Inter-organisatoriske problemstillinger knyttet til etablering og drift av velferdsteknologi, telemedisin og responssenter tjenester. Prosjekt: Modell for Alarmmottak, M4ALMO Delrapport 3 – 2017

Denne rapporten er en sluttrapport fra FoU-prosjektet M4ALMO og gir en oppsummering av erfa-ringsinnhenting gjennom en serie workshops som er avholdt med representanter for brukere og tjenestene i de 10 kommunene som har deltatt in prosjektet. Det belyses viktige deler av prosedy-rer og samarbeid mellom de kommunale pleie- og omsorgstjenester og responssenter tjenester som organiseres på interkommunal basis. Det er viktig med strukturert informasjonsflyt og god sammenheng i tjenestetilbudet. Rutiner for kvalitetssikring av tjenestene må innarbeides. Det er utarbeidet forslag til prosedyrer for behovskartlegging og vedtak om teknologiske tiltak, der også involvering av pårørende og frivillig…

User-centred Design of the User Interface of a Collaborative Information System for Inter-municipal Dementia Team

In the Norwegian Health sector there are currently undergoing changes at local, regional and national level triggered by recent health reforms. Municipalities are facing for first time the duty of implementing new primary health services. Inter-municipal coordination (IMC) health care teams have been created to operate across borders to share costs, extend geographical range of operation and optimise resources. This study focuses on the development and evaluation of the user interface (UI) functional prototype of a collaborative information system for IMC dementia team in Norway. Employing a user-centred design approach, the interface prototype was built based on the information gathered on…

Security Management in Electronic Health Records: Attitudes and Experiences Among Health Care Professionals

Electronic health records play an important role for management, exchange and storage of information within health care organizations. Health care organizations are obliged to adopt strategies for information security and privacy associated with access to medical and sensitive information, but at the same time, the information needs to be available for authorized health care professionals carrying out patient treatment. This paper presents a study about attitudes and experiences among health care professionals towards security management in electronic health records. Qualitative research methods were used, with an initial literature review that was followed by observations and interviews wi…

User-centred Design of a Digital Care Plan for Patients and Professionals in Cross-organisational Teams

Care for patients with multimorbidity and long-term complex needs is costly and with demographic changes this group is growing. The research project Dignity Care addresses how to improve the care for this patient group by studying how a conceptual shared digital care plan for complex clinical pathways can guide and support cross-organisational care teams. This paper presents the user-centred design process for the digital care plan development. Panels of patients and health care professionals will participate in co-creation user workshops and simulation of complex patients’ pathways. The main contribution from this work is recommendations for how to actively involve user groups in digital h…

A Case Study of the Technology Use and Information Flow at a Hospital-driven Telemedicine Service

Health care services face the challenge of providing individualised treatment to a growing ageing population prone to chronic conditions and multi-morbidities. The research project Patients and Professionals in Productive Teams aims to study health care services that are run with a patient-centred teamwork approach. In this context, a case study was made of a hospital-driven telemedicine service for chronic obstructive pulmonary disease patients after hospital discharge, with a focus on information flow and technology use. The methods used were observation and interviews with key informants. The results showed that the technology was perceived as well-functioning for telemedicine support, b…

Infrastructure and Procedure for Simulation of Cardiac Remote Monitoring: Experiences from the Telemedicine Agder Project

Telemedicine are remote electronic clinical consultations using technology for delivery of health care services. Telemedicine can be offered as a service to citizens living at home with an aim of reducing the number of hospital visits or visits to the General Practitioner and improving longterm cost-effectiveness. In Norway, a recent health reform has caused municipalities to re-organize their design of health services, with an increased use of telemedicine. In this context, the “Telemedicine Agder” project focuses on the organization, implementation and operation of large scale telemedicine services. In the project, a simulation of a telemedicine service for monitoring of heart failure was…

