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The European health care is facing challenges with an increasing ageing population with a higher frequency of chronic diseases which have resulted in rising health care costs Meanwhile the trend shows how patients and citizens are becoming more active in their personal health care with the number of existing doctors and nurses subsiding furthermore entailing problems The area of eHealth which involves information and communication technologies with health care is hence seen as a partial long-term solution and is considered being a rapidly growing market both in Sweden but also in Europe eHealth services further consider to promote increased access mobility and interoperability in the health care but the lack of wholehearted commitment financial support and complex EHR-systems in Sweden s municipalities and county councils might partially impeding down the development The purpose of this report is therefore targeting to explore identify and analyze prominent aspects for the continued development of the Swedish health care and eHealth services The study also examines what subsequent benefits an implementation of an eHealth service entails which also has been related to the identified prominent aspects This master thesis is based on a thorough literature review extracted from a theoretical framework including an interoperability- security- mobility- and business-modeling perspective which are used as a foundation for the building of a set of hypotheses which are subsequently verified with the aid of gathered empirics The empirics are obtained from 10 semi-structured qualitative interviews as well as two case studies which together resulted in key-findings and conclusions Firstly in relation to the interoperability perspective it became clear how there should exist both a technical and social interoperability that communicate with each other The EHR-systems of today are often considered difficult to learn non-intuitive and lacking interfaces that are user-friendly designed for the end-user Increased interoperability was also seen as enabling and simplifying the access to the patient s medical history which the EHR-system TakeCare evidently demonstrated Furthermore it was acknowledged how there is no correlation between the increased time spent by health care professionals with administrative tasks and documentation with an increased interoperability It also emerged that patients and the dominant part of the population had either no or very limited knowledge regarding the underlying security and overall management of personal health information in health care Patients instead often blindly trust the Swedish health care system being secure and prioritizing other things during medical appointments The knowledge of security issues in the health care is predicted to increase among patients if they in the future would obtain full access to their own medical records There is also a general opinion among health care professionals and related instances how new security risks will arise alongside the eHealth wave with a particular concern for the increasing involvement of mobile devices Relationships between an increased interoperability also seem to favor increased mobility in health care but security aspects often prevent the mobility development Finally it was unanimously espoused how non-financial values must not be ignored where the on-going debate argues whether what real impact these non-financial values have where inter alia strict budgets and large gaps between the decision-makers and end-users appeared as issues Similar arguments were encountered regarding the actual impact of the opinions of patients in relation to business modeling where a tripartite-problem and the patients limited access to their medical records was partly seen as a primary issue Secondly the case studies demonstrated how a transition to the EHR-system TakeCare generally did result in cost- and resource savings in terms of local servers IT-maintenance and inventory management The TakeCare implementation also led to an increased visibility among health care centers by enabling and simplifying the access to patient medical history Increased communication awareness and more effective internal processes due to integrated modules and direct connections to ePrescriptions could also be accessed from the TakeCare transition Finally it emerged that relations existed between simplified access to the patient s medical history and how it subsequently resulted in an increased interoperability A correlation was also seen as the health care become generally more mobile due to increased