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  • 1.
    Bakunzibake, Pierre
    et al.
    Örebro University, Örebro University School of Business. College of Science and Technology, School of Engineering and School of ICT, , Rwanda.
    Grönlund, Åke
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    E-Government Implementation in Developing Countries: Enterprise Content Management in Rwanda2016In: Electronic Government and Electronic Participation, Amsterdam: IOS Press, 2016, p. 251-259Conference paper (Refereed)
    Abstract [en]

    E-Government is now on the rise in developing countries. While developing countries can "leapfrog" technology generations, the necessary organizational change is another matter. In industrialized countries technical systems have been developed over long time in parallel with institutional development; developing countries hope to make that journey faster. Most of the e-Government implementation research focuses on developed countries. It is important to explore the relation between the literature and the findings in the context of developing countries as to come up with a gap to reduce. An interview study with 56 people in 10 government organizations involved in implementing a government-wide enterprise content management system was conducted to find out how critical success factors found in literature on implementation of information management systems relate to the situation in the Rwanda public sector to discover the step forward in Rwanda. We find a large gap between expectations and results due to a strong focus on the technical tool and little concerns about issues related to organizational change.

  • 2.
    Bakunzibake, Pierre
    et al.
    Örebro University, Örebro University School of Business. University of Rwanda, Rwanda.
    Grönlund, Åke
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Organisational Challenges in the Implementation of ‘one-stop’ e-Government in Rwanda2019In: Electronic Journal of e-Government, ISSN 1479-439X, E-ISSN 1479-439X, Vol. 17, no 1, p. 1-19Article in journal (Refereed)
    Abstract [en]

    One-stop e-government holds potential benefits in all contexts and especially in the context of developing countries and in the Least Developed Countries (LDCs). Implementation of one-stop e-government can be challenging as it normally requires addressing a number of organisational issues including those related to the integration of the individual government information systems of different departments which traditionally function as silos; tackling organisational issues can be difficult due to the nature of the public sector. However, the contemporary literature paints a picture of scarce research on the organisational issues that impede the implementation of one-stop e-government initiatives in LDCs. This paper explores the organisational issues underlying the implementation of ‘one-stop’ e-government initiatives in Rwanda, an LDC. The study explores the status of these elements as of and up to March 2017. The qualitative case study methodology used for this study involved data collection by means of documents and interviews with key managers from central government organisations, from a private company, and from local government service clerks. Template analysis was used as a method for data analysis. Even though the number of online services for citizens, businesses, and other agencies is growing rapidly and easy payment of service fees is available, a number of organisational issues were identified. These include the lack of a clear plan of ‘to-be’ service processes and a corresponding change management strategy. Service re-design was taking place very much ad hoc. There were also unclear systematic organisational learning mechanisms and unclear operational goals in the local government. Addressing these issues would contribute towards improving the implementation of one-stop e-government and its corresponding services in such a context. The paper contributes to research by providing insights into organisational issues in a country currently in an early stage of e-government development. For Rwandan e-government professionals, the paper suggests a way forward. It also helps decision makers in Rwanda and similar countries undertaking one-stop initiatives to understand the problem context of actions taken towards IT-driven institutional reform.

  • 3.
    Bakunzibake, Pierre
    et al.
    Örebro University, Örebro University School of Business. University of Rwanda, College of Science and Technology, School of ICT, Rwanda.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Islam, M. Sirajul
    Örebro University, Örebro University School of Business.
    A Model for Process Improvement in the Implementation of e-Government Services: Plan-Do-Evaluate-Resolve (PDER)Manuscript (preprint) (Other academic)
  • 4.
    Bakunzibake, Pierre
    et al.
    Örebro University, Örebro University School of Business. College of Science and Technology, School of ICT, University of Rwanda, Kigali, Rwanda; Centre for Empirical Research on Information Systems, Örebro University School of Business, Örebro, Sweden.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business. Centre for Empirical Research on Information Systems.
    Islam, M. Sirajul
    Örebro University, Örebro University School of Business. Centre for Empirical Research on Information Systems.
    E-government implementation and monitoring: The case of Rwanda ‘one-stop’ E-government2019In: Electronic Journal of Information Systems in Developing Countries, ISSN 1681-4835, E-ISSN 1681-4835, Vol. 85, no 5, article id e12086Article in journal (Refereed)
    Abstract [en]

    Taking the case of the “one‐stop” e‐government initiative in Rwanda, the present study aims to find out how the “one‐stop” e‐government initiative is monitored at different government levels and stages and the extent to which the initiative is monitored. Furthermore, the study also aims to identify potential areas for improvement in the monitoring process. An exploratory qualitative study was undertaken in Rwandana gencies. The findings show that the monitoring of the process of implementing and improving one‐stop e‐government is partly formal at central government level and informal at local government level. Furthermore, the focus of the monitoring at the stage of use and maintenance leans more towards the benefits of end users as service consumers than those of the service providers. Incorporating formal methodological approaches at local government level and in all stages of the implementation and improvement process at central government level, as well as paying increased attention to back‐end process performance aspects, could introduce additional improvements into the monitoring practice and, in turn, increase project benefits.

  • 5.
    Bakunzibake, Pierre
    et al.
    University of Rwanda, School of ICT/ Engineering, Rwanda.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Islam, M. Sirajul
    Örebro University, Örebro University School of Business.
    E-Government Implementation Process in Rwanda: Exploring Changes in a Socio-technical Perspective2019In: Business Systems Research Journal, ISSN 1847-8344, E-ISSN 1847-9375, Vol. 10, no 1, p. 53-73Article in journal (Refereed)
    Abstract [en]

    Background: Failures in e-government projects to deliver expected results are frequent in the context of developing countries. These are partly attributed to the lack of balanced attention to both technical and social aspects in the implementation. However, there has been limited research on these aspects in the least Developed Countries.