Usability Evaluation of a COPD Remote Monitoring Application

- Telemedicine applications have the potential to enhance patient’s safety at home by remote monitoring of chronic diseases. Telemedicine involves the interaction between multiple user groups through a system, making the usability aspect of such system crucial for the continuous, efficient and satisfactory use of the application. The main objective of this study was to carry out a usability evaluation in the field of a telemedicine application for remote monitoring of chronic obstructive pulmonary disease (COPD) patients to improve the application’s user interface before system deployment. A field trial was performed with six COPD patients at their homes, continuously using the system’s app…

User Evaluation of a Smartphone Application for Anticoagulation Therapy

Anticoagulation therapy with Warfarin is used for specific cardiovascular diseases to control the ability of blood clotting. Traditional ways of selfmanagement therapy are based on paper forms and procedures. This paper presents an evaluation of the smartphone application Warfarin Guide, a computer-assisted decision-support system used to help patients in their management of anticoagulation therapy related to International Normalized Ratio (INR) values. The evaluation consisted of a usability test with 4 participants and a field test with 14 participants who used the application at home during four months. A mixed methods research approach included quantitative and qualitative analysis of t…

Usability Evaluation of Electronic forms and Collaborative Assessment Report in an Inter-municipality Health Care team for Dementia Diagnose

Despite that paper-based medical procedures have historically been the most common way of registering and exchanging patient data; it does not avoid the potential risks of unauthenticated access; unregistered data loss; legibility and difficulty to share the data with third parties. The Coordination Reform 2009 (Samhandlingsreformen) has demanded from municipalities to implement health services for citizens based on electronic messaging that eases the access to and sharing of patient data. In the context of the Research project “Collaboration without borders” (Samhandling uten grenser); electronic forms and collaborative assessment report by videoconference have been usability tested in thi…

Teaching Methods in a Health and Social Informatics Master Program

Education is an important contribution to the digital transformation in society. In health care services, there is a need to combine knowledge in health science and information-and communication technologies. At the University of Agder in Norway, there is a Master's Program in Health and Social Informatics targeting students with health educational background. This paper shares the experiences on methods for teaching basic information-and communication technology to this student group. A quantitative study was made to evaluate the pedagogical methods and the organization of a technical master course with respondents from the last two classes. The experiences on the course execution and the …

Telemedicine follow up of Chronic Obstructive Pulmonary Disease Integrated into a Patient-centered Health Care Team Setting- Impacts on Patient Empowerment and Safety

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User Experiences and Satisfaction with an Electronic Health Record System

Electronic health records have a crucial role for communication and information management in health care organizations. Electronic health records have improved the access to up-dated medical information at the point-of-care, but they have also been linked to usability issues and user problems. This paper presents a study about the user experience among health care professionals regarding an electronic health record system in Norway. Qualitative research methods were used, with interviews and observations made at a university hospital, where 14 clinical end-users of an electronic health record system contributed. The aim was to study the user experiences and the user satisfaction regarding …

User Evaluation of the Smartphone Screen Reader VoiceOver with Visually Disabled Participants

Touchscreen assistive technology is designed to support speech interaction between visually disabled people and mobile devices, allowing hand gestures to interact with a touch user interface. In a global perspective, the World Health Organisation estimates that around 285 million people are visually disabled with 2/3 of them over 50 years old. This paper presents the user evaluation of VoiceOver, a built-in screen reader in Apple Inc. products, with a detailed analysis of the gesture interaction, familiarity and training by visually disabled users and the system response. Six participants with prescribed visual disability took part in the tests in a usability laboratory under controlled con…

An Evaluation of Telemedicine Systems in Patient-centred Care Teams

A Decision-support Algorithm for Self-management of Anticoagulation Therapy Used in a Smartphone Application

Warfarin for anticoagulation therapy is used by patients with specific cardiovascular diseases to control the ability of blood clotting. Traditional ways for self-management of the therapy are based on paper forms and procedures. This paper presents an algorithm developed for the smartphone application “Warfarin Guide”, which is a computer-assisted decision-support system used to help patients with self-management of their anticoagulation therapy related to International Normalized Ratio (INR) values. The algorithm was based on clinical guidelines for Warfarin therapy and it was adapted for the software application to address challenges with regular INR checks and adjustments for temporary …

