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  • 1.
    Hägglund, Maria
    et al.
    Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.
    Scandurra, Isabella
    Örebro University, Örebro University School of Business. APRI eHealth, Själevad, Sweden.
    Does user centred design work in homecare for elderly?: a retrospective on the OLD@HOME case2011In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 11Article in journal (Refereed)
    Abstract [en]

    Introduction: Mobile information and communication technology (ICT) has been suggested to improve collaboration in integrated homecare, yet, few successful implementations are available. User centred design (UCD) can improve the usefulness of ICT, however, it is often claimed to be expensive and difficult to use in healthcare. In the action research project OLD@HOME (Sweden 2002–2005) a user centred approach was adapted to the specific context of integrated homecare for elderly.

    Aim: To revisit OLD@HOME and explore what methodological adjustments were needed to adapt UCD to integrated homecare of elderly, and what the long-term effects of using UCD were.

    Results: Our collaborative design method included all stakeholders and enabled development of both new work situations and new tools. Five years after implementation, the system is still used by home help service personnel, for both homecare- and office-based work, as it provides ubiquitous access to information and communication. Technical support is rarely needed; experienced users handle occurring problems, training and introduction of new users.

    Conclusions: We consider the development method a key factor for the OLD@HOME system’s success as it enabled the design of a homecare system that is not only easy to use, but adapted to the context of integrated homecare for elderly

  • 2.
    Hägglund, Maria
    et al.
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden .
    Scandurra, Isabella
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden .
    Moström, Dennis
    XLENT Technology AB, Örnsköldsvik, Sweden.
    Koch, Sabine
    Department of Medical Sciences, Uppsala University, University Hospital, Uppsala, Sweden; Center for eHealth, Uppsala University, Uppsala, Sweden .
    Bridging the gap: a virtual health record for integrated home care2007In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 7Article in journal (Refereed)
    Abstract [en]

    Introduction: The coexistence of different information systems that are unable to communicate is a persistent problem in healthcare and in integrated home care in particular.

    Theory and methods: Physically federated integration is used for design of the underlying technical architecture to implement a mobile virtual health record for integrated home care. A user centered system development approach is followed during design and development of the system.

    Results: A technical platform based on a service-oriented approach where database functionality and services are separated has been developed. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardized way. A physically federated integration enables point-of-care documentation, integrated presentation of information from different feeder systems, and offline access to data on handheld devices. Feeder systems deliver information in XML-files that are mapped against an ideal XML schema, published as an interface for integration with the information broker, and inserted into the mediator database.

    Conclusions: A seamless flow of information between both different care professionals involved in integrated home care and patients and relatives is provided through mobile information access and interaction with different feeder systems using the virtual health record.

  • 3.
    Laleci Erturkmen, Gokce Banu
    et al.
    SRDC Software Research Development and Consultancy Corp, Turkey.
    Yuksel, Mustafa
    SRDC Software Research Development and Consultancy Corp, Turkey.
    Sarigul, Bunyamin
    SRDC Software Research Development and Consultancy Corp, Turkey.
    Lindman, Pontus
    MEDIXINE, Finland.
    Chen, Rong
    CAMBIO, Sweden.
    Zhao, Lei
    University of Warwick, United Kingdom.
    Bouaud, Jacques
    INSERM, UPMC Univ Paris, France.
    Lilja, Mikael
    Region Jämtland Härjedalen, Sweden.
    de Manuel, Esteban
    Kronikgune, Spain.
    Verdoy, Dolores
    Kronikgune, Spain.
    de Blas, Antonio
    Osakidetza, Basque Country Health Public System, Spain.
    Marguerie, Christopher
    South Warwickshire NHS Foundation Trust, United Kingdom.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Lim Choi Keung, Sarah Niukyun
    University of Warwick, United Kingdom.
    Arvanitis, Theodoros N.
    University of Warwick, United Kingdom.
    Management of personalised guideline-driven care plans addressing the needs of multi-morbidity via clinical decision support services2018In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 18, no 132, p. A132-A132Article in journal (Refereed)
    Abstract [en]

    Introduction: The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. C3-Cloud project aims to build an integrated care platform for addressing the growing demand for improved health outcomes of multimorbid and long-term care patients. 

