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Abstract

As many evaluations show, healthcare organizations do not accomplish the intended effects of their eHealth systems due to inadequate usability. On behalf of the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish healthcare have been analysed from the perspective of healthcare and social service professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, seven workshops were held where researchers within health informatics collaborated with staff from different care providers, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents a foundation for further development of eHealth systems, condensed into 10 issues that the Swedish health and social care professionals find imperative to improve. The study emphasizes that the development of eHealth systems is always a matter of organizational and process development and must be integrated into the care practice improvement process. Further, based on the findings, some identified challenges are discussed.
Disturbing or Facilitating?
On the Usability of Swedish eHealth
Systems 2013
Isabella SCANDURRAa,1 Maria HÄGGLUND b, Anne PERSSON c and
Rose-Mharie ÅHLFELDT c
a
Uppsala University, Department of Information Technology
b
Karolinska Institutet, Health Informatics Centre
c University of Skövde, School of Informatics
Abstract. As many evaluations show, healthcare organizations do not accomplish
the intended effects of their eHealth systems due to inadequate usability. On behalf
of the Swedish Ministry of Health and Social Affairs, the usability of current
eHealth systems in Swedish healthcare have been analysed from the perspective of
healthcare and social service professionals. The objective of the study was to
report on current problems, potential solutions as well as to relate these to research
in relevant areas. Using a participatory approach, seven workshops were held
where researchers within health informatics collaborated with staff from different
care providers, representatives of the national associations of health and social care
professionals and the national eHealth system vendor organization. This paper
presents a foundation for further development of eHealth systems, condensed into
10 issues that the Swedish health and social care professionals find imperative to
improve. The study emphasizes that the development of eHealth systems is always
a matter of organizational and process development and must be integrated into the
care practice improvement process. Further, based on the findings, some identified
challenges are discussed.
Keywords. eHealth systems, user participation, Participatory design, healthcare
and welfare development, evaluation, validation, usability, patient-centricity.
Introduction
eHealth systems, i.e. information technology (IT) applied in the health and social care
sector, has great potential to enhance efficiency, improve quality of life and strengthen
innovativeness in health and social care. Extensive resources are currently being
invested in eHealth development at local, regional and national levels of society. To
achieve the maximum benefits from these investments, eHealth systems that really
support health and social care professionals in their work, focusing on health as an
effect of the care and treatment given, are required. However, technology is in health
and social care often regarded as a barrier to providing good healthcare in an efficient
way [1]. Specifically, insufficient usability of the systems is identified as a major
obstacle [1,2,3]. Unfortunately, little effort is put into health information system
1 Corresponding Author: Isabella Scandurra, e-mail: isabella.scandurra@it.uu.se
e-Health – For Continuity of Care
C. Lovis et al. (Eds.)
© 2014 European Federation for Medical Informatics and IOS Press.
This article is published online with Open Access by IOS Press and distributed under the terms
of the Creative Commons Attribution Non-Commercial License.
doi:10.3233/978-1-61499-432-9-221
221
development according to usability requirements and methodology, leading to
bottlenecks in eHealth systems when implemented into daily practice [3,5].
1. Background
The Swedish National Strategy for eHealth in Health and Social Care [6] identifies
useful and accessible information, as well as decision-making support for staff as
important priority areas. In a review (RiR 2011:19), the Swedish National Audit Office
concluded that the eHealth strategy has not been able to secure the benefits from the
efforts made. Current IT-systems do still not give health and social care professionals
access to “the right information at the right time” [7]. The Gartner report [2],
commissioned by the Ministry of Health and Social Affairs, indicated that
professionals primarily identified a need for improvement of the usability of eHealth
systems to increase their utilization. Based on the mentioned evaluations, the Swedish
Ministry of Health and Social Affairs acknowledged the need to address usability
issues in eHealth from a national perspective [5], which was the starting point for the
study presented in this paper; Usability of Swedish eHealth Systems 2013 (USeHS).
