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kari dyb

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Sakher Alqahtani

King Saud University

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Universidade Estacio de Sa, Brasil

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Scuola Superiore Sant'Anna

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Papers by kari dyb

Can Increased Patient Involvement Reduce the Number of Surgery Cancellations? Lessons Learned from a Research and Development Project in Norway

International Conference on eHealth, Telemedicine, and Social Medicine, Mar 22, 2020

Increased patient involvement is the new mantra in modern healthcare, indicating that patients ca... more Increased patient involvement is the new mantra in modern healthcare, indicating that patients can play an important role in improving the quality of their health and care services. In this paper, we study the reality of increased patient involvement within the current organizational structure of hospitals by revisiting the findings from a recent research and development project at a university hospital in Norway. Through the development and implementation of a tool for electronic two-way communication between patients and hospitals, the overarching goal of the eTeam-Surgery project (2013-2019) was to better prepare the hospital and the patient for surgical procedures and thereby reduce the number of surgery cancellations. To approach this goal, researchers from the field of health informatics, medicine and sociology explored a quality improvement initiative at the hospital, made field observations and interviewed patients and health professionals. eTeam-Surgery demonstrated that establishing a tool for active involvement of patients in the pre-operative planning process was not an easy task. The research revealed (1) diverse reasons for surgery cancellations, (2) a lack of uniformity in the preoperative workflow and (3) a hospital practice of marking a surgery as cancelled when patients tried to rebook for a different date. Focusing on increased patient involvement, this paper demonstrates how the main reasons for cancellation at the hospital and the lack of uniformity of the pre-operative workflow both originate from hospital organizational issues and, consequently, will not be solved with increased patient involvement. On the other hand, increased patient involvement can improve the current hospital practice of marking surgeries as cancellations when patients are actually trying to rebook. It is our conclusion that hospitals have a long way to go before the new mantra of active patient involvement can be a reality. However, we still believe that active patient involvement can positively contribute to the problem of elective surgery cancellation. The first step would be for hospitals to offer patients the option of choosing their own date of surgery, similar to booking an airline ticket online.

Patient Reported Reasons for Surgery Cancellations Do Not Necessarily Correspond with Hospitals' Representation of the Same Problem

PubMed, Jul 4, 2019

Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery pr... more Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery project addressed the problem of elective surgery cancellation at a Norwegian hospital and explored the potential to reduce surgery cancellation by providing a tool for secure online communication between the hospital and the patient. This communication would occur before surgery while the patient was still at home. The causes of elective surgery cancellation are divided into two major categories: hospital- and patient-related reasons. As part of the e-Team Surgery project, this study addressed patient reasons for cancelling surgery through qualitative interviews with 11 patients who fit these criteria. The study found that most patients called the hospital to reschedule, not to cancel, their upcoming surgery. The patient interviews had significant implications for the e-Team Surgery project. They affected the overall understanding of the surgery cancellation problem and made more clear the data and information needed when developing sustainable systems to reduce elective surgery cancellation.

Bruk/ikke bruk av telemedisin i svangerskaps- og fødselsomsogen

Nordisk Tidsskrift for Helseforskning, Jan 30, 2012

Norge har, i likhet med flere andre stater i den vestlige verden, investert betydelige beløp på i... more Norge har, i likhet med flere andre stater i den vestlige verden, investert betydelige beløp på innføring av informasjons-og kommunikasjonsteknologi (IKT) i helsesektoren. Til tross for politisk optimisme viser forskning at mange teknologiprosjekter feiler. Forklaringene på feilslåtte teknologiprosjekter er mange og til dels ulike. Det er likevel en klar tendens til å kategorisere IKT-utfordringene enten som teknologiske eller som organisatoriske. Denne artikkelen viser at det er mer til saken med å forstå utfordringene med bruk av IKT. Med utgangspunkt i en empirisk analyse av hvordan telemedisin både blir brukt og ikke tatt i bruk i svangerskaps-og fødselsomsorgen argumenterer Dyb for hvordan en materiellsemiotisk tilnaerming er et godt inntak til å belyse mangfoldet i hva som skjer når ny teknologi blir innført i helsesektoren. Til slutt drøfter hun hvordan en materiellsemiotisk tilnaerming dermed også er et godt inntak til refleksjoner omkring helsepolitiske teknologiforståelser.

