Lina Nilsson

The importance of interaction in the implementation of information technology in health care: A symbolic interactionism study on the meaning of accessibility

A challenge when groups from different disciplines work together in implementing health information technology (HIT) in a health-care context is that words often have different meanings depending upon work practices, and definition of situations. Accessibility is a word commonly associated with HIT implementation. This study aimed to investigate different meanings of accessibility when implementing HIT in everyday work practice in a health-care context. It focused on the perspective of nurses to highlight another view of the complex relationship between HIT and information in a health-care context. This is a qualitative study influenced by institutional ethnographic. District nurses and student nurses were interviewed. The results indicate that when implementing HIT accessibility depends on working routines, social structures and patient relationship. The findings of the study suggest that interaction needs to take on a more important role when implementing HIT because people act upon words from the interpreted meaning of them. Symbolic interactionism is proposed as a way to set a mutual stage to facilitate an overall understanding of the importance of the meaning of words. There is a need for making place and space for negotiation of the meaning of words when implementing HIT in everyday work practice.

Social Challenges When Implementing Information Systems in Everyday Work in a Nursing Context

Implementation of information systems in healthcare has become a lengthy process where healthcare staff (eg, nurses) are expected to put information into systems without getting the overall picture of the potential usefulness for their own work. The aim of this study was to explore social challenges when implementing information systems in everyday work in a nursing context. Moreover, this study aimed at putting perceived social challenges in a theoretical framework to address them more constructively when implementing information systems in healthcare. Influenced by institutional ethnography, the findings are based on interviews, observations, and written reflections. Power (changing the existing hierarchy, alienation), professional identity (calling on hold, expert becomes novice, changed routines), and encounter (ignorant introductions, preconceived notions) were categories (subcategories) presented in the findings. Social Cognitive Theory, Diffusion of Innovations, organizational culture, and dramaturgical analysis are proposed to set up a theoretical framework. If social challenges are not considered and addressed in the implementation process, it will be affected by nurses’ solidarity to existing power structures and their own professional identity. Thus, implementation of information systems affects more aspects in the organization than might have been intended. These aspects need to be taken in to account in the implementation process.

Health in hand: Putting mHealth design in context

Wireless technologies, cloud computing and connectivity have enabled mobile services that extend the coverage of health services, resulting in a branch of eHealth now commonly referred to as mHealth. However, at least in Sweden, where the healthcare sector is heavily institutionalized and regulated, mHealth has so far mainly evolved in the form of applications for support of healthy life-style and self-management of chronic diseases, implemented outside of the firewalls of traditional healthcare delivery environments. In this paper we present an on-going Indo-Swedish research and development project in which we are putting mHealth design into context both from a patients perspective and from the perspective of a healthcare team working within a professional healthcare organization. Our research approach is inspired by the Scandinavian tradition of Participatory Design of ICT and informed by studies of how to measure usability, user experience and impact of mHealth interventions. The involved research teams are multi-disciplinary, including researchers from engineering, computing and health sciences. The project includes, on the Swedish side, a partner from the public healthcare sector, three SME:s and an industrial partner who is currently providing Electronic Patient Record and other healthcare information system solutions and who is interested in developing mobile solutions for healthcare professionals. We are currently in the process of collaborative articulation and specification of problems, goals and requirements within the framework of the first Swedish case study of the project, focused on mobile support for patients with diabetes type 2 and their healthcare teams.

Framing the implementation process of video conferencing in discharge planning–According to staff experience

Challenges of improving discharge planning have been an area of concern for many years, including problems related to the lack of time for professionals to participate. In a county in South East Sweden, video conferencing was implemented in discharge planning sessions to enable distance participation of the professionals. To examine the implementation process, interviews were conducted with the implementers, who were project leaders, discharge planning coordinators in the hospital, and in home-care. The interviews were analyzed qualitatively, using directed content analysis with a deductive approach to a theoretical framework that was composed from theories about implementation processes to be suitable for the healthcare sector, consisting of the factors: implementation objects; implementation actions; actors; users; inner context and outer context. The results of this study are consistent with the framework but with the addition of a new dimension–time, i.e. time to prepare; time to understand; time to run through and time to reflect. It is suggested that implementation frameworks are useful when IT is introduced in healthcare. Framing the implementation process supports the exposure of factors and highlights relationships and states of dependence between those factors which may affect implementation.

PD 3.1 to the rescue: challenges for participatory design in a health care context

A National Strategy for E-health has been introduced in Swedish county councils. The strategy indicates that health care needs to become more accessible. To generate usable and sustainable e- Health solutions in Swedish health care, Participatory Design (PD) was introduced as a working method in an e-Health project in the south of Sweden. The project has met with opposition; e-health solutions are not exactly what Swedish health care wanted at the same time as different arenas within the health care organization have difficulties understanding each other. The aim of this study is to find work methods that result in applicable, usable, and sustainable ICT- solutions in every day work within Swedish health care. The study suggests that a modification of third generation of PD may be one way to the challenges PD has come across in the health care context.

Nurses’ Use and Perception of an Information and Communication Technology System for Improving Coordination During Hospital Discharges: A Survey in Swedish Primary Healthcare

To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses’ use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses’ perceptions of the information and communication technology system’s contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system’s usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

Video Conference as a Tool to Enable Participation in Discharge Planning -- Experiences from Implementers about the Implementation Process

The problems and challenges that arise in the task of improving discharge planning have been an area of concern for many years, including problems related to the lack of time for professionals to participate. In a county council area in South East Sweden, video conferencing was implemented in discharge planning sessions to enable distance participation. As part of a larger research study of the implementation process, interviews were conducted with two of the implementers. The interviews were analysed qualitatively, using directed content analysis with a deductive approach to considering a framework developed by Nilsen et al. The results of this study are consistent with the actual framework but with the addition of time, i.e. time to prepare, time to understand, time to run through and time to reflect. Further research is proposed to focus more on leadership during the implementation process and its influence on the meaning of time.