    Objectives: Taking a socio-technical perspective, this study aims at exploring the extent of changes and effects in the implementation of e-government service-oriented initiatives in Rwanda, one of the Least Developed Countries.

    Methods/Approach: An empirical investigation was conducted, via interviews at 8 agencies during the period from January 2017 to May 2018. This involved two case projects, an Enterprise Content Management System and a One-Stop e-government system. Furthermore, government documents and online material were analyzed.

    Results: A number of changes in technology, processes and people aspects were faced in both projects. However, those changes are coupled with secondary effects; there is a need for a better fit between technical systems and social systems of organizations implementing e-government; a larger gap was identified in the first case project.

    Conclusions: Addressing the issues as a socio-technical system would contribute to improved work systems of agencies and better services.

  • 6.
    Chen, Rong
    et al.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm.
    Enberg, Gösta
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Klein, Gunnar O.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm; Department of Medicine, Karolinska Institutet, Stockholm.
    Julius: a template based supplementary electronic health record system2007In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 7, article id 10Article in journal (Refereed)
    Abstract [en]

    Background: EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems.

    Methods: We have designed and developed a template based system (called Julius) that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database.

    Results: The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems.

    Conclusion: The approach of the template system in combination with various local EHR systems can facilitate the sharing and reuse of validated clinical information from different health care units. However, future system developments for these purposes should consider using the openEHR/CEN models with shareable archetypes.

  • 7.
    Chen, Rong
    et al.
    Department of Biomedical Engineering, Linköping University, Linköping.
    Garde, Sebastian
    Ocean Informatics UK, London, United Kingdom.
    Beale, Thomas
    Ocean Informatics UK, London, United Kingdom.
    Nyström, Mikael
    Department of Biomedical Engineering, Linköping University, Linköping.
    Karlsson, Daniel
    Department of Biomedical Engineering, Linköping University, Linköping.
    Klein, Gunnar
    Karolinska Institute, Stockholm.
    Ahlfeldt, Hans
    Department of Biomedical Engineering, Linköping University, Linköping.
    An archetype-based testing framework2008In: eHealth Beyond the Horizon: Get IT There, Amsterdam, Netherlands: IOS Press, 2008, Vol. 136, p. 401-6Conference paper (Refereed)
    Abstract [en]

    With the introduction of EHR two-level modelling and archetype methodologies pioneered by openEHR and standardized by CEN/ISO, we are one step closer to semantic interoperability and future-proof adaptive healthcare information systems. Along with the opportunities, there are also challenges. Archetypes provide the full semantics of EHR data explicitly to surrounding systems in a platform-independent way, yet it is up to the receiving system to interpret the semantics and process the data accordingly. In this paper we propose a design of an archetype-based platform-independent testing framework for validating implementations of the openEHR archetype formalism as a means of improving quality and interoperability of EHRs.

  • 8.
    Chen, Rong
    et al.
    Department of Biomedical Engineering, Linköping University.
    Klein, Gunnar
    Department of Medicine, Karolinska Institutet, Stockholm.
    The openEHR Java reference implementation project2007In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 129, no Pt 1, p. 58-62Article in journal (Refereed)
    Abstract [en]

    The openEHR foundation has developed an innovative design for interoperable and future-proof Electronic Health Record (EHR) systems based on a dual model approach with a stable reference information model complemented by archetypes for specific clinical purposes.A team from Sweden has implemented all the stable specifications in the Java programming language and donated the source code to the openEHR foundation. It was adopted as the openEHR Java Reference Implementation in March 2005 and released under open source licenses. This encourages early EHR implementation projects around the world and a number of groups have already started to use this code. The early Java implementation experience has also led to the publication of the openEHR Java Implementation Technology Specification. A number of design changes to the specifications and important minor corrections have been directly initiated by the implementation project over the last two years. The Java Implementation has been important for the validation and improvement of the openEHR design specifications and provides building blocks for future EHR systems.

  • 9.
    Chen, Rong
    et al.
    Linköping University, Linköping, Sweden; Cambio Healthcare System, Linköping, Sweden.
    Klein, Gunnar O.
    Karolinska Institutet, Solna, Sweden.
    Sundvall, Erik
    Linköping University, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Linköping, Sweden.
    Åhlfeldt, Hans
    Linköping University, Linköping, Sweden.
    Archetype-based conversion of EHR content models: pilot experience with a regional EHR system2009In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, p. 33-, article id 33Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format.

    METHODS: The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates.

    RESULTS: Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats.

    CONCLUSION: The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.

  • 10.
    Coorevits, Pascal
    et al.
    Ghent University, Ghent, Belgium; The European Institute for Health Records (EuroRec), Sint-Martens-Latem, Belgium.
    Sundgren, M
    AstraZeneca R&D, Mölndal, Sweden.
    Klein, Gunnar O.
    University of Science and Technology, Trondheim, Norway.
    Bahr, A
    Sanofi R&D, Chilly-Mazarin, France.
    Claerhout, B
    Custodix NV, Sint-Martens-Latem, Belgium.
    Daniel, C
    Paris Descartes University INSERM, Paris, France.
    Dugas, M
    University of Münster, Münster, Germany.
    Dupont, D
    Data Mining International SA, Geneva, Switzerland.
    Schmidt, A
    Pharma Product Development, F Hoffmann-La Roche Ltd, Basel, Switzerland.
    Singleton, P
    Cambridge Health Informatics, Cambridge, UK.
    De Moor, G
    Ghent University, Ghent, Belgium; The European Institute for Health Records (EuroRec), Sint-Martens-Latem, Belgium.
    Kalra, D
    University College London, London, UK.
    Electronic health records: new opportunities for clinical research2013In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 274, no 6, p. 547-60Article in journal (Refereed)
    Abstract [en]

    Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources.