Who are the “Hard-to-Reach” groups in chronic-health and health technology research? – A scoping review

Linköping Electronic Conference Proceedings

Many in health and technology research opt to focus on those who are already "engaged", not those... more Many in health and technology research opt to focus on those who are already "engaged", not those who are considered "hard-to-reach" or "unreached". This exacerbates the digital divide and inequity in healthcare. We report findings of a scoping review of literature in PubMed/Medline from 2000-2022. 90 of 795 articles were identified based upon 1) the health researchers' recruitment of unreached groups with a chronic condition for active participation in a study and 2) clear definitions of who they considered to be unreached. Findings support the need for interdisciplinary and community-level involvement to reach and include unreached groups in health studies.

Sammenvevinger av IKT, steder, yrker, kjønn og politikk

Telemedicin: Et maktperspektiv

Tidsskrift for forskning i sygdom og samfund, Nov 20, 2014

What Brings Women Into Ehealth? Women's Career Trajectories in Digital Transformations in Healthcare

Digital transformation of health care services is addressed worldwide in order to more efficientl... more Digital transformation of health care services is addressed worldwide in order to more efficiently meet the patients' information and health care needs. However, little is known about the people working with this transformation, where two traditionally gendered fields meet; health care and IT. While work with digitalization generally is dominated by men, digitalization of health care services involves a large number of women. This case study explores the career trajectories of women working with the digital transformation of eHealth services. Who are the women in this eHealth project, and how did they come to working with this digital transformation? The analysis shows different types of trajectories that brought the women into eHealth transformations: The first illustrating women who were pushed into working with eHealth by their job descriptions, the second showing women using eHealth as an escape route from something else, and the last trajectory showing how women stumbled across eHealth and decided to stay on. This has implications for the educational system, and points to the need for being able to study computer science later in life. It also calls for a better understanding of what drives women in transformation processes.

Promoting Patient Voices on the Internet

International Conference on eHealth, Telemedicine, and Social Medicine, Apr 24, 2016

Web-based promotion of qualitative research has a potential to reform traditional scientific diss... more Web-based promotion of qualitative research has a potential to reform traditional scientific dissemination, as well as it challenges ethical norms of research participation and anonymity. In this poster, we discuss ethical considerations of web-based dissemination of qualitative research on patient narratives through video recordings. Including subjective unanonymized patient stories in research dissemination to inform and support, might have benefits for the field of science, patients, health professionals and the general population. However, ethical norms and guidelines for anonymity needs to be considered with care when promoting patient voices on the Internet.

The Establishment of Communities of Practice for Electronic Medicines Management

IOS Press eBooks, Aug 31, 2022

Digital medicines management is a high priority in Norwegian e-health strategies. A key challenge... more Digital medicines management is a high priority in Norwegian e-health strategies. A key challenge is the existence of multiple electronic information sources and systems, which require multi-professional cooperation. Lack of communication, understanding and collaboration between pharmacies, hospitals and community caregivers is also a challenge. Communities of practices (CoPs) have been used to establish arenas for discussing issues challenging the workflow to reach a common agreement on successful work practices for electronic medicines management. The purpose of this paper is to explore: How can we establish communities of practice (CoPs) to gather new knowledge on the facilitators and challenges for electronic medicines management practices in Norway? The results show engagement in establishing the CoPs and a willingness for joint enterprise. The establishment of the CoPs was performed simply based on established forms of collaboration. For CoPs to be effective, established alliances need to be expanded and renewed to form new group dynamics and thus a basis for new knowledge about electronic medicines management.

Implementing eHealth Technologies: The Need for Changed Work Practices to Reduce Medication Errors

PubMed, Jul 4, 2019

Medication errors are a significant health problem and a serious threat to patient safety. In Nor... more Medication errors are a significant health problem and a serious threat to patient safety. In Norway, an estimated one-third of the elderly population has been exposed to potentially inappropriate medications. The Norwegian government has assumed a pivotal role in reducing medication errors and providing safer medication management for its citizens, particularly through the national eHealth system's e-prescription and Summary Care Record. In the present study, we depart from the governmental eHealth initiatives and examine why access to pharmaceutical information is not sufficient to solve the problem with medication errors. Empirical data were collected from 2015 to 2019 through the conduction of 56 qualitative interviews that were transcribed, thematically coded and analysed. The results illustrate how eHealth systems are helpful, at the same time, we emphasise changed work practices and professional knowledge-sharing as a basis for solving the issue of medication errors.