interoperability Ha lso- och sjukva rden i Europa sta r info r utmaningar i och med en stigande a ldersgrupp med en sto rre andel kroniska sjukdomar vilket resulterat i stegrande sjukva rdskostnader Samtidigt ses en trend i hur patienter och medborgare bo rjar bli mer aktiva i sin egen va rd och efterfra gan pa sjukva rdspersonal o kar med o kande utmaningar som fo ljd eHa lsa-omra det vilket involverar informations- och kommunikationsteknik inom sjukva rden ses da rfo r som en potentiell la ngsiktig del-lo sning och anses samtidigt vara ett starkt va xande omra de i Sverige men ocksa pa den o vriga europeiska marknaden eHa lsa betraktas vidare fra mja en o kad a tkomst mobilitet och interoperabilitet inom sjukva rden men bristen pa helhja rtat engagemang finansiellt sto d och det stora antal komplexa journalsystem i Sveriges olika kommuner och landsting ses delvis ligga till grund fo r en bromsad utveckling Syftet med denna rapport a r da rfo r att underso ka kartla gga och analysera de mest centrala aspekterna fo r den fortsatta utvecklingen av svensk sjukva rd och eHa lso-tja nster Studien underso ker a ven vad implement av en eHa lso-tja nst praktiskt har medfo rt med ett fokus pa journalsystem da r de enskilda fo ra ndringarna a ven har relaterats till de identifierade centrala aspekterna Examensarbetet a r baserat pa en gedigen litteraturstudie som utifra n ett teoretiskt ramverk inkluderande ett interoperabilitets- sa kerhets- mobilitets- och affa rsmoduleringsperspektiv ligger till grund fo r framtagandet av hypoteser som sedan verifierats med hja lp av empiriskt insamlad information Empirin a r erha llen fra n tio semi-strukturerande kvalitativa intervjuer samt tva fallstudier vilka tillsammans har resulterat i ett flertal slutsatser Utifra n ett interoperabilitetsperspektiv framgick det hur det bo r finnas ba de en teknisk och social interoperabilitet som kommunicerar med varandra da journalsystem idag anses vara sva ra att la ra sig icke intuitiva och ej anva ndarva nligt utformade fo r slutanva ndaren O kad interoperabilitet ses a ven mo jliggo ra och fo renkla a tkomsten av patienthistorik vilket journalsystemet TakeCare tydligt pa visat Vidare kunde det konstateras att det inte finns en korrelation mellan den progressivt o kande avsatta tiden som sjukva rdspersonal idag tillbringar med administrativa uppgifter och dokumentation med en fo rho jd interoperabilitet Det framkom a ven att patienter har va ldigt liten eller obefintlig kunskap ro rande den underliggande sa kerheten och hanteringen av personlig information i sjukva rden da de ofta blint litar pa att svensk sjukva rd anses vara sa ker samt att patienter prioriterar annat vid la karbeso k Kunskaper om sa kerheten i sjukva rden bland patienterna anses dock o ka ifall de i framtiden fa r tillga ng till sin journal Det finns a ven en allma n oro bland sjukva rdspersonal och na rbesla ktade instanser fo r att nya sa kerhetsrisker kommer att uppsta i och med eHa lsa-va gen med ett sa rskilt orosmoln fo r den o kande anva ndningen av mobila enheter Relationer mellan hur o kad interoperabilitet a ven gynnar fo rho jd mobilitet sa gs a ven fo rekomma men att det ofta samtidigt a r sa kerhetsaspekter som hindrar den mobila utvecklingen Avslutningsvis fo respra kades det hur icke-finansiella va rden inte fa r bli ignorerade men problemet kring hur verkningsfull dess faktiska pa verkan a r relateras bland annat till strikta budgetar samt stora avsta nd mellan beslutstagare och slutanva ndare Liknande argument pa tra ffades anga ende den faktiska inverkan av a sikter fra n patienter vid affa rsmodulering da r ett trepartsproblem och patienternas begra nsade a tkomst till sina journaler delvis sa gs ligga till grund Fallstudierna pa visade hur o verga ngen till journalsystemet TakeCare generellt har lett till resursbesparingar i form av lokala servrars underha ll och lageranva ndning samt en o kad synlighet i va rden med fo rba ttrad tillga ng till patienthistorik ja mfo rt med tidigare journalsystem En o kad kommunikation och medvetenhet samt effektivare interna processer pa grund av integrerade moduler och direktkoppling till eRecept kunde a ven pa visas Slutligen framgick det att relationer fo rekom mellan den o kande a tkomsten av patienthistorik och andra journaler och hur fo rho jd interoperabilitet medfo rt detta Samband kunde a ven ses hur o kad interoperabilitet positivt gynnar mobiliteten i sjukva rden

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eHealth development in Sweden : A study of prominent aspects and benefits from a multi-user perspective / eHälsa-utveck...

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