Medication Reconciliation as Repair Work.

In Norway, the process of developing a national shared medication list has been underway for several years. The shared medication list provides an overview of all the medications used by a patient. However, its proper use requires that it be maintained regularly through so-called medication reconciliation processes in which health personnel clarify - and ask patients - what and how much medication they use. We explore the work embedded in the bedside medication reconciliation process at a hospital, the health personnel conducting this work and the implications for the shared medication list. We argue that reconciliation processes can be conceptualized as collective repair work that needs to be continued after the shared medication list is implemented.

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.

How to Represent the Patient Voice in the Electronic Health Record?

There is an agreement among patients, professionals, as well as leaders, and governance that person-centered care (PCC) is central to care quality. PCC care is a sharing of power to ensure that the answer to: "What matters to you?" drives care decisions. Thus, the patient voice needs to be represented in the EHR to support both patients and professionals in the shared decision-making process and enable PCC. The aim of this paper is therefore to investigate how to represent the patient voice in an EHR. This was a qualitative study of a co-design process with six patient-partners and a team of healthcare personnel. The result of the process was a template for the information needed to represent the patients' voice in the EHR based on three questions: "What is important for you right now?". "What matters to you in your life?". "What do you want your care team to know about your history?".

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?

Scaling AI Projects for Radiology - Causes and Consequences.

Artificial intelligence (AI) for radiology has the potential to handle an ever-increasing volume of imaging examinations. However, the implementation of AI for clinical practice has not lived up to expectations. We suggest that a key problem with AI projects in radiology is that high expectations associated with new and unproven AI technology tend to scale the projects in ways that challenge their anchoring in local practice and their initial purpose of serving local needs. Empirically, we focus on the procurement of an AI solution for radiology practice at a large health trust in Norway where it was intended that AI technology would be used to process the screening of images more effectively. Theoretically, we draw on the information infrastructure literature, which is concerned with scaling innovative technologies from local settings, with a limited number of users, to broad-use contexts with many users.

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.

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.

Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team.

BACKGROUND: The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient's response to "What matters to you?" drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care. OBJECTIVE: The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions. METHODS: This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders. RESULTS: The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination. CONCLUSIONS: The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios.

Preconditions for Enabling Advanced Patient-Centered Decision Support on a National Knowledge Information Infrastructure.

In Western healthcare, an important goal is to provide clinical decision support "for the right healthcare personnel, in the right situation, at the right time". In this poster, we use a qualitative approach to outline the preconditions for enabling such advanced patient-centered decision support. This study indicates that establishing a national knowledge information infrastructure demands well-defined national standards, codes, and terminologies, as well as structured clinical data. An extensive governance structure is also required.

From Free-Text to Structure in Electronic Patient Records.

We report from the initial steps of a collaboration project between two post-doctoral projects, both using a qualitative action research approach to address challenges related to shifting from a free text to a structured EPR system constituting important preconditions for establishing advanced decision support and reuse of healthcare data. We have started to explore three areas that may influence this process related to: 1) Legislative challenges of getting access to all relevant healthcare data. 2) Challenges of exchanging data between silo systems and open platform systems. 3) Replacing a free text silo EPR with an open platform system - and the practical challenges of defining the content of the context sensitive structured EPR. Hence, we ask the following research questions: How to address challenges related to the shift from free text to structured EPR systems? How will the need for semantic interoperability between different EPRs influence the goal of advanced clinical decision support? Empirically, we draw on the regional FRESK program (2017-2022), in the North Norwegian Health Region, which includes implementing both a new regional open platform based EPR system, and a proprietary medical chart system.