User-centred Design and Evaluation of Health Information Technology : Doctoral Dissertation for the Degree Philosophiae Doctor (PhD) in Information and Communication Technology

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User-Centred Design of a Digital Care Plan for Patients and Professionals in Cross-Organisational Teams

Care for patients with multimorbidity and long-term complex needs is costly and with demographic changes this group is growing. The research project Dignity Care addresses how to improve the care for this patient group by studying how a conceptual shared digital care plan for complex clinical pathways can guide and support cross-organisational care teams. This paper presents the user-centred design process for the digital care plan development. Panels of patients and health care professionals will participate in co-creation user workshops and simulation of complex patients’ pathways. The main contribution from this work is recommendations for how to actively involve user groups in digital h…

Patient Experiences and Digital Involvement in Patient-centred Care Models

The provision of individualised treatment and care from health care services to patients with chronic conditions and multi-morbidities is under pressure because of an increasing elderly population. There is a need for services that are: 1) person-centred, 2) integrated and 3) proactive, and supported by digital technology. The research project 3P- Patients and Professionals in Productive Teams aims to study different patient-centred teamwork models in Norway and Denmark. This paper presents a study on patients’ experiences and digital involvement in patient-centred care teams. Qualitative research methods were applied with interviews and demonstrations of technology use made at patient’s ho…

User-centred Design of a Mobile Application for Chronic Pain Management

Chronic pain patients constitute a large and heterogeneous patient group and it is important to build tools and methods that can identify efficient treatment options for each individual patient. It is estimated that 20-30% of the population has suffered from chronic pain and this imposes enormous costs on society and the national welfare programs. The research project Chronic Pain addresses the problem of how to provide patients and physicians with relevant, valid and adapted decision alternatives in a shared decision making tool. This paper presents the results from co-creation workshops early in the user-centred design process of the chronic pain mobile application. The end-users contribu…

Sharing With Care - Multidisciplinary Teams and Secure Access to Electronic Health Records

Published: Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies Vol 5 2018

User-Centered Design of a Scenario-Based Serious Game: Game-Based Teaching of Future Healthcare

A scenario-based serious game for teaching about healthcare solutions was developed and tested in multiple iterations. The serious game captures the complexity of a real-world healthcare scenario, projecting it into a “scenario system” that can be accessed by the game participants to explore and experience the playthrough of a critical healthcare situation. The aim is to teach about existing health technology, and its uses and interactions between healthcare professionals, technologies, and patients. The platform for the serious game is mobile, such that different locations can be chosen for different scenarios. Actions of the participants trigger further actions, tasks, and storyline progr…

Innovative Simulation of Health Care Services in the Usability Laboratory: Experiences from the Model for Telecare Alarm Services-project

In Norway, a recent health reform urged municipalities to prepare for telecare alarm services to handle alarms associated to welfare technology and telecare technology in citizens’ homes. That requires a re-organisation of health and social services in many municipalities and several are preparing to establish new telecare alarm services operated in inter-municipal response centres. In this context, the research project “Model for Telecare Alarm Services” aims to study how existing telecare alarm services in Norwegian municipalities are organised and operated, and identify critical factors when designing new models for future services. This paper presents how an innovative simulation of hea…

Telemedicine Follow Up of Chronic Obstructive Pulmonary Disease Integrated into a Patient-Centered Health Care Team-Setting Impacts on Patient Empowerment and Safety

Health care services are facing challenges with a growing ageing population prone to chronic conditions and multi-morbidities. Telemedicine applications have the potential to enhance patient’s safety at home by monitoring of chronic diseases, promoting coping and independence. The research project Patients and Professionals in Productive Teams aims to study patient-centered teamwork across organizational borders, supported by technology. This paper describes the research agenda for a study on how telemedicine follow-up impacts on chronic obstructive pulmonary disease patients’ quality of life and possible effects on patient empowerment, in the health region of Southern Norway. The outcome i…