Concept Testing Toward a Patient-Validated Information Architecture

International Conference on eHealth, Telemedicine, and Social Medicine, Apr 24, 2016

A Norwegian research group is adopting the Database of Individual Patient's Experience of Illness... more A Norwegian research group is adopting the Database of Individual Patient's Experience of Illness (DIPEx) international methodology standards for collecting qualitative research into people's health experiences and disseminating it on a web site. We are in the concept phase of developing the web site, and decided to build a topical ambiguous taxonomy together with a more clinically influenced taxonomy with toplevel labels "Health and lifestyle" and "Illness" for the information architecture of the web site. In this paper, we report from usability testing of the top-level label of the topical taxonomy. We ran qualitative and quantitative A/B tests on wireframe concept sketches. The two top-level labels were a generic variant, "Topic", tested against the control variant, "Everyday life". Both qualitative and quantitative tests indicate better results for "Everyday life" as the top-level label for the topical ambiguous taxonomy of the web site. While not fully conclusive, the results provide reasonable confidence in the more descriptive label "Everyday life" at this early stage. It is preferable in that it both seems to create a more coherent set of expectations amongst the users, and more closely matches the content of the web site. The concept test is therefore deemed a useful first step in a rigorous testing program to ensure that the development process is informed by a patientvalidated information architecture.

Study protocol: Health talk Norway

This paper is a study protocol. "Health talk Norway" is a one year project where we will pilot a ... more This paper is a study protocol. "Health talk Norway" is a one year project where we will pilot a new and increasingly popular international methodology for qualitative research on people's health experiences; the DIPEx methodology, developed by the Health Experiences Research Group (HERG) at the University of Oxford. This study will explore if Norwegian research and dissemination on health experiences can be improved using the DIPEx methodology. At the core of the DI-PEx methodology is a web site disseminating people's accounts of their health experiences. DIPEx has been founded to promote the spread of well-researched data on personal experiences of illness and health for the benefit of patients, professionals (both clinical and academic), health services, health care providers and carers. The methodology has been developed in the UK and has so far been adapted to 9 other countries, in Europe, Australia, North America and Asia. Results from the pilot will be of importance for future development of a Norwegian health talk web site, and support research infrastructure for qualitative research on health experiences.

eHealth initiatives; the relationship between project work and institutional practice

BMC Health Services Research, Jul 24, 2019

Background: Large-scale, national eHealth services, such as the summary care record (SCR) and ele... more Background: Large-scale, national eHealth services, such as the summary care record (SCR) and electronic prescriptions (e-prescriptions), have been implemented by project managers as Norwegian health authority initiatives. Few studies have been conducted on the large-scale implementation of eHealth services and the relationship between the implementers' work and the use of the tools in healthcare practices. Hence, there was a need to determine the project work with a focus on changes in practice. This study explores the implementation of the SCR and e-prescriptions from the perspective of project managers; how does the implementation work by project managers relate to institutional practices in large-scale initiatives? Methods: Twenty-two semi-structured interviews were held with project managers in 2016 and 2018 and were recorded, transcribed, and coded according to the content. The analytical concepts of the "project" and "practice" were used to focus on tensions between the dimensions of time connecting historically established social practice and in situ actions. Results: The eHealth initiatives were demonstrated to have been implemented as a part of the national strategy and achieved through close collaboration with the Norwegian Directorate of eHealth (NDE). Tensions arose in relation to task-oriented actions during the implementation of the project and the daily management thereafter. Further, the work tasks of the project managers were related to the dissemination of the tools while, in practice, the tools were related to actual use by professionals. The implementation of several projects simultaneously created tensions between the implementation of a tool and a specific practice, as well as between tools. Conclusion: The objectives set out by the project managers in relation to their work should be viewed as temporary, whereas a long-term objective should apply to the use of the tools. Hence, the work of implementing eHealth initiatives might call for a renewed definition of the empirical object. Identifying factors that affect uptake, such as gaps between the intended use of an object and in situ actions or historically established activities, might expedite the future success of national eHealth initiatives. The social aspect of institutional practice has a direct bearing on the potential of a project to be implemented successfully.