2. Method
The national associations of health and social care professionals carried out a joint
initiative in the autumn of 2012 to create the project financed by the Ministry of Health
and Social Affairs. The aim of the project was to collect and highlight lessons learned
and examples of best practice as a basis for improved integration of health and social
care providers and their IT support, as well as answering the following questions:
- Which problems do care professionals experience as users of eHealth systems? !
- Which solutions do they regard as being most important? !
- How do these findings relate to existing research regarding usability in eHealth? !
The concept of usability, according to the international standard for usability 9241-11,
focuses on a specific user in a specific context performing a specific task [4]. Therefore
it is challenging to address usability issues on an overall national level with the aim to
create national strategies. Therefore, such an initiative needs to be approached by a
bottom-up approach and by involving the real end-users [8].
The research approach of this work is based on three principles; user-centered
development, cross-organizational health and social care and real patient-centered
processes [8]. Hence, a participatory approach was adopted, inspired by the
Scandinavian tradition’ emphasizing participation in design [9,10,11]. The major
Swedish national associations of health and social care professionals were a driving
force and members (actual end-users) from each organization were involved from the
start of the study. In order to collect data, representatives of health and social care staff,
researchers in the area of usability in health informatics, and representatives of
suppliers of eHealth systems have participated in nine workshops [8]. In the first
workshop researchers, representatives from care profession organizations and the
ministry of health set the focus and aim for the following workshops. In workshops 2
and 3 end-users worked together with researchers to identify problems, and propose
potential solutions and future work scenarios. The fourth workshop involved vendors,
I. Scandurra et al. / Disturbing or Facilitating?222
while workshop 5-7 focused on discussing the results with other researchers and user
representatives throughout Sweden. Finally, in workshop 8 the results were prioritized
into an action list, and workshop 9 was an open workshop at a national eHealth
conference where more feedback and comments were gathered.
3. Results
As a first step, current eHealth usability problems were identified based on users
experiences. After that, potential solutions to the problems were proposed and
prioritized in the workshops as well as by representatives of eHealth systems vendors
and other Swedish eHealth researchers [5]. In this paper, the focus is not on describing
the problems but rather to emphasize what needs to be done in order to improve the
situation. Important actions to perform locally, in each healthcare organization, were
formulated, as well as suggestions for how to operationalize usability improvement
work from a national perspective. Further, examples of eHealth systems and services
with high usability for healthcare professionals were identified.
3.1. Ten priorities for improving usability
The development of eHealth systems is always a matter of organizational and process
development and must be integrated into the care practice improvement process. To
stress this, the USeHS study highlights the following ten priorities for improving
usability. Addressing them is imperative in order to capitalize on the potential of
eHealth systems.
1. eHealth systems must be managed, evaluated, supervised and continuously optimized in
relation to the usability needs of the organization that it is intended to support. There is
a need for more collaborative efforts to integrate work processes and eHealth systems
into a coherent and meaningful whole.
2. Increased participation of usability experts, health informatics specialists and users is
required in the development, implementation and evaluation of eHealth systems. Care
professionals must be involved in managing each eHealth project.
3. All health and social care professionals must have a basic understanding of the
opportunities offered by eHealth systems, as well as adequate knowledge of how the
eHealth systems should be used and how work processes relate to eHealth systems.
Training and enhancement of informatics skills must be prioritized in the education and
then continue in employment. Education in health informatics must be substantially
expanded and take into account sector-independent knowledge in the area of informatics
as well.
4. The technical prerequisites to document and access information must be met at the point
of care. The need is particularly great in the social care sector where access to technical
support is low and mobile work is common.
5. The technical infrastructure must be sufficiently powerful and reliable enough for users
to be able to rely on it. Security solutions must be implemented so that users can
perform their work without unnecessary interruptions. The systems must be developed
in order to ensure that response times are kept to a minimum. The IT environment is
becoming increasingly complex, partly as a consequence of increasing requirements for
exchange of information between health and social care providers. To manage this, care
providers must coordinate their organizations for the operation and administration of
eHealth systems more efficiently.