The Technology Use and Information Flow at a Municipal Telemedicine Service

Health care services face challenges with providing individualised treatment to an ageing population prone to chronic conditions and multi-morbidities. The research project Patients and Professionals in Productive Teams aims to study patient-centred teamwork service models. This paper presents an evaluation of a telemedicine service for chronic obstructive pulmonary disease patients integrated with municipal health care services. Qualitative methods were used to study the technology use and information flow. The results showed that the telemedicine technology was a standalone system, not integrated with the electronic health record of the municipality. A benefit of the system was a function…

Sharing With Care- Multidisciplinary Teams and Secure Access to Electronic Health Records

Published: Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies Vol 5 2018 Ensuring patient privacy and improving patient care quality are two of the most significant challenges faced by healthcare systems around the world. This paper describes the importance and challenges of effective multidisciplinary team treatment and the sharing of patient healthcare records in healthcare delivery. At present, electronic health records are used to create, manage and share patient healthcare information efficiently and effectively. The security and privacy concerns with sharing and the proper use of protected health information need to be highlighted…

The Steps of User-Centered Design in Health Information Technology Development: Recommendations from a PhD Research Study

This study was carried out to explore the steps of User-centered Design in development of health information technology. The technology was developed in two research projects: the European Union project United4Health that created a collaborative telemedicine system for remote monitoring of Chronic Obstructive Pulmonary Disease and the Southern Norway regional project eHealth-extended Care Coordination that built an information system for coordination in inter-municipal health care teams. In both projects, the end-users were involved as active contributors in a User-centered Design process spanning from idea-generation until final deployment stages. This paper presents the steps in the User-…

eHealth-Extended Care Coordination: Development of a Collaborative System for Inter-municipal Dementia Teams: A Research Project with a User-Centered Design Approach

- In Norway, a health reform was recently adopted to improve continuity of care. Services that were carried out in hospitals were transferred to municipalities. Small and medium size municipalities have established inter-municipal cooperation to provide specialized services across borders. The research project eHealth-extended Care Coordination studied the inter-municipal cooperation for assessment of dementia, identifying a need for improved communication and coordination. This paper presents the development process of a collaborative information system for dementia assessment using a user-centered design approach. Mixed methods, such as observations, semi-structured interviews and questio…

Evaluation of a Telemedicine Service Run with a Patient-centred Care Model

The number of patients with chronic conditions and multi-morbidities is increasing, addressing a need for patient-centred care. The research project Patients and Professionals in Productive Teams aims to study patient-centred teamwork for this patient group. This paper presents an evaluation of a telemedicine service for chronic obstructive pulmonary disease patients run with a patient-centred care model. Observations and interviews were made to study the technology use and information flow. The results showed that the technology worked well in a patient-centred care perspective, even though the system was a standalone system for telemedicine services. The information in the system was only…

User-Centred Design with a Remote Approach: Experiences from the Chronic Pain Project

User-centred design involves end-users or user groups during all the parts of the development process. The research project Chronic Pain aims to develop a shared decision making application for patients and physicians, addressing individually adapted pain treatment. The project employs a user-centred design process, and in middle of it, Covid-19 pandemic social distancing restrictions were imposed. This paper presents how the user-centred design process together with a patient organisation was transformed to a digital approach and the experiences from performing a remote co-creation user workshop. The digital approximation had a satisfactory result and the main contribution lies in the shar…

Curriculum Development of a Health Informatics Master Course in Understanding Technology

Education in health informatics is an important contribution to the digital transformation in health care services, and there is a need to combine health and technology competencies. Traditional ways with separation of health sciences and computer science have shortcomings, and there is need for individuals with a holistic view and relevant education background for improving the technology-supported clinical work processes. This paper presents how the curriculum was organised in a course in “Understanding Technology”, which was a part of a Master's Programme in Health Informatics. The course targeted different aspects of technology for students with a diverse background, and it was organise…

User-Centered Design of a COPD Remote Monitoring Application Experiences from the EU-project United4Health