  • 11.
    Emmanouil, A.
    et al.
    Centre for Health Telematics, Karolinska Institute, Stockholm, Sweden.
    Klein, Gunnar O.
    Centre for Health Telematics, Karolinska Institute, Stockholm, Sweden.
    Anamnesis via the Internet: Prospects and pilot results2001In: MEDINFO 2001: Proceedings of the 10th World Congress on Medical Informatics, PTS 1 and 2 / [ed] V.L. Patel, R. Rogers, R. Haux, Amsterdam, Netherlands: IOS Press, 2001, Vol. 84, p. 805-809Chapter in book (Refereed)
    Abstract [en]

    A comprehensive computerized questionnaire was developed to obtain the anamnesis of patients seeking contact with a physician for any type of new problem. The purpose of this pilot study was to investigate ifa structured questionnaire filled out by the patient and complementing an interview at the physician’s office would contribute to a better quality of the total anamnesis and/or lead to savings in time at the visit. The results encourage further developments in this direction. The potential uses proposed are, in addition to being used to improve a visit, the correct assessment of the history for prioritization and scheduling of visits and in some situations, the anamnesis obtained over the net may be the basis for medical advice without a visit. This study emphasizes the great improvement of information captured by this type of questionnaire based on medical knowledge about associated symptoms and relevant questions depending on the problem presented compared to the results obtained by a simple open question used in many e-health services today.

  • 12.
    Forsum, Urban
    et al.
    Linköping universitet/landstinget i Östergötland, Linköping, Sweden.
    Klein, Gunnar O.
    Karolinska Institutet, Stockholm, Sweden; Råcksta Vällingby Närvård, Vällingby, Sweden.
    Morgell, Roland
    Jorbro vårdcentral, Stockholms läns landsting, Stockholm, Sweden.
    Anna-Karin Hatt hade visst rätt2010In: Svenska Dagbladet, ISSN 1101-2412Article in journal (Other (popular science, discussion, etc.))
  • 13. Fu, Qiang
    et al.
    Xue, Zhanggang
    Klein, Gunnar
    Örebro University, Örebro University School of Business.
    Using mobile information technology to build a database for anesthesia quality control and to provide clinical guidelines.2003In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 95, p. 629-634Article in journal (Refereed)
    Abstract [en]

    The paper describes a mobile information system to collect patient information for anaesthesia quality control. In this system we use handheld computers, to collect patient data at the bedside with a daily synchronization of the data of the anaesthesiologist's handheld with the anaesthesia database center, later used for quality control analysis. Further, we design mobile clinical guidelines to be used on the same handhelds.

  • 14.
    Fu, Qiang
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Xue, Zhanggang
    Zhongshan Hospital affiliated to Fudan University, Shanghai, China.
    Zhu, Jie
    Computer Informatics College of Fudan University, Shanghai, China.
    Fors, Uno
    Karolinska Institutet, Stockholm, Sweden.
    Klein, Gunnar
    Karolinska Institutet, Stockholm, Sweden.
    Anaesthesia record system on handheld computers: pilot experience and uses for quality control and clinical guidelines2005In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 77, no 2, p. 155-63Article in journal (Refereed)
    Abstract [en]

    This paper describes a mobile information system to collect patient information for anesthesia quality control. In this system, a mobile database program was designed for use on handheld computers (Pocket PC). This program is used to collect patient data at the bedside on the handhelds, with a daily synchronization of the data between the anaesthesiologists' handhelds with the anaesthesia database. All collected data are later used for quality control analysis. Furthermore, clinical guidelines will be included on these same handhelds. During the pilot phase, data from a sample set of about 300 patients were incorporated. The processes and interfaces of the system are presented in the paper. The current mobile database system has been designed to replace the original paper-based data collection system. The individual anaesthesiologist's handheld synchronizes patient data daily with anaesthesia database center. This information database is analyzed and used not only to give feedback to the individual doctor or center, but also to review the use of the guidelines provided and the results of their utilization.

  • 15. Hasman, A
    et al.
    Andersen, S K
    Klein, Gunnar O
    Örebro University, Örebro University School of Business.
    Schulz, S
    Aarts, J
    Mazzoleni, M C
    MIE 2008: eHealth beyond the horizon-get IT there.2009In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 48, no 2, p. 135-136Article in journal (Refereed)
  • 16.
    Kajbjer, Karin
    et al.
    Linköpings universitet, Linköping, Sweden.
    Nordberg, Ragnar
    JMP Research & Development AB, Mölndal, Sweden.
    Klein, Gunnar O
    Karolinska Institute, Stockholm, Sweden.
    Electronic Health Records in Sweden: From Administrative Management to Clinical Decision Support2011In: History Of Nordic Computing 3: Third IFIP WG 9.7 Conference, HiNC 3, Stockholm, Sweden, October 18-20, 2010, Revised Selected Papers / [ed] John Impagliazzo, Per Lundin, Benkt Wangler, Springer, 2011, Vol. 350, p. 74-82Conference paper (Refereed)
    Abstract [en]

    Computer support for health care started in Sweden in the mid-1960s, with a series of pilot tests using clinical records at the Karolinska Hospital. This had very little impact in health care due to its limited volume and scope. In addition, the first automation of chemistry laboratories that created many benefits in the form of increased efficiency from the early 1970s, rapid results delivery and the possibilities of quality control also occurred in the mid-1960s. The 1970s and first part of the 1980s saw the independent development of several patient administration systems, based on central mainframes in the counties, as well as a large number of dumb terminals in the hospitals and later also in the outpatient clinics. From the early 1990s, we saw an explosion of primary care electronic health records with twenty-seven different products in 1995.

