Does Health-IT Improve People Centered Care?

Patient involvement can be supported in many ways, some of these through health IT (HIT). Health care practice is changing with digitalization and technologies that patients can use to generate data outside the formal health facilities are growing. Inequality affect citizens ability to participate. There is a need to be mindful of the perceptions and the willingness of citizens and the health care professionals to meet this change. Selected data from two Danish surveys, highlight the citizens and health care professional's perspective on health IT. From the analysis emerge central considerations on what to be aware of in the future development of HIT.

Requirements for implementing online information material for patients with low back pain in general practice: an interview study.

OBJECTIVE: To identify general practitioners' (GPs) barriers and facilitators regarding the use of health information technology (HIT) in the treatment of patients with low back pain (LBP). DESIGN: A qualitative study employing a participatory design approach, with an inductive analytical thematic approach utilising semi-structured interviews. Empirical data was analysed using the qualitative data analysis software (QDAS) Nvivo. SETTING: General practices in Denmark. SUBJECTS: Eight interviews were conducted with an average duration of 60 min. The interviewees were GPs from different geographical settings and different organisational structures, varying in age and professional interests. MAIN OUTCOME MEASURES: Barriers and facilitators for future use of the HIT application for patients with LBP. RESULTS: Through the inclusion of healthcare professionals in the design process, this study found that in order for GPs to recommend a HIT application it is essential to target the application towards their patients. Furthermore, GPs required that the HIT application should support patient self-management. Additionally, the content of the HIT application should support the initiated treatment and it should be easy for GPs to recommend the HIT application. Finally, healthcare professionals need to be involved in the design process. CONCLUSION: When designing health IT applications for patients with LBP in general practice it is important to include both patients and GPs in the design process. GPs would be more willing to recommend a HIT application that: applies content in line with frequently used recommendations; targets patients; supports patients' self-management; and supports the patients' needs. KEY POINTS Online information is currently applied in general practice to some patients with low back pain Online information cannot replace the GP, but can rather be a bonding tool between the patient and the GP It is important to address both GP and patient barriers to applying new technology and to consider the literacy level Participatory methods could play a central role in the future development of online information material.

Equality Challenges in the Use of eHealth: Selected Results from a Danish Citizens Survey.

The increased focus on and use of citizen/patient generated health data has spurred a wide range of personal health technology projects within digital intervention in health, e.g. telehealth. These developments are focused on objectives of improving health, but also claiming to provide health services at a lower cost. However, the question is: do the ways healthcare technologies are designed and developed support and improve healthcare services for those who need it the most? Survey data from our study point toward health informatics challenges in reaching the people who are considered in 'health risk' group, who, in this study, are interpreted as people with low level of education. The study shows that this group is less likely to use and communicate through health information technologies (HIT) and is generally more sceptical towards the benefits of HIT. We conclude that there is a need to pay specific attention to the patient groups that are socio-economically and health wise weakest during HIT design and development. It would also provide equality and equity in digital health intervention and access to healthcare for them in the future.

Patients' Perception of Clinicians Use of ICT During Patient Consultation in the Different Sectors of Danish Healthcare.

In Denmark ICT is a central part of almost all healthcare professionals' daily practices, and patients are increasingly encouraged to take and active interest in own health data. Therefore, ICT is an important part of what happens at consultations between the patients and the healthcare professionals. We explore the impact of ICT based on a survey of citizens'/patients' experience of interaction with healthcare professionals. How often and for what ICT was used in communication with the patients in different sectors of the Danish healthcare. The results show that ICT is used in communication with citizens and during interaction with patient, however the use of ICT is mostly for the healthcare professionals own benefit and only about 15%-39% of the reported instances ICT was used to communication and interact with the patient. Through the concept of boundary objects we proposes a model that split the object of the technology mediated information into three setting for communication between patients and healthcare professionals. We propose further studies into how ICT can be used to explore the possibilities for more interactive and involving care processes as a key element in further development of eHealth.

Techno-Anthropologists as Change Agents: A case in health informatics.

Studying technology will often involve studying change - or in the perspective of this chapter should involve not just studying but also actively being involved with change. Your presence and the questions you ask shape the way people think and act and on the other hand their responses and your study of practice change the researchers perspective. For Techno-Anthropologist, this means that asking in specific ways about technology and having a focus on technology in the data collection and fieldwork will (should) influence what they see, the data they collect and their analysis - and also the way the informants think and the way people talk about practice and technology. The Techno-Anthropological researcher should be aware and actively use the potential for change in the empirical study of technology. In this chapter I exemplify and examine how and why change can be embraced and seen as an integral part of Techno-Anthropological studies in Health Informatics and beyond. This statement is supported through reflections on empirical examples, qualitative methods, and ethical and philosophical considerations on research and change. The chapter concludes that Techno-Anthropologists should actively consider and engage in the potential for change of the empirical studies of technology.

The Role of the IT Department in Organizational Redesign.