The Norwegian National Summary Care Record: a qualitative analysis of doctors’ use of and trust in shared patient information

BMC Health Services Research, Apr 6, 2018

Background: This paper explores Norwegian doctors' use of and experiences with a national tool fo... more Background: This paper explores Norwegian doctors' use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals' use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors' direct SCR experiences. Methods: We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach. Results: The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool's six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data. Conclusion: Therefore, we can assume that the popularity of the pharmaceutical summary among doctors is based on their preference to place their trust inand therefore more often utiliseautomatically updated information. In addition, the doctors' lack of trust in manually updated information might have severe implications for the future success of the SCR and for similar digital tools for sharing patient information.

Facilitating Interprofessional Collaboration on Electronic Medicines Management

Studies in health technology and informatics, Jun 29, 2023

Medicines are important for well-being. Thus, medication errors can have severe consequences, eve... more Medicines are important for well-being. Thus, medication errors can have severe consequences, even death. Transfers between professionals and levels of care are a challenge in terms of medicines management. Norwegian governmental strategies encourage communication and collaboration between levels of care, and several initiatives are invested in to improve digital medicine management. In the project Electronic Medicines Management (eMM), we established an arena for interprofessional discussions about medicines management. This paper provides an example of how the eMM arena contributed to knowledge sharing and development in current medicines management practices at a nursing home. Building on communities of practice as a method we carried out the first of several sessions, with nine interprofessional participants. The results illustrate how discussion and agreement were reached on a common practice across different levels of care, and how the knowledge required bringing this knowledge back to the local practices.

eTELEMED 2015, The Seventh International Conference on eHealth, Telemedicine, and Social Medicine

International Conference on eHealth, Telemedicine, and Social Medicine, 2015

eTELEMED 2015 : The Seventh International Conference on eHealth, Telemedicine, and Social Medicine

Det vanskelige ekteskapet mellom teknologi og omsorg

Tidsskrift for omsorgsforskning

Digitized patient–provider interaction: How does it matter? A qualitative meta-synthesis

Social Science & Medicine, Oct 1, 2018

Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers’ beliefs matter

BMC Health Services Research, Mar 17, 2021

Background: Technology support and person-centred care are the new mantra for healthcare programm... more Background: Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016-2020). It originates at one of ten work packages in this project. Method: The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. Results: While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. Conclusion: Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.

electronic Medicines Management (eMM) in Norway

International Journal of Integrated Care, Nov 4, 2022

Can Increased Patient Involvement Reduce the Number of Surgery Cancellations? Lessons Learned from a Research and Development Project in Norway

International Conference on eHealth, Telemedicine, and Social Medicine, Mar 22, 2020

Increased patient involvement is the new mantra in modern healthcare, indicating that patients ca... more Increased patient involvement is the new mantra in modern healthcare, indicating that patients can play an important role in improving the quality of their health and care services. In this paper, we study the reality of increased patient involvement within the current organizational structure of hospitals by revisiting the findings from a recent research and development project at a university hospital in Norway. Through the development and implementation of a tool for electronic two-way communication between patients and hospitals, the overarching goal of the eTeam-Surgery project (2013-2019) was to better prepare the hospital and the patient for surgical procedures and thereby reduce the number of surgery cancellations. To approach this goal, researchers from the field of health informatics, medicine and sociology explored a quality improvement initiative at the hospital, made field observations and interviewed patients and health professionals. eTeam-Surgery demonstrated that establishing a tool for active involvement of patients in the pre-operative planning process was not an easy task. The research revealed (1) diverse reasons for surgery cancellations, (2) a lack of uniformity in the preoperative workflow and (3) a hospital practice of marking a surgery as cancelled when patients tried to rebook for a different date. Focusing on increased patient involvement, this paper demonstrates how the main reasons for cancellation at the hospital and the lack of uniformity of the pre-operative workflow both originate from hospital organizational issues and, consequently, will not be solved with increased patient involvement. On the other hand, increased patient involvement can improve the current hospital practice of marking surgeries as cancellations when patients are actually trying to rebook. It is our conclusion that hospitals have a long way to go before the new mantra of active patient involvement can be a reality. However, we still believe that active patient involvement can positively contribute to the problem of elective surgery cancellation. The first step would be for hospitals to offer patients the option of choosing their own date of surgery, similar to booking an airline ticket online.