  • 17.
    Karni, Liran
    et al.
    Örebro University, Örebro University School of Business.
    Memedi, Mevludin
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Targeting Patient Empowerment via ICT interventions: An ICT-specific Analytical Framework2019In: AMCIS 2019 Proceedings, Cancun, Mexico: Association for Information Systems, 2019Conference paper (Refereed)
    Abstract [en]

    Empowerment of patients is today often an explicit goal of various ICT interventions where the patients themselves use ICT tools, often via the internet. This study is proposing a framework model for ICT interventions aiming to empower patients. Our new model includes different aspects of the Empowerment concept, general possible strategies to achieve Empowerment using different ICT services. Finally, the ICT services and the underlying strategic model can be used to define evaluations of such interventions where the aim is to demonstrate Empowerment. Our model is based on a review of various general models of Empowerment and the Behavioral Intervention Technology Model (BIT). The implications of our model are discussed using two case studies projects, the C3-Cloud EU project about empowering patients with 4 chronic diseases and the EMPARK project about Internet-of-Things sensors based real time feedback to Parkinson patients.

  • 18.
    Karni, Liran
    et al.
    Örebro University, Örebro University School of Business.
    Memedi, Mevludin
    Örebro University, Örebro University School of Business.
    Kolkowska, Ella
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    EMPARK: Internet of Things for Empowerment and Improved Treatment of Patients with Parkinson's Disease2018Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    Objective: This study aims to assess the effects of patient-directed feedback from remote symptom, medication, and disease activity monitoring on patient empowerment and treatment in Parkinson’s disease (PD).

    Background: There is a need to empower patients with PD to be able to understand better and control their disease using prescribed medication and following recommendations on lifestyle. The research project EMPARK will develop an Internet of Things system of sensors, mobile devices to deliver real-time, 24/7 patient symptom information with the primary goal to support PD patients empowerment and better understanding of their disease. The system will be deployed in patient homes to continuously measure movements, time-in-bed and drug delivery from a micro-dose levodopa system. Subjective symptom scoring, time of meals and physical activities will be reported by the patients via a smartphone application. Interfaces for patients and clinicians are being developed based on the user center design methodology to ensure maximal user acceptance. 

    Methods: This is a randomized controlled trial where 30 PD patients from 2 university clinics in Sweden will be randomized to receive (intervention group) or not (control group) continuous feedback from the results of the EMPARK home monitoring for 2 weeks. Disease-specific (UPDRS, PDQ-39), Quality of Life (QoL) (modified EuroQoL EQ-5D) and empowerment questionnaires will be collected prior and after the intervention. The correlation of technology-based objective and patient-reported subjective parameters will be assessed in both groups. Interviews will be conducted with the clinicians and observations will be made about the patient-clinician interaction to assess the potential treatment benefits of the intervention.

    Results: Preliminary results from workshops with patients and clinicians show potential to improve patient empowerment and disease control among patients. Completion of the trial will show the degree of patient empowerment, individualized treatment, and patientclinician interactions.

    Conclusions: Raising patients’ awareness about disease activity and home medication is possible among PD patients by providing them with feedback from the results of a home monitoring system. This randomized, controlled trial aims to provide evidence that this approach leads to improved patient empowerment and treatment results.

  • 19.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    C3-Cloud “A Federated Collaborative Care Cure Cloud Architecture for Addressing the Needs of Multi-morbidity and Managing Poly-pharmacy”: D7.1 Evidence Based Clinical Guideline Definitions and Flowcharts for Individual Chronic Conditions2016Report (Other academic)
  • 20.
    Klein, Gunnar O
    Center for health telematics, Karolinska institute, Stockholm, Sweden.
    Enabling health online: The case for standards2001In: MEDINFO 2001: PROCEEDINGS OF THE 10TH WORLD CONGRESS ON MEDICAL INFORMATICS, PTS 1 AND 2, Amsterdam: IOS Press, 2001, Vol. 84, p. 123-123Conference paper (Refereed)
    Abstract [en]

    Healthcare policies in many countries, in the European Union and of the United Nations stress the importance of using information and communications technology to achieve the goals of improving health for all while controlling accelerating costs. This paper reviews the major areas where standards actions are required on a national, European and global level.

  • 21.
    Klein, Gunnar O.
    Karolinska institutet, Stockholm, Sweden; Karolinska universitetssjukhuset, Solna, Sweden.
    Fagterapi kan vara räddningen när antibiotika inte längre fungerar [Bacteriophage therapy can be the rescue when antibiotics no longer work]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 40, p. 2530-3Article in journal (Refereed)
    Abstract [sv]

    Resistens mot antibiotikablir snabbt ett allt större problemäven om vi hittills i Sverigevarit relativt förskonadejämfört med många andraländer.Det finns ett alternativ, alltförlänge nästan bortglömt,som är värt mycket störreuppmärksamhet och nyaprövningar.Det är att använda bakteriofager,virus som oftast mycketspecifikt och effektivt kanlysera många av våra besvärligastepatogena bakterier.Terapeutiska effekter har påvisatsi ett antal olika situationerända sedan metodenförst lanserades av fransmannenFélix d’Hérelle 1920,långt före sulfan och penicillinet.