Focus within eHealth research is often on development and implementation. However, the role of information systems maintenance and management is often neglected. In order for the IT department to accommodate the needs of the hospitals and continuous change of organization and practice there is a need for developing an understanding of the complex relationship between the IT department and clinical practice. In this paper the concept of redesign is used to deepen our understanding of IT related organizational change in healthcare organizations. In the paper I argue that the IT department is a central partner, steward and power in organizational change and learning in hospitals as the IT department serve both as a barrier and a catalyst of change and flexibility in the organization through management of information systems maintenance and redesign. Therefore it is important to consider and secure appropriate forms for stewarding redesign and learning in cooperation between the health care organizations and the IT department.

Citizen Personas: Exploring Challenges of Citizen-Centric eHealth.

Within the field of eHealth, there is a shift towards a patient perspective. However, the focus on the patient often fails to acknowledge and achieve a citizen-centric perspective because there is a lack of understanding of the context and complexities of the person and her relations, interests and activities. In this paper we use the persona of 'Citizen Hanne' for two purposes. Firstly, to highlight and provide detail in the understanding of the citizen perspective and thereby facilitate a shift towards a citizen-centric perspective, which is advanced by many in the field of eHealth. Secondly, we want to further nourish a critical goal of highlighting the challenges in doing citizen-centric eHealth and pointing out the barriers for reaching this goal.

Cooperation and communication challenges in small-scale eHealth development projects.

AIM: In eHealth development there is an increasing focus on user participation inspired by the information systems field of practice and research. There are, however, many other challenges in developing information systems that fit healthcare practices. One of these is the challenge of cooperation and communication in development projects that are initiated and managed by clinicians e.g. cooperating with IT professionals in 'bottom up' health informatics projects that have been initiated and are managed by healthcare professional project managers. METHOD: The analysis and results are drawn from a qualitative case study on a systems development project that was managed by a local, non-technical, healthcare professional and the complex blend and interactions with the IT professionals in the phases of ideas, design, development, implementation, maintenance and distribution. RESULTS: We analyze the challenges of cooperation and communication using perspectives from information systems research and the concepts of 'language-games' and 'shared design spaces', and thereby exploring the boundaries between the different communication, practice and culture of the IT professionals and the healthcare professionals. CONCLUSION: There is a need to (a) develop a better understanding of the development process from the point of view of the 'user' and (b) tools for making technical knowledge explicit in the development process. Cooperative and communicative methods are needed that support and develop the shared design spaces between IT professionals and the clinical context in order to strengthen small-scale health information systems projects.

A culture and power perspective on the management of health information technology in hospitals.

The three traditionally dominating professional hospital cultures - physicians, nurses and management - are challenged by the increasing use of health information technology (HIT) in health care. A fourth group of actors, the IT-professionals has become an exceedingly powerful player challenging the boundaries of the traditional hospital cultures. The hospital cultures are being redefined by and are redefining the technologies as well as the divisions of labour between the professional groups. The IT-professionals have become central actors in this and thereby they constitute a fourth powerful professional culture in the hospitals. This study draws out the phenomenon of IT-professionals as a fourth culture through a qualitative case study of both the IT-department and clinical and managerial hospital practices. The study finds evidence of how the IT-professionals and the IT-departments play a central part in the development of hospital practices constituting them as an influential culture and player in the hospitals. The tendency to see IT as merely infrastructure is hereby challenged and the conclusions demand further research into how to consider IT strategically in the hospitals, possibly pointing towards further user involvement in IT management.

Complexities in securing sustainable IT infrastructures in hospitals: the many faces of local technical support.

This paper contributes to an understanding of the complexity of support work and stress the need for local technical support in hospitals in order to maintain a sustainable infrastructure of information systems (IS) and information technology (IT). Given this complexity it is pointed out that a naïve trust in formal stylized models of support organization is problematic. With an increasing number of critical systems in the hospitals technical support is becoming an essential service needed for maintenance, acute failure of systems and help with the everyday use of hardware and software. In order for the health informatics technologies and systems to work, the healthcare institutions need strong IT organizations to support and maintain the IS/IT infrastructure on which these technologies and systems rely. Through a qualitative study of IS/IT support at hospitals I have examined the work and competencies of the service level in the IT organization. On this basis I recommend a nuanced understanding of the complexity of the work of these local technical supporters. I contrast this to the understanding of the organization of IT support through rationalized, formal 'best practice' models that emphasize centralization and cost-effectiveness through single point of contact. It is argued that there is a need for local technical supporters in hospitals with organizational and local knowledge because a) the local circumstances are key to supplying effective support and b) the supporter supply pro-active support that aid to secure the sustainability of the IT infrastructure.

Communication challenges in system development: involvement of system developers in small-scale IT projects.

A well-known challenge in system development is the aspect of user participation. In this paper we shift perspective from how to involve users in system development to how project managers with a clinical background, but without technical system knowledge, can involve system developers in IT projects. Using data from the development of an online patient book (an ICT application for clinical practice), we analyze challenges using the concept of language-games. We conclude that further research and development of participatory and communicative methods to involve system developers in IT projects, based in a clinical context, is needed.