Patient Reported Reasons for Surgery Cancellations Do Not Necessarily Correspond with Hospitals' Representation of the Same Problem

PubMed, Jul 4, 2019

Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery pr... more Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery project addressed the problem of elective surgery cancellation at a Norwegian hospital and explored the potential to reduce surgery cancellation by providing a tool for secure online communication between the hospital and the patient. This communication would occur before surgery while the patient was still at home. The causes of elective surgery cancellation are divided into two major categories: hospital- and patient-related reasons. As part of the e-Team Surgery project, this study addressed patient reasons for cancelling surgery through qualitative interviews with 11 patients who fit these criteria. The study found that most patients called the hospital to reschedule, not to cancel, their upcoming surgery. The patient interviews had significant implications for the e-Team Surgery project. They affected the overall understanding of the surgery cancellation problem and made more clear the data and information needed when developing sustainable systems to reduce elective surgery cancellation.

Bruk/ikke bruk av telemedisin i svangerskaps- og fødselsomsogen

Nordisk Tidsskrift for Helseforskning, Jan 30, 2012

Norge har, i likhet med flere andre stater i den vestlige verden, investert betydelige beløp på i... more Norge har, i likhet med flere andre stater i den vestlige verden, investert betydelige beløp på innføring av informasjons-og kommunikasjonsteknologi (IKT) i helsesektoren. Til tross for politisk optimisme viser forskning at mange teknologiprosjekter feiler. Forklaringene på feilslåtte teknologiprosjekter er mange og til dels ulike. Det er likevel en klar tendens til å kategorisere IKT-utfordringene enten som teknologiske eller som organisatoriske. Denne artikkelen viser at det er mer til saken med å forstå utfordringene med bruk av IKT. Med utgangspunkt i en empirisk analyse av hvordan telemedisin både blir brukt og ikke tatt i bruk i svangerskaps-og fødselsomsorgen argumenterer Dyb for hvordan en materiellsemiotisk tilnaerming er et godt inntak til å belyse mangfoldet i hva som skjer når ny teknologi blir innført i helsesektoren. Til slutt drøfter hun hvordan en materiellsemiotisk tilnaerming dermed også er et godt inntak til refleksjoner omkring helsepolitiske teknologiforståelser.

Who are the “Hard-to-Reach” groups in chronic-health and health technology research? – A scoping review

Linköping Electronic Conference Proceedings

Many in health and technology research opt to focus on those who are already "engaged", not those... more Many in health and technology research opt to focus on those who are already "engaged", not those who are considered "hard-to-reach" or "unreached". This exacerbates the digital divide and inequity in healthcare. We report findings of a scoping review of literature in PubMed/Medline from 2000-2022. 90 of 795 articles were identified based upon 1) the health researchers' recruitment of unreached groups with a chronic condition for active participation in a study and 2) clear definitions of who they considered to be unreached. Findings support the need for interdisciplinary and community-level involvement to reach and include unreached groups in health studies.

Sammenvevinger av IKT, steder, yrker, kjønn og politikk

Telemedicin: Et maktperspektiv

Tidsskrift for forskning i sygdom og samfund, Nov 20, 2014

What Brings Women Into Ehealth? Women's Career Trajectories in Digital Transformations in Healthcare

Digital transformation of health care services is addressed worldwide in order to more efficientl... more Digital transformation of health care services is addressed worldwide in order to more efficiently meet the patients' information and health care needs. However, little is known about the people working with this transformation, where two traditionally gendered fields meet; health care and IT. While work with digitalization generally is dominated by men, digitalization of health care services involves a large number of women. This case study explores the career trajectories of women working with the digital transformation of eHealth services. Who are the women in this eHealth project, and how did they come to working with this digital transformation? The analysis shows different types of trajectories that brought the women into eHealth transformations: The first illustrating women who were pushed into working with eHealth by their job descriptions, the second showing women using eHealth as an escape route from something else, and the last trajectory showing how women stumbled across eHealth and decided to stay on. This has implications for the educational system, and points to the need for being able to study computer science later in life. It also calls for a better understanding of what drives women in transformation processes.

Promoting Patient Voices on the Internet

International Conference on eHealth, Telemedicine, and Social Medicine, Apr 24, 2016

Web-based promotion of qualitative research has a potential to reform traditional scientific diss... more Web-based promotion of qualitative research has a potential to reform traditional scientific dissemination, as well as it challenges ethical norms of research participation and anonymity. In this poster, we discuss ethical considerations of web-based dissemination of qualitative research on patient narratives through video recordings. Including subjective unanonymized patient stories in research dissemination to inform and support, might have benefits for the field of science, patients, health professionals and the general population. However, ethical norms and guidelines for anonymity needs to be considered with care when promoting patient voices on the Internet.

