Citizens Access to Health Information in National Portals in the Nordic Countries.

National eHealth portals for citizens are available in the five Nordic countries. This study describes and compares the Nordic citizen portals and identifies variations in content access and functionality. The findings suggest that availability of information and services depend on the organisation of the health system, the connection to national health information exchange platforms and incentives for providing data and services.

Knocking on Doors - How Healthcare Workers Informally Develop Expertise in Biomedical and Health Informatics.

With digital systems permeating the healthcare sector, the healthcare workforce (clinical and administrative) need insight in biomedical health informatics (BMHI) to some degree. This study shows how novices in BMHI had to knock hard on several doors to find and become part of a community of practice to gain such expertise within BMHI. While it may be generally understood that gaining access to expertise is important, our findings suggest that more attention is needed to how such access is gained. The study exemplifies that the needed skills and competencies are difficult to identify in the individual projects and are highly situated - not least because it requires access to various experts in communities of practices. Therefore, there is a continued need to reframe the necessary education and training. Knowing when to knock on doors, which doors to knock on, and keeping doors open is central to becoming - and keep on being - a part of a community of practice centring on health information technology and BMHI.

Sharing Quality Information in New Digital Systems: Management Considerations.

Health information technology is often assumed to improve healthcare. However, expectations of health information technology are seldomly met in full for multiple reasons. While the implementation of health information technology, is increasingly being investigated and evaluated, less attention has been paid to the preceding choices made by key people on how to share relevant information in new HIT systems. This study brings to light the central considerations exercised by key people in charge of managing the process of how to share information through locally developing new digital systems for quality information management. The multiple decisions revolved around three main considerations: user conditions and role, integration into local setup, and resources. Weighing the cost benefit balances of these perspectives are likely to influence subsequent access to and use of high-quality information in public healthcare and are therefore central to the management of effective health information technology.

Access to Development Opportunities in Biomedical and Health Informatics.

In between users and trained informaticians, we find a group of people carrying out important work in implementing and further developing health information technology, without access to formal biomedical and health informatics (BMHI) training. Study findings show what is required of novices in BMHI to gain access to communities of practice through which expertise can be developed.

The Last Mile Problem and Beyond in HIT - The Role of Context-Sensitive Digital Integrators.

Issues of non-use of available health information technology (HIT) have been referred to as the 'last mile problem' impeding harnessing the full potential of HIT. We reflect upon which competencies are needed to address the last mile problem by ensuring a context-sensitive implementation. We argue that there is a need for context-sensitive digital integrators, who can navigate the realm where technological systems meet practice. This entails a situated, socio-technical, context-sensitive approach and competencies which are not easily addressed through formal training but require lifelong situated learning, as the field evolves continuously. Our ambition is to highlight the complexities of implementation and integration into local practice. This paper emphasizes the role of digital integrators in the hope of fostering further discussions on how to acknowledge and nourish these competencies in order to address and go beyond the last mile problem.

Capacity Building in Preparing the Health Workforce to Deliver the Digital Future.

Programs supporting the necessary combination of digital, organizational, and cultural transformational change, motivating and engaging the workforce, are scarce. This discussion paper reports on the initial experiences from a competency development program aiming at building capacity within the workforce, leaders, and organization in secondary healthcare to navigate and facilitate digitally transformative healthcare systems. The program aims to support employees and leaders who i) understand digitalization in and of practice, ii) reflect and approach digitalization in a critical and ethical way, iii) are curious and maintain a growth mind-set, iv) engage in development and implementation of digitalization, and v) can convey and communicate digitalization. The insights from the prototype can be useful in further promoting sustainable digitalization within healthcare and supporting leaders in their conduct and management of digital health initiatives.

People Centeredness, Chronic Conditions and Diversity Sensitive eHealth: Exploring Emancipation of the 'Health Care System' and the 'Patient' in Health Informatics.

Health care systems struggle to consistently deliver integrated high-quality, safe, and patient-centered care to all in an economically sustainable manner. Inequity of access to health care services and variation in diagnostic and treatment outcomes are common. Further, as health care systems become ever more complex, iatrogenesis and counter productivity have emerged as real dangers. In exploring this paradox, this paper considers a subset of those in society living with chronic conditions. Their attributes and circumstances have led to them being marginalized or excluded from 'end-user' engagement and/or from their requirements being incorporated into technology supported chronic disease management initiatives. Significantly, these citizens are often the most vulnerable and socially disadvantaged and tend to achieve poorer results and cost more per capita than the 'average patient' in their interactions with the health care system. Critically, this paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. This paper suggests innovative ways of supporting interactions with these 'end-users' and highlights how reflection on these approaches can contribute to emancipating the health system to move towards more socially inclusive eHealth solutions.