I. Scandurra et al. / Disturbing or Facilitating? 223
6. Health and social care staff must be able to move between different eHealth systems and
still be able to find vital information quickly in time-critical situations. This requires the
presentation of certain types of health and social care information to be structured and
standardized graphically, while still supporting personalization, based on e.g. role,
activity and situation.
7. Multiple recording of the same data must be eliminated. A set of information should be
recorded only once and communicated automatically in its existing or aggregated form
to other systems. The work on the National Interdisciplinary Terminology and the
National Information Structure as well as the implementation of automated transfer of
data must be accelerated.
8. Important information must follow the care recipient across health and social care
provider boundaries to facilitate person-centered health and social care. Unnecessary
legal obstacles must be eliminated. At the same time, eHealth systems must be
developed to support the enforcement of legal and ethical requirements when data flows
across health and social care provider boundaries.
9. Research on the usability of eHealth systems must be strengthened and the knowledge
applied in practice. More usable systems lead to improved capture and recording of data,
which in turn can provide improved feedback to the care staff and valid data for
research.
10. eHealth skills are a strategic development resource that must be present at all levels of
management in health and social care. Understanding of usability is the key to achieve
benefits of eHealth systems, and essential for good and reliable health and social care.
4. Discussion and conclusion
Based on the findings, some of the challenges are discussed, both from the health and
social care sectorsas well as the researchers’ point of view.
The users stated that the eHealth systems of tomorrow must follow the work
processes much better. The systems must provide overview, take little time to
assimilate and navigate and give the user a sense of control. This is in blatant contrast
to the present situation, where the users need to add manual check-points in and
between systems, both in terms of information and documentation. The systems need to
be adjusted to the particular task in question and the circumstances in which it is
carried out. Multiple recording of the same information as well as constant log-ins and
log-outs are issues that must be prioritized and dealt with immediately [5]. In the health
and social care of municipalities, access to mobile and situationbased eHealth systems
and tools must improve substantially [12].
Usability in current eHealth systems must be improved to guarantee patient safety
and support a person-centered health and social care as well as optimal use of resources
[13]. The users point out that there is a need for digital tools and systems where the
information follows the care recipient across care provider boundaries and where the
presentation of information is adapted to the users’ professions, situations and previous
choices or preferences. Certain types of health and social care information must be
structured uniformly no matter which care provider is involved. E.g., standardized
support for medication management is needed in order to reduce the risk of errors in
the medication supply chain, and uniform access to vital information is necessary in
order to guarantee safe and timely decision-making in time-critical situations [14].
Based on the results achieved in USeHS, it is clear that the research about what is
required to improve the usability of eHealth systems needs to be increased in order to
I. Scandurra et al. / Disturbing or Facilitating?224
support future successful development of eHealth systems. Furthermore, the results
show that there seems to be a lack of knowledge in healthcare organizations concerning
how usability work should be conducted.
The relationship between poor usability and stress factors does not seem to be well
known in organizations, although healthcare professionals explicitly identify IT-related
disturbances as a major health and safety problem. Furthermore, continuous monitoring
of the usability of eHealth systems at the national level, which could serve as a basis
for collaboration and supervision in developing and adopting eHealth systems, is
currently missing. Specific evaluations have been made [1]. However, a long-term
follow-up on how usability evolves over time is still missing. Finally, there is a need to
deepen and disseminate the knowledge in the health and social care domains about
eHealth in general and about the usability aspect of eHealth systems in particular.