The Establishment of Communities of Practice for Electronic Medicines Management

IOS Press eBooks, Aug 31, 2022

Digital medicines management is a high priority in Norwegian e-health strategies. A key challenge... more Digital medicines management is a high priority in Norwegian e-health strategies. A key challenge is the existence of multiple electronic information sources and systems, which require multi-professional cooperation. Lack of communication, understanding and collaboration between pharmacies, hospitals and community caregivers is also a challenge. Communities of practices (CoPs) have been used to establish arenas for discussing issues challenging the workflow to reach a common agreement on successful work practices for electronic medicines management. The purpose of this paper is to explore: How can we establish communities of practice (CoPs) to gather new knowledge on the facilitators and challenges for electronic medicines management practices in Norway? The results show engagement in establishing the CoPs and a willingness for joint enterprise. The establishment of the CoPs was performed simply based on established forms of collaboration. For CoPs to be effective, established alliances need to be expanded and renewed to form new group dynamics and thus a basis for new knowledge about electronic medicines management.

Implementing eHealth Technologies: The Need for Changed Work Practices to Reduce Medication Errors

PubMed, Jul 4, 2019

Medication errors are a significant health problem and a serious threat to patient safety. In Nor... more Medication errors are a significant health problem and a serious threat to patient safety. In Norway, an estimated one-third of the elderly population has been exposed to potentially inappropriate medications. The Norwegian government has assumed a pivotal role in reducing medication errors and providing safer medication management for its citizens, particularly through the national eHealth system's e-prescription and Summary Care Record. In the present study, we depart from the governmental eHealth initiatives and examine why access to pharmaceutical information is not sufficient to solve the problem with medication errors. Empirical data were collected from 2015 to 2019 through the conduction of 56 qualitative interviews that were transcribed, thematically coded and analysed. The results illustrate how eHealth systems are helpful, at the same time, we emphasise changed work practices and professional knowledge-sharing as a basis for solving the issue of medication errors.

Concept Testing Toward a Patient-Validated Information Architecture

International Conference on eHealth, Telemedicine, and Social Medicine, Apr 24, 2016

A Norwegian research group is adopting the Database of Individual Patient's Experience of Illness... more A Norwegian research group is adopting the Database of Individual Patient's Experience of Illness (DIPEx) international methodology standards for collecting qualitative research into people's health experiences and disseminating it on a web site. We are in the concept phase of developing the web site, and decided to build a topical ambiguous taxonomy together with a more clinically influenced taxonomy with toplevel labels "Health and lifestyle" and "Illness" for the information architecture of the web site. In this paper, we report from usability testing of the top-level label of the topical taxonomy. We ran qualitative and quantitative A/B tests on wireframe concept sketches. The two top-level labels were a generic variant, "Topic", tested against the control variant, "Everyday life". Both qualitative and quantitative tests indicate better results for "Everyday life" as the top-level label for the topical ambiguous taxonomy of the web site. While not fully conclusive, the results provide reasonable confidence in the more descriptive label "Everyday life" at this early stage. It is preferable in that it both seems to create a more coherent set of expectations amongst the users, and more closely matches the content of the web site. The concept test is therefore deemed a useful first step in a rigorous testing program to ensure that the development process is informed by a patientvalidated information architecture.

Study protocol: Health talk Norway

This paper is a study protocol. "Health talk Norway" is a one year project where we will pilot a ... more This paper is a study protocol. "Health talk Norway" is a one year project where we will pilot a new and increasingly popular international methodology for qualitative research on people's health experiences; the DIPEx methodology, developed by the Health Experiences Research Group (HERG) at the University of Oxford. This study will explore if Norwegian research and dissemination on health experiences can be improved using the DIPEx methodology. At the core of the DI-PEx methodology is a web site disseminating people's accounts of their health experiences. DIPEx has been founded to promote the spread of well-researched data on personal experiences of illness and health for the benefit of patients, professionals (both clinical and academic), health services, health care providers and carers. The methodology has been developed in the UK and has so far been adapted to 9 other countries, in Europe, Australia, North America and Asia. Results from the pilot will be of importance for future development of a Norwegian health talk web site, and support research infrastructure for qualitative research on health experiences.