  • 22.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Framtidens vårdinformationsstöd: Vad menar vi med beslutsstöd2016Report (Other academic)
  • 23.
    Klein, Gunnar O.
    Karolinska Institutet, Stockholm, Sweden.
    History of Electronic Prescriptions in Sweden: From Time-Sharing Systems via Smartcards to EDI2011In: History Of Nordic Computing 3: Third IFIP WG 9.7 Conference, HiNC 3, Stockholm, Sweden, October 18-20, 2010, Revised Selected Papers / [ed] John Impagliazzo, Per Lundin, Benkt Wangler, Springer, 2011, Vol. 350, p. 65-73Conference paper (Refereed)
    Abstract [en]

    Managing prescriptions for medication, using ICT support, started in the 1970s with the computerization of the pharmacy branch offices where local systems registered handwritten prescriptions and to print labels. In 1984, the first online prescribing started with physicians connected to their local pharmacy system in a pilot test. Then in 1987, the first pilot test started with an off-line system in which PC-based prescriber support systems transferred data to patient-held smart cards that were taken to the pharmacy. In the 1990s, we had the first use of messaging using EDIFACT syntax for prescriptions. These had a relatively small volume until 2000, when an XML version of a European standard based on object-oriented modeling became popular and made electronic prescribing the normal practice, which meant important quality gains.

  • 24.
    Klein, Gunnar O
    Örebro University, Örebro University School of Business.
    ISO and CEN standards for health informatics-synergy or competition.2003In: Advanced Health Telematics and Telemedicine: The Magdeburg Expert Summit Textbook / [ed] Blobel, Bernd; Pharow, Peter, Amsterdam: IOS Press, 2003, Vol. 96, p. 259-265Conference paper (Refereed)
    Abstract [en]

    The European standardisation of health informatics in CEN/TC 251 started in 1990 with the now twenty national standards bodies as members and a political mandate from the European Union and EFTA. The start of the international work in ISO/TC 215 has been welcomed by Europe and there is a lot of co-operation where European pre-standards have often been the basis for the start of international standards work, particularly in the area of medical device communication and for health cards. CEN and ISO also collaborate with other bodies in the field such as DICOM for imaging, IEEE for devices and the US based HL7 organisation for message development. It is important to find the right level of standards work for different aspects. The European CEN work will be maintained for issues like the electronic health record, some security aspects and medication related communication where there are common views and legislation makes European consensus necessary and achievable. The device market on the other hand requires global standards. In addition to multinational co-operation, it is important with a national strategy for the use of standards and adaptation and promotion of specific profiles to achieve interoperability in the still mainly national health systems.

  • 25.
    Klein, Gunnar O.
    Dept. of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Sweden.
    Metadata: an international standard for clinical knowledge resources2011Conference paper (Refereed)
    Abstract [en]

    This paper describes a new European and International standard, ISO 13119 Health informatics - Clinical knowledge resources - Metadata that is intended for both health professionals and patients/citizens. This standard aims to facilitate two issues: 1) How to find relevant documents that are appropriate for the reader and situation and 2) How to ensure that the found knowledge documents have a sufficient or at least declared quality management? Example of use is provided from the European Centre for Disease Control and Prevention.

  • 26.
    Klein, Gunnar O.
    GKAB, Stockholm, Sweden.
    Smart cards: a security tool for Health Information Systems1994In: International Journal of Bio-medical Computing, ISSN 0020-7101, Vol. 35, no Suppl., p. 147-151Article in journal (Refereed)
    Abstract [en]

    Expanding use of information technology in health case, both within and between the institutions, leads to additional security demands. The role is discussed that can be played by smart cards for healthcare professionals.

  • 27.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business. Informatics/eHealth Division.
    Standardization of Cryptographic Techniques - The Influence of the Security Agencies2015In: History of Nordic Computing 4 / [ed] Gram C.,Ostergaard S.D.,Rasmussen P., Springer, 2015, p. 321-327Conference paper (Refereed)
    Abstract [en]

    This paper is inspired by the global debate emerging after the release by Edward Snowden in 2013 of many documents describing the policy and practice of the US National Security Agency (NSA) and some of its collaborating partners in other countries, GCHQ in the UK and FRA in Sweden. This paper gives five examples from 1989-1995 on how security experts from Norway, Denmark and Sweden were put under pressure by actions from NATO and various security agencies during their work for the European standardization bodies, CEN and ETSI. Even after the cold war essentially ended by the fall of the Berlin Wall in 1989, the use of cryptographic techniques, today completely legal and an essential part of the information society, was highly sensitive at least through 1996. The security experts were put under strong pressure to favour weak encryption algorithms that would facilitate eavesdropping by the national security agencies.