References
[1] Users Award, Vård IT-rapporten 2010 - en sammanfattning och Vård-IT-rapporten 2010 Enkätunder-
sökningar, flödesstudier och uppföljning av Vård-IT-kartan 2004: ,in Swedish. Retrieved 5 Jan 2014.
http://www.usersaward.com/
[2] Gartner, eHälsa i Sverige nuläge och framtida mål: Rapport för Socialdepartementet 2012:
330006695
[3] Viitanen J, Hyppönen H, Lääveri T, Vänskä J, Reponen J, Winblad I, National questionnaire study on
clinical ICT systems proofs: Physicians suffer from poor usability. Int J Med Inf, 80 (2011), 708-725
[4] International Organization for Standardization, ISO 9241-11:1998, Part 11: Guidance on usability
http://www.iso.org/iso/home/store/catalogue _tc/catalogue_detail.htm?csnumber=16883
[5] Scandurra I, Störande eller stödjande? Om eHälsosystemens användbarhet 2013 Retrieved 5 Feb 2014
http://www.storandeellerstodjande.se
[6] Socialdepartementet, Nationell eHälsa - strategin för tillgänglig och säker information inom vård och
omsorg, S2010.020 (2010). Retrieved 5 Feb 2014. http://www.regeringen.se/sb/d/108/a/148429
[7] Riksrevisionen, .Rätt information vid rätt tillfälle inom vård och omsorg samverkan utan verkan? RiR
2011:19. Retrieved 2 feb 2014. http://www.riksrevisionen.se/sv/rapporter/Rapporter/EFF/2011/
[8] Scandurra I, Åhlfeldt R, Persson A, Hägglund M., Building Usability into National eHealth Strategies,
an Action Research Approach. The 4th Infrastructure workshop on Infrastructures for Healthcare:
Action Research, Interventions, and Participatory Design. Tromsö, Norway, June 2013
[9] Bødker S, Ehn P, Sjögren D & Sundblad Y., Cooperative design perspectives on 20 years with "the
Scandinavian IT Design Model”. Proceedings of the first Nordic conference on Human-computer
interaction. Association for Computing Machinery, 2000.
[10] Stirna, J. Persson, A. Sandkuhl, K., Participative enterprise modelling: experiences and
recommendations, in Krogstie, J. Opdahl, A.L. Sindre, G. (Eds.): 19th Int Conf on Advanced
Information Systems Engineering (CAiSE 2007), LNCS 4495, 2007, Springer Verlag
[11] Scandurra I, Hägglund M, Koch S, From user needs to system specifications: multi-disciplinary
thematic seminars as a collaborative design method for development of health information systems
Journal of biomedical informatics 2008:41 (4): 557-569
[12] Rigby M, Hill P, Koch S, Keeling D. Social Care Informatics as an Essential Part of Holistic Health
Care: A Call for Action. Int J Med Inform (2011) 80: 544-554
[13] Söderström, E., Åhlfeldt, R-M and Eriksson, N. , Trusting digitized patient-related information: The
need for a new approach, In Furnell and Clarke (eds.), Proceedings of the 5th International Symposium
on Human Aspects of Information Security and Assurance (2011), London, pp.119-129, ISBN: 978-1-
84102-284-0
[14] Åhlfeldt, R., Persson, A., Krasniqi, H., and Wåhlander, K. Supporting Active Patient and Healthcare
Collaboration - A Prototype for Future Healthcare Information Systems. In Sibte, Abidi and Bath (eds.),
Proceedings of the 16th International Symposium on Health Information Management Research
(ISHIMR 2013). Halifax, June 26-28 2013, pp 13-23, ISSN: 2048-4712
I. Scandurra et al. / Disturbing or Facilitating? 225
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Trust is receiving increasing attention nowadays, particularly since new technology enables communication and collaboration like it has never been seen before. However, trust is a fuzzy concept that needs further examination and attention from multiple levels. For example, security is very important from a user’s point of view in trusting that technology will function in accordance with the user’s intended and requested function. This paper reviews the concept of patient safety, which thus far has been discussed and defined from a narrow technical perspective. We demonstrate that it is much more complex, and that it is not primarily the technical issues that are problematic, but rather the cultural, process-related and personnel issues. Our results point to a need for a new approach, which takes the patients’ view of healthcare and the patient-related digital information as its focus. The discussion is made from a Swedish perspective, but the issues are international. The needs for information and knowledge in healthcare are obvious. Without clear definitions of concepts and roles, a good information flow or process cannot be designed. Our discussion shows that trusted digital patient information gives an opportunity for a patient-focused healthcare. Multidimensional trust must be addressed on all levels; organization, person and technology. More empirical research into trust in digital patient-related information is necessary, to develop a model for patient safety from a trust perspective that encompasses all levels of trust.