    Theory/Methods: C3-Cloud has established an ICT infrastructure enabling continuous coordination of patient-centred care activities by a multidisciplinary care team MDT and patients/informal care givers. The Coordinated Care and Cure Delivery Platform C3DP allows, collaborative creation and execution of personalised care plans for multi-morbid patients through systematic and semi-automatic reconciliation of clinical guidelines. Clinical decision support CDS systems implementing flowcharts from evidence based clinical guidelines are integrated to present suggestions for treatment goal and activities e.g. medications, follow-up appointments, diet, exercise, lab tests. Pilot site local care systems are integrated with the C3DP via the technical and semantic interoperability platform to facilitate informed decision making. Active patient involvement is realized through a Patient Empowerment Platform presenting personalized care plan to the patient and establishing a continuous bi-way communication with the patient to collect patient observations, questionnaire responses, symptoms and feedback about care plan goals and activities.

    Results: The following research results have been achieved to enable guideline enabled personalised care plan management for addressing the needs of multi-morbidity:

    43 logical flowcharts were designed out of 4 disease guidelines Type 2 Diabetes, Heart Failure, Renal Failure and Depression.

    181 CDS rules assessing 166 patient criteria and recommending 154 goal/activity suggestions were implemented as CDS services in GDL covering T2D and RF.

    52 reconciliation rules were designed for eliminating contradicting guideline recommendations due to multi-morbidity.

    23 HL7 FHIR profiles were defined for representing care plan and patient data.

    C3DP has been integrated with these CDS services via CDS-Hooks specification to recommend personalised care plan goals and activities.

    Discussions: In this research, we have successfully implemented an ICT infrastructure enabling guideline-driven integrated care for multi-morbid patients. Although our ICT solution covers all the technical requirements identified by clinical partners, effective implementation of integrated care in real-life care setting requires major changes in organisational responsibilities and care pathways.

    Conclusions: User-centred design and usability testing have successfully been completed. C3-Cloud pilot application will now be operated in 3 European pilot sites with the participation of 62 MDT members and 1200 multi-morbid patients for 15 months.  

    Lessons learned: There are two main research lines for reconciliation of contradicting guideline recommendations: 1 fully-automated reconciliation via ontology reasoning, 2 manually-crafted reconciliation rules by clinical expert groups. Although first approach is more dynamic, research results are still for very primitive cases and not clinically validated. As we are targeting an industry-ready solution after piloting in real-life settings, we have opted for the second option.

    Limitations: When a new chronic disease is to be addressed within our platform, reconciliation rules covering all disease combinations have to be re-assessed by the clinical expert group.

    Suggestions for future research: Fully-automated reconciliation approaches need to be further studied and validated in real-life settings. 

  • 4.
    Scandurra, Isabella
    et al.
    APRI eHealth, Själevad, Sweden..
    Hägglund, Maria
    A collaborative design method to support integrated care.: An ICT development method containing continuous user validation improves the entire care process and the individual work situation2009In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 9, no Suppl.Article in journal (Refereed)
    Abstract [en]

    Introduction

    Integrated care involves different professionals, belonging to different care provider organizations and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process [1].

    Purpose

    To present a method for development of usable and work process-oriented information and communication technology (ICT) systems for integrated care.

    Theory and method

    Based on Human-computer Interaction Science and in particular Participatory Design [2], we present a new collaborative design method in the context of health information systems (HIS) development [3]. This method implies a thorough analysis of the entire interdisciplinary cooperative work and a transformation of the results into technical specifications, via user validated scenarios, prototypes and use cases, ultimately leading to the development of appropriate ICT for the variety of occurring work situations for different user groups, or professions, in integrated care.

    Results and conclusions

    Application of the method in homecare of the elderly resulted in an HIS that was well adapted to the intended user groups. Conducted in multi-disciplinary seminars, the method captured and validated user needs and system requirements for different professionals, work situations, and environments not only for current work; it also aimed to improve collaboration in future (ICT supported) work processes. A holistic view of the entire care process was obtained and supported through different views of the HIS for different user groups, resulting in improved work in the entire care process as well as for each collaborating profession.

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