To Örebro University

Developing and Implementing National eHealth Services for Patients – An Interactive Exploration of Challenges and Potential Solutions Isabella Scandurra, Informatics, School of Business, Örebro University, Sweden; Maria Hägglund, Health Informatics Centre, Karolinska Institutet, Sweden As a means to address current challenges for and demands on health and social care, e.g. quality of care and patient empowerment, information and communication technologies (ICT) are being used to supply citizens with various health services. One example is to give patients web access to their own electronic health records (EHRs). In this workshop, we will provide examples and experiences from ongoing work in Sweden to develop and implement eHealth services for citizens; SUSTAINS [1] and My Care Pathways [2].The workshop participants will be engaged in interactive discussions regarding challenges and potential solutions based on their experiences from different contexts. The aim of the workshop is twofold: 1. To explore challenges for developing and implementing e-health systems for citizens to access their patient information and other e-health services online. 2. To suggest strategies and activities that could provide potential solutions to the identified challenge. Workshop structure The disposition of the workshop is as follows: a 90 minute session, a 15 minutes break and another 75 minute session. The two sessions will contain both presentations from the workshop organizers and interactive discussions and work in smaller groups to engage all participants and share experiences from different contexts. This disposition requires active participants to generate new ideas and knowledge through discussions and reflections where all participants contribute with their knowledge and understanding of the problem. The topic is expected to engage a lot of people, maybe not only those present at the workshop or at the conference. The workshop organizers will encourage live tweeting during the sessions and invite followers. 

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.

The central role of eHealth to enable the successful implementation of integrated care is commonly acknowledged today. This is easier said than done. To provide correct, understandable, and timely information at the point of need and to facilitate communication and decision support for a network of actors with different prerequisites and needs are some of the big challenges of integrated care. This book chapter focuses on the specific challenges related to informatics and socio-technical issues when designing solutions for integrated eCare. Methods for requirements elicitation, evaluation, and system development using user-centred design in collaborative environments involving a variety of stakeholders are presented. Case studies in homecare of older patients, in the care of stroke patients, and regarding citizen eHealth services in general illustrate the application of these methods. Possible solutions and pitfalls are discussed based on the experiences drawn from the case studies. To address the main infor-matics and socio-technical challenges in integrated eCare, namely informatics-supported collaborative work and to provide coordinated continuity for the patient, top-down activities such as health informatics standardization, and bottom-up activities resulting in the definition of concrete patient journey descrip-tions, interaction points, information needs (that can be transformed into standardized data sets), as well as visualization and interaction patterns need to go hand in hand.

It is crucial to involve the patient in the development of patient accessible eHealth systems. But who, how and when? Patientinvolvement in development of e-health services for citizens has gained little attention to date. It is important to highlight theexperiences, pros and cons, and explore new issues and future challenges that arise for all different stakeholders involved in e-healthdevelopment. One source of inspiration for this workshop is the European funded SUSTAINS project which aims to deploy e-healthservices with the patient as an important actor. Another is the Swedish research project My Care Pathways where focus is ondevelopment of new e-health services that enable the patient to follow and interact with their care processes. This workshop aims todiscuss the experiences made in ongoing European deployment projects of online e-health services as well as methods to improvepatient participation in such development based on current evaluations and future needs. The objective is to collect and disseminatevarious experiences from novel e-health service deployment in Europe; during the workshop active participation is desired via twitterand other eLearning tools, and afterwards the results of the workshop are published on easily accessible web sites.

The development of information and communication technology (ICT) for citizen-centered care requires insight into concrete problems in care processes as well as an understanding of the goals and values that should guide these. In this retrospective study we return to results from two research projects focusing on the needs of senior citizens and stroke patients. We describe the intersections between health care services, social care services and private services, and analyze these with focus on the needs of independence, continuity and participation. The current state of ICT in relation to the identified needs is also addressed. In conclusion, an increasing number of solutions are available to support senior citizens in different parts of their lives, yet they remain isolated and have limited impact. In order to harness value for senior citizens, it is imperative to continue with multidisciplinary research focusing on socio-technical aspects; addressing technological, organizational, legal and business-related aspects.