Conference Paper
The objective of this paper is to report a set of experiences of applying participative enterprise modeling in different organizational contexts. While the authors have successfully applied the approach in many organizations, the paper primarily concentrates on three cases. On the basis of these experiences the paper presents a set of generic principles for applying participative enterprise modeling.
Article
Objective: In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field. Methods: A national web questionnaire study was conducted in Finland in spring 2010 with 3929 physicians actively working in patient care. For the purposes of the study, we described three dimensions of clinical ICT system usability that reflect the physicians' viewpoint on system usage: (1) compatibility between clinical ICT systems and physicians' tasks, (2) ICT support for information exchange, communication and collaboration in clinical work, and (3) interoperability and reliability. The dimensions derive from the definitions of usability and clinical context of use analysis, and reflect the ability of ICT systems to have a positive impact on patient care by supporting physicians in achieving their goals with a pleasant user experience. The research data incorporated 32 statements with a five-point Likert-scale on physicians' experiences on usability of their currently used ICT systems and a summative question about school grade given to electronic health record (EHR) systems. Results: Physicians' estimates of their EHR systems were very critical. With the rating scale from 4 or fail to 10 or excellent, the average of the grades varied from 6.1 to 8.4 dependent on the kind of facility the physician is working. Questionnaire results indicated several usability problems and deficiencies which considerably hindered the efficiency of clinical ICT use and physician's routine work. Systems lacked the appropriate features to support typical clinical tasks, such as decision making, prevention of medical errors, and review of a patient's treatment chart. The systems also required physicians to perform fixed sequences of steps and tasks, and poorly supported the documentation and retrieval of patient data. The findings on ICT support for collaboration showed mainly negative results, aside from collaboration between co-located physicians. In addition, the study results pointed out physicians suffering from system failures and a lack of integration between the systems. Conclusions: The described study and related results are unique in several ways. A national usability study with nearly 4000 respondents had not been conducted in other countries in which healthcare technologies are widely adopted. The questionnaire study provided a generalized picture about the usability problems, however, it should be noted that there were significant differences between legacy systems in use. Previously, researchers had not approached contextual aspects of usability the context of clinical work, where numerous systems are in use. The described usability dimensions and the presented study results can be considered as the first step towards conceptualizing ICT usability in the unique setting of clinical work.
Article
This paper presents a new multi-disciplinary method for user needs analysis and requirements specification in the context of health information systems based on established theories from the fields of participatory design and computer supported cooperative work (CSCW). Whereas conventional methods imply a separate, sequential needs analysis for each profession, the "multi-disciplinary thematic seminar" (MdTS) method uses a collaborative design process. Application of the method in elderly homecare resulted in prototypes that were well adapted to the intended user groups. Vital information in the points of intersection between different care professions was elicited and a holistic view of the entire care process was obtained. Health informatics-usability specialists and clinical domain experts are necessary to apply the method. Although user needs acquisition can be time-consuming, MdTS was perceived to efficiently identify in-context user needs, and transformed these directly into requirements specifications. Consequently the method was perceived to expedite the entire ICT implementation process.
eHälsa i Sverige – nuläge och framtida mål: Rapport för
  • Gartner
Gartner, eHälsa i Sverige – nuläge och framtida mål: Rapport för Socialdepartementet 2012: 330006695
Part 11: Guidance on usability http
International Organization for Standardization, ISO 9241-11:1998, Part 11: Guidance on usability http://www.iso.org/iso/home/store/catalogue _tc/catalogue_detail.htm?csnumber=16883