- Recent health reforms in Norway have produced changes at all levels of the health sector, bringing to light a need for technology solutions explicitly designed for enhancing end-user collaboration. Telemedicine technology can support in this context new services that enable communication across local borders, optimizing resources and increasing cost effectiveness. This study focuses on the user-centered design, iterative development and evaluation of the user interface of a mobile application for a new telemedicine service for remote monitoring of chronic obstructive pulmonary disease patients. The tablet device application was developed based on information gathered in a workshop and gro…

The SmartSight Project: Use of Electronic Glasses to Improve Impaired Fields of Vision

Electronic glasses use advanced assistive technology that can improve function for persons with visual impairments. This paper presents work in progress in the SmartSight project, where existing versions of electronic glasses are adapted and tested for persons with the visual impairments; macular degeneration and retinitis pigmentosa. The project aims are to adapt and innovate electronic glasses for persons with impaired fields of vision and study the impact on the daily function and quality of life. In a pilot test of the electronic glasses, promising results were found that imply a big difference for persons with impaired vision. The outcome of the SmartSight project might change the clin…

User-Centered Design of a National Medical Registry for Tick-Borne Diseases

Tick-borne diseases are increasing in a global perspective, with Lyme disease and tick-borne encephalitis as the most frequent. The Norwegian National Advisory Unit on Tick-borne Diseases is preparing the development of a national medical registry for clinical follow-up of patients with tick-borne diseases based on the best practice guidelines and for research purposes. This paper presents the methodological approach of a user-centered design process applied in the initial phase of the registry development. A user workshop identified user needs, requirements and proposed a service workflow for the registry operation. As the next step, a simulation of the proposed service workflow was perfor…

Simulation of eHealth Scenarios with Role-play Supported by an Interactive Smartphone Application

Evaluation of touchscreen assistive technology for visually disabled users

Touchscreen assistive technology is designed to support speech interaction between visually disabled people and mobile devices, allowing the use of a choreography of gestures to interact with a touch user interface. This paper presents the evaluation of VoiceOver, a screen reader in Apple Inc. products, made in the research project Visually impaired users touching the screen- A user evaluation of assistive technology together with six visually disabled test participants. The aim was to identify challenges related to the performance of the gestures for screen interaction and evaluate the system response to the gestures. The main results showed that most of the hand gestures were easy to perf…

Recommendations of a Laboratory Infrastructure for Simulation of Telemedicine Services

In Norway, a health reform targeting coordination and continuity of care has urged municipalities to re-organize their services as there is an increasing use of remote monitoring and sensor technologies in citizens’ homes. In this context, the research project “Telemedicine Agder” is an opportunity to study the implementation, organization and operation of large scale telemedicine services, and identify the service models of the future. As part of the project, simulation of a telemedicine service for remote monitoring of diabetes II was tested in a clinical laboratory with key informants from municipalities, hospital and research partners. This paper presents the technical and physical infr…

Usability Evaluation of a Collaborative Health Information System - Lessons from a User-centred Design Process

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User-Centered Design of a National Medical Registry for Tick-Borne Diseases

Tick-borne diseases are increasing in a global perspective, with Lyme disease and tick-borne encephalitis as the most frequent. The Norwegian National Ad-visory Unit on Tick-borne Diseases is preparing the development of a national medical registry for clinical follow-up of patients with tick-borne diseases based on the best practice guidelines and for research purposes. This paper presents the methodological approach of a user-centered design process applied in the in-itial phase of the registry development. A user workshop identified user needs, requirements and proposed a service workflow for the registry operation. As the next step, a simulation of the proposed service workflow was perf…

Accessibility of Mobile Devices for Visually Impaired Users: An Evaluation of the Screen-reader VoiceOver

A mobile device's touchscreen allows users to use a choreography of hand gestures to interact with the user interface. A screen reader on a mobile device is designed to support the interaction of visually disabled users while using gestures. This paper presents an evaluation of VoiceOver, a screen reader in Apple Inc. products. The evaluation was a part of the research project "Visually impaired users touching the screen - a user evaluation of assistive technology". nivå1

How to enhance digital support for cross-organisational health care teams? A user-based explorative study