National monitoring and evaluation of eHealth: a scoping review.

OBJECTIVE: There has been substantial growth in eHealth over the past decade, driven by expectations of improved healthcare system performance. Despite substantial eHealth investment, little is known about the monitoring and evaluation strategies for gauging progress in eHealth availability and use. This scoping review aims to map the existing literature and depict the predominant approaches and methodological recommendations to national and regional monitoring and evaluation of eHealth availability and use, to advance national strategies for monitoring and evaluating eHealth. METHODS: Peer-reviewed and grey literature on monitoring and evaluation of eHealth availability and use published between January 1, 2009, and March 11, 2019, were eligible for inclusion. A total of 2354 publications were identified and 36 publications were included after full-text review. Data on publication type (eg, empirical research), country, level (national or regional), publication year, method (eg, survey), and domain (eg, provider-centric electronic record) were charted. RESULTS: The majority of publications monitored availability alone or applied a combination of availability and use measures. Surveys were the most common data collection method (used in 86% of the publications). Organization for Economic Co-operation and Development (OECD), European Commission, Canada Health Infoway, and World Health Organization (WHO) have developed comprehensive eHealth monitoring and evaluation methodology recommendations. DISCUSSION: Establishing continuous national eHealth monitoring and evaluation, based on international approaches and recommendations, could improve the ability for cross-country benchmarking and learning. This scoping review provides an overview of the predominant approaches to and recommendations for national and regional monitoring and evaluation of eHealth. It thereby provides a starting point for developing national eHealth monitoring strategies.

Development and Progression in Danish eHealth Policies: Towards Evidence-Based Policy Making.

In order to realise the potential benefits of eHealth, governments develop eHealth policies to define and prioritise initiatives, the strategic goals and the resulting benefits. During the 23 years with eHealth policies in Denmark only a few status reports with a systematic and transparent evaluation have been made. This paper advocates a more systematic approach to strategic planning of development and implementation of eHealth systems, by encouraging the concept of evidence-based policy making through analysis of how focus of the Danish eHealth policies have evolved. The Danish eHealth policies have very different framings following the different focus points for the policies. Interestingly, strategies for evaluating the devolopment of eHealth and eHealth policies were very sparcely noted in the policies. For the first time the de-emphasising of evaluations of eHealth policies in Denmark has been empirically demonstrated, thus undermining the objective of obtaining evidence-based eHealth policies.

Monitoring and Benchmarking eHealth in the Nordic Countries.

The Nordic eHealth Research Network, a subgroup of the Nordic Council of Ministers eHealth group, is working on developing indicators to monitor progress in availability, use and outcome of eHealth applications in the Nordic countries. This paper reports on the consecutive analysis of National eHealth policies in the Nordic countries from 2012 to 2016. Furthermore, it discusses the consequences for the development of indicators that can measure changes in the eHealth environment arising from the policies. The main change in policies is reflected in a shift towards more stakeholder involvement and intensified focus on clinical infrastructure. This change suggests developing indicators that can monitor understandability and usability of eHealth systems, and the use and utility of shared information infrastructure from the perspective of the end-users - citizens/patients and clinicians in particular.

Translating eHealth Visions from Strategy to Practice - A Benefit Management Approach.

The municipalities and the Regional Health Authorities in Central Norway have been assigned a mandate to implement a shared electronic health record, Helseplattformen, reflecting the visions set out in the national eHealth white paper 'One Citizen - One Record'. This study identifies and describe anticipated benefit streams of clinical decision support in 'One Citizen - One Record' and the user requirement specification documents of Helseplattformen. This study found that the benefit stream of clinical decision support translates from the health policy visions stated in 'One Citizen - One Record' into Helseplattformen. However, business changes, although a critical element of achieving benefits, were not emphasised in either. This calls for the programme of Helseplattformen to pay careful attention to how the information system and information technology requirements must be accompanied by enabling changes as well as business changes in order to achieve the identified benefits of 'One Citizen - One Record' and Helseplattformen.

