How to Retain Participants in User-Centered Design? Towards Recommendations for Minimizing Dropouts.

Dropout and fatigue is present in most research projects. The present project Chronic Pain includes Fibromyalgia patients and applies a user-centered design approach. Surprisingly to the research group, two years into the project there is zero dropout. As a step towards designing a survey to investigate the patient adherence to the project, the characteristics of the user-centered design process are described in this paper.

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 health development, applying a partly remote approach of user-centred design methodology during the Covid-19 pandemic.

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 sharing of recommendations for how to practically apply a remote user-centred design methodology.

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 employed, with interviews and observations to map and evaluate the information flow and the digital support of collaborative work across organisations. The evaluation showed a lacking interoperability between the digital systems and a limited support for cross-organisational teamwork, causing raised manual efforts to maintain the information flow. Tools for coordination and planning across organisations were lacking. To enhance the situation, principles for a cloud-based health portal are proposed with a shared workspace, teamwork functionality for cross-organisational health care teams, and automatic back-end synchronisation of stored information. The main implications of this paper lie in the proposed principles which are transferable to a multitude of clinical contexts, where ad-hoc based access to shared medical information is of importance for decision-making and life-saving treatment.

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 contributed in mapping the user needs and requirements, and made paper prototyping of the user interface. The main contribution lies on how a user-centred design methodology can be applied in a clinical development context.

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 clinical practise on treatment and rehabilitation of persons with impaired fields of vision, and on how the support services are organised.

An Evaluation of Telemedicine Systems in Patient-Centred Care Teams.

The research project 3P- Patients and Professionals in Productive Teams has studied different patient-centred teamwork models for patients with chronic conditions and multi-morbidities. This paper presents outcomes from a qualitative study on the information flow and technology use in patient-centred care teams utilizing telemedicine, located in three health regions of Norway and Denmark. The aim was to identity barriers for collaborative work and propose models for the e-solutions of the future. The study showed fragmentation in information storage with limited interoperability causing that several systems had to be used for telemedicine follow-up and there was limited teamwork support functionality.

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 homes. The results showed that the patients were satisfied with the patient-centred service models and had an increased feeling of safety. A constraint was information sharing between the patient-centred health care team and the patients. Most of them did not have access to read own medical information and mainly verbal information was shared between the patients and the health providers.

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.

Evaluation of Technology Use in an Inter-Disciplinary Patient-Centered Health Care Team.

Health care services are facing challenges with carrying out 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 different patient-centered teamwork service models. This paper presents an evaluation on the technology support in a patient-centered health care team providing services to elderly people with chronic conditions and multi-morbidities in the transition from hospital to a home setting. The team had employees both from a university hospital and municipal health services. Qualitative research methods were applied in the evaluation of the technology use and information flow. The results showed that two information systems were used, that were not integrated and caused double manual work and registrations by the health care professionals. A benefit was that information sharing was improved between the hospital and municipal health care services, but the constraint was added workload.

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

The transformation and digitalization of health services foresees a need for recruiting individuals with the combined knowledge of technical and health sciences. Education of young people in the domain of eHealth is an important contribution in the on-going digital transformation process. In this context, the research project High School Students as Co-researchers in eHealth aims to introduce technology-supported health care scenarios and research methods to young students in the Southern region of Norway. As a part of the project, simulation of eHealth scenarios was made in a clinical research laboratory together with high school students and experienced researchers. In the simulation, role-play was used to carry out the scenarios. To inform the roles, the tasks and their associated actions, an interactive smartphone application was used. This paper presents the simulation procedure and how the interactive smartphone was developed and used to guide the scenarios.

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 organised with the aim to provide the students with theoretical technical insights and apply the knowledge through problem-solving and practical use. The course was decentralised and had a student-centred teaching approach over one semester.

The Technology Use and Information Flow at a Municipal Telemedicine Service.

Health care services facechallenges 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 teamworkservice 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 to provide the patient with written instructions on agreements and advices. As a constraint for the patient-centred team approach, the information in the telemedicine system was available only for the telemedicine nurses and not to other health care professionals.

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 patientsrun 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 available for professionals providing the telemedicine services and was not shared with other health care providers.

Patient Accessible Electronic Health Records: Impacts on Nursing Documentation Practices at a University Hospital.

In a Norwegian health region, patients have online access to their own electronic health record and they can also read the nursing documentation. This paper presents a qualitative study made at a university hospital to investigate how patient accessible electronic health records impact on nursing documentation practices. Semi-structured interviews were made with 12 informants from 5 cardiology departments at one hospital regarding how they used electronic nursing documentation in their daily practice and how they experienced patient accessible nursing documentation. The nurses emphasized that they focused on a clear and well-written nursing documentation, but in some situations, they were hesitant to write sensitive information. The study concluded that the implementation of patients' reading access to the electronic health record had limited impact on the nursing documentation and the daily practice at the departments, but the nursing handover had an even more important function for oral exchange of information.

Point of Care Solutions: Implementation of Sustainable Service Models.

Recent health reforms and strategies have urged Norwegian municipalities to re-organize their services to prepare for new ways of combining traditional home-based services with technology-assisted point of care interventions. This paper presents the outcomes from a qualitative study on modelling the municipal health care services for the future. The aim was to study the organisation and operation of point of care solutions and identify critical factors for how to model the services of the future.

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 self-management 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 the test results. The results showed that participants evaluated the Warfarin Guide as 'useful' for self-management of anticoagulation therapy, reporting key issues for further improvement.

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, but the technology used was a standalone system and not integrated with the electronic health record of the hospital. In addition, there was lack of support to provide the patients at home with written instructions on advices of medical treatment and care. The electronic information used for this telemedicine services, allowed shared access of information for teamwork between professional only within the hospital.

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.

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".