvalitet i den vård som ges och att ställa om till en mer digitaliserad vård som sker i mer samproduktion mellan vårdpersonal och patienter. Ett teknikområde som förväntas kunna bidra till att lösa dessa utmaningar är AI, men forskning har visat att det finns många hinder för att lyckas med att införa och använda AI-applikationer inom hälso- och sjukvården. Hälso- och sjukvårdspersonal har en viktig roll att spela i förändringsarbete inom vården och AI-applikationer kan komma att konkurrera med det monopol på kunskap i förhållande till hälsa och behandling av sjukdomar som vårdpersonalen erhållit genom lång akademisk utbildning, träning och praktisk erfarenhet. Det övergripande syftet med forskningsprojektet ImpAI är att generera ny kunskap om implementering och användning av AI-applikationer i rutinsjukvård och hur professionella roller kan fungera som barriärer under implementeringsprocessen. Det teoretiska ramverket består av professionsteori med fokus på tillit och arbetets gränser samt implementeringsteori. Projektet bygger på olika case i form av AI-applikationer som implementeras under 2023–2024 i Region Halland, Sverige och mixad metod används vid processutvärderingen av dessa case. Resultatet kommer både att främja förståelsen för hur processer kan etableras vid införande av AI applikationer i hälso- och sjukvården och bidra med information om hur sådana processer kan bygga på hälso- och sjukvårdspersonalens kompetens och roller.

Presentationen kommer att beskriva forskning kring implementering av AI och informationsdriven vård i samverkan mellan forskargruppen Healthcare Improvement vid Högskolan i Halmstad och flera svenska och internationella företag, kommuner samt Region Halland. Resultat från pågående studier kommer att presenteras tillsammans med en överblick av planerat arbete inom forskningsprofilen CAISR Health och företagsforskarskolan NHIRS.

Background: Artificial intelligence (AI) is predicted to improve healthcare, increase efficiency, save time and resources. However, research shows an urgent need to develop guidance to ensure that the use of AI in healthcare is ethically acceptable.

Purpose: To develop an ethical model to support AI implementation in practice.

Methods: The study used an explorative and empirically driven qualitative design. Individual interviews were conducted with 18 healthcare professionals from two emergency departments in Sweden where the county council has developed an AI application to predict the risk for unexpected mortality within 30 days after visiting an emergency department. A deductive analysis based on ethical theory i.e virtue, deontology and consequentialism, was used.

Findings: The developed model shows how the healthcare professionals use ethical reasoning in relation to the implementation of AI. In relation to virtue ethics, moral considerations in relation to the use of AI were mentioned. In relation to deontology, considerations were mentioned on actions performed based on information acquired from the technology and adherence to specific duties, roles and responsibilities. In relation to consequentialism, considerations about how to provide better resources more rapidly in an equal way and how the technology can be adjusted to each patients’ individual needs and preferences in order to support decisions, self-determination, and actions that are in the patients best interest.

Conclusions: Our findings provide an ethical model demonstrating the relevance of virtue, deontology and consequentialism when AI are to be implemented in practice.

Background: Artificial intelligence (AI) is often presented as a technology that will change healthcare and be useful inclinical work in disease prediction, diagnosis, and precision health. More knowledge is needed regarding the value of AI applications based on the perspectives of healthcare leaders to understand their roles as gatekeepers and facilitatorsfor successful implementation.

The purpose of the study: To explore healthcare leaders’ perceptions of the value of AI applications in clinical work.

Methods: The study had an explorative qualitative approach. Individual interviews were conducted from October2020 to May 2021 with 26 healthcare leaders with different experiences in implementing AI in clinical practice in acounty council in Sweden. Inductive qualitative content analysis was used, and eight sub-categories and threecategories emerged.

Findings: The value of AI applications in clinical care was described in terms of expected benefits for patients as toolssupporting person-centered information and individualized self-management. The expected benefits for healthcareprofessionals included decision-support in diagnostics, risk assessments, and treatment recommendations but alsoproviding warning systems and second opinions in clinical work. On an organizational level, the benefits comprisedpatient safety and decision-support in prioritizing healthcare resources in and across healthcare organizations.

Conclusions: The healthcare leaders perceived that AI applications would provide value on different levels inhealthcare for patients, healthcare professionals, and organizations. Across these levels, the implementation of AI cansupport person-centeredness, patient self-management, quality of care, patient safety, and resource optimization.