Health care service provision of individualised treatment to an ageing population prone to chronic conditions and multimorbidities is threatened. There is a need for digitally supported care, that is, (1) person-centred, (2) integrated, and (3) proactive. The research project 3P, Patients and Professionals in Productive Teams, aimed to validate and verify the prerequisites for health care systems run with patient-centred service models. This paper presents an explorative study of the digital support of a cross-organisational health care team in Norway, providing services to elderly frail people with multimorbidities in hospital discharge transition. Qualitative research methods were employe…

Infrastructure for Health Care Simulation: Recommendations from the Model for Telecare Alarm Services Project

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A Comparison of the User Experiences of Primary Care Electronic Health Record Systems

Digital health records play an important role for the information flow in primary care organizations that carry out services at patient’s home. Mobile digital solutions have improved the access to up-dated care information at the patient’s home, facilitating new ways for clinical workflow and care delivery. This paper presents a study comparing the user experiences of two electronic health record systems in two primary care organizations in Norway. Qualitative research methods were applied with interviews and observations made between 2017 and 2019 where clinical end-users of primary care electronic health records participated. The study showed that the systems had an important function for…

A Case Study of Technology Use and Information Flow at a Danish E-clinic

Author´s accepted manuscript (postprint). © 2020 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works. There is an urgent call from health organizations, health professionals and health authorities to re-design care delivery for patients with chronic conditions and multimorbidities. The research project 3P- Patients and Professionals in Productive Teams aims to study health…

Point of Care Solutions: Implementation of Sustainable Service Models

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Security Management in Health Care Information Systems — A Literature Review

Health care information systems play an important role for communication across the organizational borders of health care services. The electronic health record represents the main entity in the management, exchange and storage of medical information. Health care organizations must adopt strategies for security and privacy risks associated with access to health care information systems, but on the other hand, the information needs to be accessible and readable for authorized health care professionals carrying out patient treatment. This paper presents a literature review on security management in health care information systems. The aim was to analyze descriptions and definitions of informa…

Recommendations on a Test Infrastructure for Evaluation of Touchscreen Assistive Technology for Visually Impaired Users

Published version of a paper from the 13th Scandinavian Conference on Health Informatics, Tromsø Mobile technologies’ touchscreen allows the use of choreography of gestures to interact with the user interface. Relevant aspects in mobile technology design become crucial when targeting users with disabilities. For instance, when assistive technology is designed to support speech interaction between visually impaired users and a system, accessibility and ease-of-use of such technology should be included in the usability and technical evaluation of their effectiveness. This paper presents the analysis of the technical and physical infrastructure of a controlled laboratory environment for user e…

User-centred Design with a Remote Approach: Experiences from the Chronic Pain Project

User-centred design involves end-users or user groups during all the parts of the development process. The research project Chronic Pain aims to develop a shared decision making application for patients and physicians, addressing individually adapted pain treatment. The project employs a user-centred design process, and in middle of it, Covid-19 pandemic social distancing restrictions were imposed. This paper presents how the user-centred design process together with a patient organisation was transformed to a digital approach and the experiences from performing a remote co-creation user workshop. The digital approximation had a satisfactory result and the main contribution lies in the shar…

Scenario-based Serious Game to Teach about Healthcare

Author's accepted manuscript (postprint). © 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works. Available from 29/10/2021. In this paper, we explore the concept of a scenario-based serious game for healthcare solutions. The complexity of the interactions and the multitude of actors is captured in a scenario, which is then played with the help of an additional game pl…

Warfarin Guide: Co-design of a Mobile Computer-Assisted Anticoagulant Therapy

Patients with some types of cardiovascular disease are prescribed anticoagulation therapy with Warfarin in order to control the ability of blood clotting. This work presents a co-designed mobile application, called Warfarin Guide, for a computer-assisted anticoagulant therapy. The application addresses the challenges that unexperienced patients may find when having to remember to regularly check their INR values and make temporary adjustments for INR value fluctuations that are not easy to interpret without direct medical advice. nivå1

Evaluation of the Technology Use in an Inter-disciplinary Patient-centered Health Care Team