National Monitoring and Evaluation of Health IT: Protocol for a Scoping Review.

BACKGROUND: Monitoring the pace of Health Information Technology (HIT) adoption across states is critical for providing data to formulate future national and regional HIT policies. However, repeated monitoring of the progress on implementation of the strategies is often scarce. The lack of systematic monitoring of progress in availability and use of HIT has led to a need for an overview of the key concepts and methodologies used in the scattered scientific literature. The scoping study aims at achieving both in-depth and broad results, identifying all relevant material, regardless of the design. This paper presents and discuss a protocol for a scoping review. OBJECTIVE: We aim to provide a comprehensive overview of the existing body of knowledge and to assess the extent, range and nature of monitoring and evaluation of availability and use of HIT at a national or regional level. This scoping review includes peer reviewed and grey literature. METHODS: The search strategy is iterative and developed in cooperation with information specialists and key researchers in the field. Inclusion, data extraction, and quality assessment will be done by two independent reviewers. Data will be collated, summarized and analyzed thematically. CURRENT STATUS: 1760 references were included for screening. After screening for eligibility based on title and abstract 84 publications were included for full text review, which is currently being done. Final results are expected in March 2017. CONCLUSION: This scoping review will map the existing body of literature and describe the current approaches to monitoring and evaluating HIT on a national or regional level. The review will provide evidence-based information in order advance national strategies for monitoring and evaluating availability and use of HIT.

How to Present Evidence-Based Usability Design Principles Dedicated to Medication-Related Alerting Systems to Designers and Evaluators? Results from a Workshop.

Medication alerting system use errors and lack of adoption are often attributed to usability issues. Previous work has used evidence from the literature to reveal usability principles specific to medication alerting systems and identify potential consequences of violating these principles. The current study sought to explore how best to convey these principles to designers and evaluators of these systems to facilitate their work. To this aim, a workshop with 19 participants was used to generate ideas and opinions on how to deliver these topic-specific design principles in a way that would be most helpful for them. Participants generated ideas for how (e.g., a collaborative, continuously updated forum) and what (e.g., illustrations, checklists, evidence sources and strength, consequences of violations) information is most useful to disseminate usability principles for medication alerting systems. Participants, especially designers, expressed desire to use these principles in practice and avoid previously documented mistakes and therefore make design and evaluation of these systems more effective and efficient. Those insights are discussed in terms of feasibility and logistical challenges to developing the proposed documentation). To move this work forward, a more collaborative approach of Human Factors specialists in medical informatics is necessary.

Monitoring the Amount of Practical Use of eHealth on National Level by Use of Log Data: Lessons Learned.

This paper set out to define the lessons learned from the process of characterizing the amount of practical use of eHealth on national level by collecting and comparing log data harvested from national logs in the Nordic countries. The health systems of the Nordic countries are quite similar in structure and their eHealth strategies include similar elements, however when confronted with the specific context in the different systems it proved challenging to define a common set of indicators for monitoring the practical use of eHealth. A thorough analysis of context leading to the definitions of the indicators is the basis needed due to the complexity of the data in the national logs. A comprehensive knowledge of the structure that underlines these logs is of utmost importance when striving for collecting comparable data. Although challenging, the process of defining indicators for practical use of eHealth by data harvested trough national logs is not an impossible task, but a task that requires in depth discussions of definitions of indicators as well as a substantial insight into the architecture and content of the national databases. There is need for continuous work on these indicators to ensure their quality and thus make sure that the defined indicators can meaningfully inform eHealth policies.

Monitoring Telemedicine Implementation in Denmark.

According to the literature, Denmark has a leading position in the dissemination and use of health informatics. However, there is a lack of systematically collected and documented experience of telemedicine solutions in Denmark. This evidence is being established with a new project, which maps out all telemedicine initiatives in Denmark. Data on all the initiatives is collected in a single database and some of the data is analyzed in this paper. It is shown that there are a very large number of telemedicine initiatives in Denmark and that the elements from the national strategy for telemedicine are clearly visible in the telemedicine map. The very large number of projects could, however, also indicate a lack of national coordination of initiatives and a need for evaluation activities to systematically collect and communicate the learning outcomes from all the new projects.