Artificial intelligence (AI) is often presented as a technology that changes healthcare and is useful in clinical work in disease prediction, diagnosis, treatment effectiveness, and precision health. This study aimed to explore healthcare leaders' perceptions of the usefulness of AI applications in clinical work. The study was based on qualitative content analysis. Individual interviews were conducted with 26 healthcare leaders. The usefulness of AI applications in clinical care was described in terms of expected benefits for 1) patients as supporting individualized self-management and person-centered information support tools 2) healthcare professionals in terms of providing decision-support in diagnostics, risk assessments, treatment recommendations, warning systems, and as a new colleague supporting the clinical work, and 3) organizations as providing patient safety and decision-support in prioritizing healthcare resources in organizing healthcare.

A digital transformation of Swedish healthcare is currently taking place, and artificial intelligence (AI) is meant to solve many of the healthcare sector's challenges. The objective of this paper is to describe and analyze how the boundaries around the physicians' work could change when AI is implemented in healthcare and what boundary work actors on different levels in a healthcare system conduct. We conducted 26 semi-structured interviews with healthcare leaders and 18 with healthcare managers and professionals. The result shows that the leaders, healthcare managers, and healthcare professionals describe different types of boundary work in regard to the implementation of AI. The implementation of AI in healthcare could change the boundaries around the healthcare professionals’ work and generate new kinds of boundary work that could affect the implementation. These findings can inform both practice and policy.

A digital transformation of Swedish healthcare is currently taking place, and artificial intelligence (AI) is meant to solve many of the healthcare sector's challenges. The objective of this paper is to describe and analyze how the boundaries around the physicians' work could change when AI is implemented in healthcare and what boundary work actors on different levels in a healthcare system conduct. We conducted 26 semi-structured interviews with healthcare leaders and 18 with healthcare managers and professionals. The result shows that the leaders, healthcare managers, and healthcare professionals describe different types of boundary work in regard to the implementation of AI. The implementation of AI in healthcare could change the boundaries around the healthcare professionals’ work and generate new kinds of boundary work that could affect the implementation. These findings can inform both practice and policy.

Background: Artificial intelligence (AI) is predicted to be a solution for improving healthcare, increasing efficiency, and saving time and recourses. A lack of ethical principles for the use of AI in practice has been highlighted by several stakeholders due to the recent attention given to it. Research has shown an urgent need for more knowledge regarding the ethical implications of AI applications in healthcare. However, fundamental ethical principles may not be sufficient to describe ethical concerns associated with implementing AI applications.

Objective: The aim of this study is twofold, (1) to use the implementation of AI applications to predict patient mortality in emergency departments as a setting to explore healthcare professionals’ perspectives on ethical issues in relation to ethical principles and (2) to develop a model to guide ethical considerations in AI implementation in healthcare based on ethical theory.

Methods: Semi-structured interviews were conducted with 18 participants. The abductive approach used to analyze the empirical data consisted of four steps alternating between inductive and deductive analyses. Results: Our findings provide an ethical model demonstrating the need to address six ethical principles (autonomy, beneficence, non-maleficence, justice, explicability, and professional governance) in relation to ethical theories defined as virtue, deontology, and consequentialism when AI applications are to be implemented in clinical practice.

Conclusions: Ethical aspects of AI applications are broader than the prima facie principles of medical ethics and the principle of explicability. Ethical aspects thus need to be viewed from a broader perspective to cover different situations that healthcare professionals, in general, and physicians, in particular, may face when using AI applications in clinical practice. © The Author(s) 2023.

Artificial intelligence (AI) is predicted to improve health care, increase efficiency and save time and recourses, especially in the context of emergency care where many critical decisions are made. Research shows the urgent need to develop principles and guidance to ensure ethical AI use in healthcare. This study aimed to explore healthcare professionals' perceptions of the ethical aspects of implementing an AI application to predict the mortality risk of patients in emergency departments. The analysis used an abductive qualitative content analysis based on the principles of medical ethics (autonomy, beneficence, non-maleficence, and justice), the principle of explicability, and the new principle of professional governance, that emerged from the analysis. In the analysis, two conflicts and/or considerations emerged tied to each ethical principle elucidating healthcare professionals' perceptions of the ethical aspects of implementing the AI application in emergency departments. The results were related to aspects of sharing information from the AI application, resources versus demands, providing equal care, using AI as a support system, trustworthiness to AI, AI-based knowledge, professional knowledge versus AI-based information, and conflict of interests in the healthcare system. © 2023 European Federation for Medical Informatics (EFMI) and IOS Press.