  • 28.
    Klein, Gunnar O
    Centre for Health Telematics, Karolinska Institutet, Stockholm, Sweden.
    Standardization of health informatics - Results and challenges2002In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 41, no 4, p. 261-270Article in journal (Refereed)
    Abstract [en]

    Objectives: This review article aims to highlight the importance of standards for effective communication and provides an overview of international standardization activities. Methods: This article is based on the experience of the author of European standardization in CEN, which he leads, and the global work of ISO, where he is leading the security working group, and an overview of the work of DICOM, IEEE and HL7, partly using their web presentations. Results: Health communication is highly dependent of the general development of information technology with standards coming from ISQ/IEC ITC1, ITU and several other organizations e.g. IETE, the World Wide Web consortium and Open group. A number of standardization initiatives have been in progress for more than ten years with the aim to facilitate different aspects of the exchange of health information. Electronic record architecture, Message structures, Concept representation, Device communication including imaging and Security are the main areas. Conclusions. Important results have been achieved, and in some fields and parts of the worked, standards are widely used today. Unfortunately, we are still facing the fact that most healthcare information systems cannot exchange information with all systems for which this would be desired. Either the existing standards are not sufficiently implemented, or the required standards and necessary national implementation guidelines do not yet exist. This causes unacceptable risks to patients, inefficient use of healthcare resources, and sub optimal development of medical knowledge. Fortunately, the different bodies are now largely co-operating to achieve global consensus.

  • 29.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Vägen till strukturerad information i vården: Delrapport inom Vinnova projektet 3H3R2016Report (Other academic)
  • 30.
    Klein, Gunnar O.
    et al.
    NSEP, Norges teknisk-naturvitenskapelige universitet (NTNU),Trondheim, Norway; Karolinska Institutet, Stockholm, Sweden; Råcksta-Vällingby Närvård, Stockholm, Sweden.
    Andersson, Kjell
    Råcksta-Vällingby Närvård, Stockholm, Sweden.
    Patient empowerment in the process of sickness certificates2012In: Quality of Life through Quality of Information / [ed] John Mantas et al, Amsterdam, Netherlands: IOS Press, 2012, Vol. 180, p. 1174-6Chapter in book (Refereed)
    Abstract [en]

    A national patient portal for secure communication between the patients/citizens and primary care (Mina vårdkontakter) is available in Sweden. This system was used in a pilot project in the Stockholm County where patients were invited to prepare the visit to their physician for the discussion on the need for prolonged sickness leave by filling out a web based questionnaire on their current health status and working conditions. The opinions of the patients and their primary care physicians about the system were analyzed with positive feedback.

  • 31.
    Klein, Gunnar O.
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Chen, Rong
    Translation of SNOMED CT: strategies and description of a pilot project2009In: Connecting Health and Humans: Proceedings of NI2009 – The 10th International Congress on Nursing Informatics / [ed] Kaija Saranto, Patricia Flatley Brennan, Hyeoun-Ae Park, Marianne Tallberg, Anneli Ensio, IOS Press, 2009, Vol. 146, p. 673-7Chapter in book (Refereed)
    Abstract [en]

    The translation and localization of SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) have been initiated in a few countries. In Sweden, we conducted the first evaluation of this terminology in a project called REFTERM in which we also developed a software tool which could handle a large scale translation with a number of translators and reviewers in a web-based environment. The system makes use of existing authorized English-Swedish translations of medical terminologies such as ICD-10. The paper discusses possible strategies for a national project to translate and adapt this terminology.

  • 32.
    Klein, Gunnar O.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Kajbjer, Karin
    eHealth tools for patients and professionals in a multicultural world2009In: Medical Informatics in a United and Healthy Europe: Proceedings of MIE 2009 – The XXIInd International Congress of the European Federation for Medical Informatics / [ed] Klaus-Peter Adlassnig, Bernd Blobel, John Mantas, Izet Masic, IOS Press, 2009, Vol. 150, p. 297-301Chapter in book (Refereed)
    Abstract [en]

    In many countries today, an important challenge for health care is the fact that the population is mixed as regards cultural background and not the least with regard to preferred language. In our country Sweden almost 20% of the population has some connection to another country and many patients seeking health care do not have sufficient mastering of the dominant Swedish language to get optimal care. We propose in this study a set of eHealth services that could be implemented within a country and in multinational co-operation to deal with some of these issues in an effective way which both empowers the citizens, improves patient safety and at the same time may offer cost savings for the publicly financed health care systems in the countries of the European Union. The basic idea is to use a set of people-people communication strategies using ICT tools combined with semantic tools for information sharing and conversion. This requires new and challenging organizational contexts.

  • 33.
    Klein, Gunnar O.
    et al.
    Råcksta-Vällingby Närvård, Vällingby, Sweden.
    Rosén, Jan
    Svenska företagsläkarföreningen, Stockholm, Sweden.
    Sjukt intyg från Försäkringskassan2010In: Dagens medisin, ISSN 1501-4290, E-ISSN 1501-4304Article in journal (Other (popular science, discussion, etc.))
  • 34.
    Klein, Gunnar O.
    et al.
    Örebro University, Örebro University School of Business.
    Singh, Karandeep
    Department of Medicine, Harvard Medical School, Boston, USA.
    von Heideken, Johan
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, USA.
    Smart Glasses: A New Tool in Medicine2015In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 216, p. 901-901Article in journal (Refereed)
    Abstract [en]

    Smart glasses, defined as a computerized communicator with a transparent screen and a video camera, wearable as a pair of glasses, have started to be tested for a variety of health related applications. This poster reviews some of the early experiences and gives a series of proposals for possible uses in medicine with a particular emphasis on medical education.