eHealth initiatives; the relationship between project work and institutional practice

BMC Health Services Research, Jul 24, 2019

Background: Large-scale, national eHealth services, such as the summary care record (SCR) and ele... more Background: Large-scale, national eHealth services, such as the summary care record (SCR) and electronic prescriptions (e-prescriptions), have been implemented by project managers as Norwegian health authority initiatives. Few studies have been conducted on the large-scale implementation of eHealth services and the relationship between the implementers' work and the use of the tools in healthcare practices. Hence, there was a need to determine the project work with a focus on changes in practice. This study explores the implementation of the SCR and e-prescriptions from the perspective of project managers; how does the implementation work by project managers relate to institutional practices in large-scale initiatives? Methods: Twenty-two semi-structured interviews were held with project managers in 2016 and 2018 and were recorded, transcribed, and coded according to the content. The analytical concepts of the "project" and "practice" were used to focus on tensions between the dimensions of time connecting historically established social practice and in situ actions. Results: The eHealth initiatives were demonstrated to have been implemented as a part of the national strategy and achieved through close collaboration with the Norwegian Directorate of eHealth (NDE). Tensions arose in relation to task-oriented actions during the implementation of the project and the daily management thereafter. Further, the work tasks of the project managers were related to the dissemination of the tools while, in practice, the tools were related to actual use by professionals. The implementation of several projects simultaneously created tensions between the implementation of a tool and a specific practice, as well as between tools. Conclusion: The objectives set out by the project managers in relation to their work should be viewed as temporary, whereas a long-term objective should apply to the use of the tools. Hence, the work of implementing eHealth initiatives might call for a renewed definition of the empirical object. Identifying factors that affect uptake, such as gaps between the intended use of an object and in situ actions or historically established activities, might expedite the future success of national eHealth initiatives. The social aspect of institutional practice has a direct bearing on the potential of a project to be implemented successfully.

The Norwegian National Summary Care Record: a qualitative analysis of doctors’ use of and trust in shared patient information

BMC Health Services Research, Apr 6, 2018

Background: This paper explores Norwegian doctors' use of and experiences with a national tool fo... more Background: This paper explores Norwegian doctors' use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals' use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors' direct SCR experiences. Methods: We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach. Results: The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool's six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data. Conclusion: Therefore, we can assume that the popularity of the pharmaceutical summary among doctors is based on their preference to place their trust inand therefore more often utiliseautomatically updated information. In addition, the doctors' lack of trust in manually updated information might have severe implications for the future success of the SCR and for similar digital tools for sharing patient information.

Facilitating Interprofessional Collaboration on Electronic Medicines Management

Studies in health technology and informatics, Jun 29, 2023

Medicines are important for well-being. Thus, medication errors can have severe consequences, eve... more Medicines are important for well-being. Thus, medication errors can have severe consequences, even death. Transfers between professionals and levels of care are a challenge in terms of medicines management. Norwegian governmental strategies encourage communication and collaboration between levels of care, and several initiatives are invested in to improve digital medicine management. In the project Electronic Medicines Management (eMM), we established an arena for interprofessional discussions about medicines management. This paper provides an example of how the eMM arena contributed to knowledge sharing and development in current medicines management practices at a nursing home. Building on communities of practice as a method we carried out the first of several sessions, with nine interprofessional participants. The results illustrate how discussion and agreement were reached on a common practice across different levels of care, and how the knowledge required bringing this knowledge back to the local practices.

eTELEMED 2015, The Seventh International Conference on eHealth, Telemedicine, and Social Medicine

International Conference on eHealth, Telemedicine, and Social Medicine, 2015

eTELEMED 2015 : The Seventh International Conference on eHealth, Telemedicine, and Social Medicine

Det vanskelige ekteskapet mellom teknologi og omsorg

Tidsskrift for omsorgsforskning

Digitized patient–provider interaction: How does it matter? A qualitative meta-synthesis

Social Science & Medicine, Oct 1, 2018

Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers’ beliefs matter

BMC Health Services Research, Mar 17, 2021

Background: Technology support and person-centred care are the new mantra for healthcare programm... more Background: Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016-2020). It originates at one of ten work packages in this project. Method: The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. Results: While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. Conclusion: Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.

electronic Medicines Management (eMM) in Norway

International Journal of Integrated Care, Nov 4, 2022