Preconditions for Implementing a Nursing App to Improve Digital Maturity.

The aim of the paper is to conduct a formative evaluation and assess the implementation of a nursing app using the qualitative TPOM framework to outline how different socio-technical aspects of the process influence digital maturity. The research question is: what are the main socio-technical preconditions for improving digital maturity in a healthcare organization? We conducted 22 interviews and used the TPOM framework for analyzing the empirical data. Exploiting the potential of lightweight technology demands a mature healthcare organization motivated actors' extensive collaboration, and good coordination of the complex ICT infrastructures. The TPOM categories are used to show the digital maturity of the nursing app implementation in relation to technology, human factors, organization, and the wider macro environment.

The Knowledge of Implementation Strategies: Impact of the Installed Base.

This study uses three case studies to investigate how the installed base affects Electronic Health Records (EHR) implementation in European hospitals: i) transition from paper-based records to EHRs; ii) replacement of an existing EHR with a similar system; and iii) replacing existing EHR system with a radically different one. Using a meta-analysis approach, the study employs the theoretical framework of Information Infrastructure (II) to analyze user satisfaction and resistance. Results show that the existing infrastructure and time factor significantly impact EHR outcomes. Implementation strategies that build upon the current infrastructure and offer immediate user benefits yield higher satisfaction rates. The study highlights the importance of considering the installed base and adapting implementation strategies to maximize EHR system benefits.

Interoperability and Governance; Important Preconditions for Establishing Large-Scale Healthcare Infrastructures Like the Akson program in Norway.

In Norway there is an overall goal to establish a national digitalization platform for primary healthcare named Akson to improve information exchange. We participated in the work with Akson and through qualitative research including interviews, we found that the project could benefit from other similar infrastructuring processes. First, a national process of defining clinical standards and establishing a governance organization to handle them. Second, improving data exchange between an EHR system and a national quality registry. The aim of the paper is to outline some lessons learned from these previous processes, for Akson and similar large-scale projects focusing on how to govern the digitalization platform at different healthcare levels and how to reuse healthcare information within and across healthcare institutions. Hence, we ask the following research question: Which experiences from previous large-scale infrastructuring processes should be considered when establishing a national digitalization platform for sharing data?

How Do Users of Modern EHR Perceive the Usability, User Resistance and Productivity Five Years or More After Implementation?

The Electronic Health Record (EHR) has been a principal component in transforming healthcare from traditional pen-and-paper documentation procedures to highly digitalized and interoperable environments. Implementation of EHR is complicated, and success is dependent on the users accepting and utilizing the system to its potential. The present qualitative multi-center study investigated health professionals perceived system usability, user resistance and productivity five to eight years after implementation of a modern EHR, across three European cites. Data was collected with semi-structured interviews with experienced health professionals that had work experience before and after implementation of the EHR. Overall, the respondents considered their EHR to have good usability, reported a low degree of user resistance, and were ambiguous on how the EHR affected their perceived workload at the present, but retrospectively reported that the road towards the present state of satisfaction was not without hurdles.

Introducing Lightweight IT - A Way to Build Flexibility for Healthcare Organizations?

The paper addresses socio technical relations of implementing a lightweight IT app in Norway. The focus is on how such technology will influence the possibilities for an organization connected to a large-scale heavyweight IT infrastructure to provide more rapid changes in line with healthcare worker's needs. The research question is therefore: How can lightweight IT support rapid organizational changes? The empirical site is one of the first health trusts in Norway implementing lightweight technology integrated to their Electronic Health Record (EHR). The lightweight technology is a nursing app for registering early- warning score (NEWS) bedside the patients. The paper is based on a qualitative interpretive approach, and the results are discussed in line with information infrastructure theory.

Open or Closed: A Project Proposal for Investigating Two Different EHR Platform Approaches.

Technical platforms form the fundament on which IT systems and Electronic Health Records (EHRs) are implemented. The use of either open or proprietary standards and technologies for information modelling and interoperability have implications for how clinical and health data is handled and made available for the system users. In Norway, two different EHRs are procured in different health regions of the Specialist healthcare service. The two platforms are characterized as one being open platform-based and the other being closed platform-based. The study aims to identify and describe consequences and implications related to two different platform approaches for EHRs from an end-user perspective. The study will employ three methods of data capturing; scoping study, interviews, and questionnaires. Data will be systematically analyzed through proven methods. Interviews and questionnaire data will be gathered from European hospitals having implemented EHRs in recent years. Results will be compared to the Norwegian context. The technical platform used for health IT systems in general, and the EHR specifically, can have substantial consequences for clinicians and organization of work. Closed platform-based EHRs still constitutes the majority of the market, but open platform approaches are rapidly gaining popularity. An assessment of the consequences related to different platform designs can shed light on the implications the chosen technical approach will have on clinical and organizational practice.

The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review.

BACKGROUND: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. OBJECTIVE: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. METHODS: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. RESULTS: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. CONCLUSIONS: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support.