  • 35.
    Klein, Gunnar O.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Smith, Barry
    University at Buffalo part of State University of New York, NewYork, USA.
    Concept Systems and Ontologies: Recommendations for Basic Terminology2010In: Jinkou Chinou Gakkai rombunshi (Online), ISSN 1346-0714, E-ISSN 1346-8030, Vol. 25, no 3, p. 433-441Article in journal (Refereed)
    Abstract [en]

    This essay concerns the problems surrounding the use of the term "concept" in current ontology and terminology research. It is based on the constructive dialogue between realist ontology on the one hand and the world of formal standardization of health informatics on the other, but its conclusions are not restricted to the domain of medicine. The term "concept" is one of the most misused even in literature and technical standards which attempt to bring clarity. In this paper we propose to use the term "concept" in the context of producing defined professional terminologies with one specific and consistent meaning which we propose for adoption as the agreed meaning of the term in future terminological research, and specifically in the development of formal terminologies to be used in computer systems. We also discuss and propose new definitions of a set of cognate terms. We describe the relations governing the realm of concepts, and compare these to the richer and more complex set of relations obtaining between entities in the real world. On this basis we also summarize an associated terminology for ontologies as representations of the real world and a partial mapping between the world of concepts and the world of reality.

  • 36.
    Klein, Gunnar O.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Sottile, Pier Angelo
    Endsleff, Frederik
    Another HISA - the new standard: health informatics - service architecture2007In: MEDINFO 2007: Proceedings of the 12th World Congress on Health (Medical) Informatics – Building Sustainable Health Systems / [ed] Klaus A. Kuhn, James R. Warren, Tze-Yun Leong, IOS Press, 2007, Vol. 129, no Pt 1, p. 478-82Chapter in book (Refereed)
    Abstract [en]

    In addition to the meaning as Health Informatics Society of Australia, HISA is the acronym used for the new European Standard: Health Informatics - Service Architecture.

    This EN 12967 standard has been developed by CEN - the federation of 29 national standards bodies in Europe. This standard defines the essential elements of a Service Oriented Architecture and a methodology for localization particularly useful for large healthcare organizations.

    It is based on the Open Distributed Processing (ODP) framework from ISO 10746 and contains the following parts:

    Part 1: Enterprise viewpoint.

    Part 2: Information viewpoint.

    Part 3: Computational viewpoint.

    This standard is now also the starting point for the consideration for an International standard in ISO/TC 215. The basic principles with a set of health specific middleware services as a common platform for various applications for regional health information systems, or large integrated hospital information systems, are well established following a previous prestandard. Examples of large scale deployments in Sweden, Denmark and Italy are described.

  • 37.
    Lagsten, Jenny
    et al.
    Örebro University, Örebro University School of Business.
    Scandurra, Isabella
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Analys av enkäten ”Användarsynpunkter” i Landstinget Sörmland, Rapport till Landstinget Sörmland2017Report (Other academic)
  • 38.
    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. 

  • 39.
    Lilja, Mikael
    Region Jämtland Härjedalen, Östersund, Sweden.
    C3-Cloud “A Federated Collaborative Care Cure Cloud Architecture for Addressing the Needs of Multi-morbidity and Managing Poly-pharmacy”: D8.1 Use Cases and Requirements Specifications of the Pilot Application2016Report (Other academic)
  • 40.
    Memedi, Mevludin
    et al.
    Örebro University, Örebro University School of Business.
    Tshering, Gaki
    Informatics, Business School, Örebro University, Örebro, Sweden.
    Fogelberg, Martin
    Informatics, Business School, Örebro University, Örebro, Sweden.
    Jusufi, Ilir
    Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden.
    Kolkowska, Ella
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    An interface for IoT: feeding back health-related data to Parkinson's disease patients2018In: Journal of Sensor and Actuator Networks, E-ISSN 2224-2708, Vol. 7, no 1, article id 14Article in journal (Refereed)
    Abstract [en]

    This paper presents a user-centered design (UCD) process of an interface for Parkinson’s disease (PD) patients for helping them to better manage their symptoms. The interface is designed to visualize symptom and medication information, collected by an Internet of Things (IoT)-based system, which will consist of a smartphone, electronic dosing device, wrist sensor and a bed sensor. In our work, the focus is on measuring data related to some of the main health-related quality of life aspects such as motor function, sleep, medication compliance, meal intake timing in relation to medication intake, and physical exercise. A mock-up demonstrator for the interface was developed using UCD methodology in collaboration with PD patients. The research work was performed as an iterative design and evaluation process based on interviews and observations with 11 PD patients. Additional usability evaluations were conducted with three information visualization experts. Contributions include a list of requirements for the interface, results evaluating the performance of the patients when using the demonstrator during task-based evaluation sessions as well as opinions of the experts. The list of requirements included ability of the patients to track an ideal day, so they could repeat certain activities in the future as well as determine how the scores are related to each other. The patients found the visualizations as clear and easy to understand and could successfully perform the tasks. The evaluation with experts showed that the visualizations are in line with the current standards and guidelines for the intended group of users. In conclusion, the results from this work indicate that the proposed system can be considered as a tool for assisting patients in better management of the disease by giving them insights on their own aggregated symptom and medication information. However, the actual effects of providing such feedback to patients on their health-related quality of life should be investigated in a clinical trial.

  • 41.
    Nhavoto, José António
    et al.
    Örebro University, Örebro University School of Business. Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique.
    Grönlund, Åke
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0176051Article in journal (Refereed)
    Abstract [en]

    Background: Studies have been conducted in developing countries using SMS to communicate with patients to reduce the number of missed appointments and improve retention in treatment, however; very few have been scaled up. One possible reason for this could be that patients or staff are dissatisfied with the method in some way. This paper reports a study of patients' and healthcare workers' (HCW) views on an mHealth intervention aiming to support retention in antiretroviral therapy (ART) and tuberculosis (TB) treatment in Mozambique.

    Methods: The study was conducted at five healthcare centres in Mozambique. Automated SMS health promotions and reminders were sent to patients in a RCT. A total of 141 patients and 40 HCWs were interviewed. Respondents rated usefulness, perceived benefits, ease of use, satisfaction, and risks of the SMS system using a Likert scale questionnaire. A semi-structured interview guide was followed. Interviews were transcribed and thematic analysis was conducted.

    Results: Both patients and HCW found the SMS system useful and reliable. Most highly rated positive effects were reducing the number of failures to collect medication and avoiding missing appointments. Patients' confidence in the system was high. Most perceived the system to improve communication between health-care provider and patient and assist in education and motivation. The automatic recognition of questions from patients and the provision of appropriate answers (a unique feature of this system) was especially appreciated. A majority would recommend the system to other patients or healthcare centres. Risks also were mentioned, mostly by HCW, of unintentional disclosure of health status in cases where patients use shared phones.

    Conclusions: The results suggest that SMS technology for HIV and TB should be used to transmit reminders for appointments, medications, motivational texts, and health education to increase retention in care. Measures must be taken to reduce risks of privacy intrusion, but these are not a main obstacle for scaling up systems of this kind.

  • 42.
    Nhavoto, José António
    et al.
    Örebro University, Örebro University School of Business. Informatics, Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique.
    Grönlund, Åke
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Use of Mobile Technologies to Improve Healthcare in Mozambique: Key Failure/Success Factors, Challenges, and Policy ImplicationsManuscript (preprint) (Other academic)
  • 43.
    Nilsson, Mats T
    et al.
    Karolinska Institutet, Department of Tumor Biology, Stockholm, Sweden.
    Klein, Gunnar O
    Karolinska Institutet, Department of Tumor Biology, Stockholm, Sweden.
    SEQ-ED - AN INTERACTIVE COMPUTER-PROGRAM FOR EDITING, ANALYSIS AND STORAGE OF LONG DNA-SEQUENCES1985In: COMPUTER APPLICATIONS IN THE BIOSCIENCES, ISSN 0266-7061, Vol. 1, no 1, p. 29-34Article in journal (Refereed)
    Abstract [en]

    The rapidly growing body of sequenced DNA demands efficient computer programs for its analysis and storage. The program described in this paper, SEQ-ED, has been designed to handle a large number of DNA sequences up to 200 kilobases [kb] long stored in a sequence library. In order to minimize the required storage space, the sequences are stored in a compressed format using three binary digits per base. In the development of this program, special care has been given to make it easy to use for molecular biologists without any previous computer experience.

  • 44. Thurin, Anders
    et al.
    Wennberg, Mats
    Antonov, Karolina
    Klein, Gunnar O
    Örebro University, Örebro University School of Business. Karolinska institute, Stockholm, Sweden.
    Shallow linguistic analysis of a large corpus of drug prescriptions.2002In: Health data in the information society: proceedings of MIE2002 / [ed] Surján, György; Engelbrecht, Rolf ; McNair, Peter, Amsterdam: IOS Press, 2002, Vol. 90, p. 411-415Conference paper (Refereed)
    Abstract [en]

    We report on first experiences from linguistic analyses of patient instructions from 19,8404 actual drug prescriptions regarding seven pharmaceutical products frequently prescribed in Sweden. The analysis includes expressions for amount, dose unit, dose interval, mode of administration, purpose and a few further details. Even simple processing seems useful to extract information from these short, rather formal text strings. We estimate the potential for calculation of prescribed dose from this material, and collected material gives a good starting point for more advanced linguistic analyses.

  • 45.
    Traore, Lamine
    et al.
    Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
    Assélé Kama, Ariane
    Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
    Lim Choi Keung, Sarah
    Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.
    Karni, Liran
    Örebro University, Örebro University School of Business.
    Klein, Gunnar O.
    Örebro University, Örebro University School of Business.
    Lilja, Mikael
    Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development Östersund Hospital, Umeå University, Umeå, Sweden.
    Scandurra, Isabella
    Örebro University, Örebro University School of Business.
    Verdoy, Dolores
    Asociacion Centro De Excelencia Internacional En Investigacion Sobre Cronicidad – Kronikgune, Spain.
    Yuksel, Mustafa
    SRDC Software Research Development & Consultancy Corp, Ankara, Turkey.
    Arvanitis, Theodoros N.
    Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.
    Tsopra, Rosy
    Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France; AP-HP, Assistance Publique des Hôpitaux de Paris, Paris, France.
    Jaulent, Marie-Christine
    Inserm, Sorbonne Université, Univ Paris 13, Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
    User-Centered Design of the C3-Cloud Platform for Elderly with Multiple Diseases: Functional Requirements and Application Testing2019In: MEDINFO 2019: Health and Wellbeing e-Networks for All / [ed] Lucila Ohno-Machado, Brigitte Séroussi, IOS Press, 2019, p. 843-847Conference paper (Refereed)
    Abstract [en]

    The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered “Collaborative Care and Cure-system” in the management of elderly with multimorbidity, enabling continous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal care givers (ICG). In this paper, we report how various components of the infrastructure were tested to fulfill the functional requirements and how the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform, to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate an overall high level of satisfaction for all Information and Communication Technologie (ICT) components among the users. The early testing also provided user feedback important to consider for technical improvement of the entire system. 

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