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Background: In Norway, as in other countries, national eHealth systems, such as the Summary Care Record (SCR), have been implemented to improve the collaboration around patients by sharing patient information between health professionals across healthcare institutions and administrative levels. Although widely implemented across the health and care services in Norway, evaluations of the SCR indicate less use than expected. There is a need for analysis that lays out the visions and expectations of the SCR and contrasts these with detailed observations of use in everyday health professional work. This study adds to the eHealth research field by exploring this reality. Method: This paper has a qualitative design with an ethnographic approach, including participant observation, qualitative interviews, and a document review. Qualitative individual interviews with 22 health professionals and six weeks of participant observation were conducted, and eight documents were reviewed. The field notes and the interview-transcriptions were analyzed following a stepwise-deductive induction analysis. Results: The document review identified the expectations and visions of the SCR, including an underlying assumption of trust in shared patient information. However, this assumption is implicit and not recognized as a crucial element for success in the documents. In our observation and interview data, we found that health professionals do not necessarily trust information in the SCR. In fact, several procedures and routines to assess the trustworthiness of SCR information were identified that complicate and disturb the expected use. In our analysis, two main themes characterize the health professionals' handling of the SCR: adapting to workflow and dealing with uncertainty. Conclusion: Our study illustrates that unconditional trust in shared patient information is an implicit assumption in SCR policy documents, but in their everyday work health professionals do not necessarily unconditionally trust shared patient information. Rather, sharing patient information through technology, such as the SCR, requires of health professionals to critically assess the digital information. The information in the SCR, as all sources of information presented to health professionals, becomes an item for their constant trust-work. Our study is of value to policymakers, health information systems developers, and the field of practice both nationally and internationally. [ABSTRACT FROM AUTHOR]

Ontology is essential for achieving health information and information technology application interoperability in the biomedical fields and beyond. Traditionally, ontology construction is carried out manually by human domain experts (HDE). Here, we explore an active learning approach to automatically identify candidate terms from publications, with manual verification later as a part of a deep learning model training and learning process. We introduce the overall architecture of the active learning pipeline and present some preliminary results. This work is a critical and complementary component in addition to manually building the ontology, especially during the long-term maintenance stage. [ABSTRACT FROM AUTHOR]

Background: The road to a more sustainable healthcare system includes creating a digital interface to the healthcare system that patients can use to engage in their health problems while outside the consultation room. The aim of the study was to evaluate trends in the use of functions in a patient portal and assess which functions were most likely to contribute to sustainable healthcare. Study design: Open, uncontrolled retrospective analysis of citizens’ use of the patient portal. Methods: Extraction and statistical analysis of log data. Results: Log analysis revealed that patients engaged with the patient portal to make appointments, fill out and submit questionnaires, send messages to their care provider, inspect their laboratory results, and view notes about themselves. The functions that displayed a significantly increasing trend were the number of appointments made, the number of messages sent, and the number of checked test results. Discussion: While portal engagement can reduce patient dependency on healthcare services, external factors also influence this outcome. Further research is needed to investigate which functions support healthcare sustainability and enhance patient empowerment, possibly through other study designs. [ABSTRACT FROM AUTHOR]

The Nordic Countries are seen as forerunners in the field of digital health technologies and national implementation has been guided by sector specific strategies for many years. In the context of new European legislation such as the European Health Data Space (EHDS), a review of the existing strategies is indicated. The objective of this policy analysis is to assess and compare the scope, ambitions and extent of accountability in national-level digital health policies in the Nordic countries. The scope of the policies from the five countries were largely centred around a) empowering and activating citizens; b) a shift towards prevention and digital first; c) supporting health operations; d) doing the groundwork; e) making health data more available in research and innovation workflows and f) supporting health personnel. Finland comes out as the most ambitious country with the aim to transform their health system by means of digitalisation. Both Finland and Iceland work towards prevention and the digital first ambition due to large populations in rural areas. These two countries also present the most accountable policies, meaning that their policy documents are the most transparent as to how they arrived at the conclusions and how they are to evaluate the achievements. [ABSTRACT FROM AUTHOR]

The quality of the digital healthcare systems relies on citizens' willingness to share their digital health data. This makes citizens’ use, perceptions, and attitudes towards digital healthcare systems pivotal. The study presented here examines Nordic citizens’ willingness to share digital health data with healthcare providers and for research purposes. A cross-sectional study design was applied to obtain answers from citizens in Denmark, Finland, Iceland, Norway, and Sweden. The results are based on answers from 5078 citizens across the five countries. Results based on descriptive statistics indicate that the majority of Nordic citizens are willing to share health data that has clinical relevance with healthcare providers and for research purposes. The odds ratio analysis reveals that citizens’ odds of sharing health data decreases with age and increases with the level of education. Conclusively, this study shows that most Nordic citizens are willing to share their health data, influenced by age and level of education. Awareness of and efforts to support citizens who are unable or unwilling to actively use and engage with the digital healthcare system is recommended. [ABSTRACT FROM AUTHOR]

Interdisciplinary team communication in eHealth development is challenging because all disciplines have unique, intrinsic discursive practices, theories and artefacts. Due to these factors, members of interdisciplinary teams can experience problems in communication and collaboration. Through a centered focus, members can benefit individually, inspire one another, and ultimately reach a timely delivery of their common pedagogical goal(s). Using the lens of dialogism, this paper aims to identify the conceptual considerations that arose during the development of a Massive Open Online Course (MOOC) for higher education in eHealth. Methods included auto-ethnography and interdisciplinary dialogue supported by literacy artefacts, including visual material. Results yielded a visual tool for meta-assessment of team communication, and an organizing principle for topics in the MOOC. A major implication is that especially for eHealth, scientific communicative competence of experts—while establishing a common understanding—can lead to a unique and meaningful delivery of high pedagogical quality. [ABSTRACT FROM AUTHOR]

Background MetaMap is a valuable tool for processing biomedical texts to identify concepts. Although MetaMap is highly configurative, configuration decisions are not straightforward. Objective To develop a systematic, data-driven methodology for configuring MetaMap for optimal performance. Methods MetaMap, the word2vec model, and the phrase model were used to build a pipeline. For unsupervised training, the phrase and word2vec models used abstracts related to clinical decision support as input. During testing, MetaMap was configured with the default option, one behavior option, and two behavior options. For each configuration, cosine and soft cosine similarity scores between identified entities and gold-standard terms were computed for 40 annotated abstracts (422 sentences). The similarity scores were used to calculate and compare the overall percentages of exact matches, similar matches, and missing gold-standard terms among the abstracts for each configuration. The results were manually spot-checked. The precision, recall, and F-measure (β =1) were calculated. Results The percentages of exact matches and missing gold-standard terms were 0.6–0.79 and 0.09–0.3 for one behavior option, and 0.56–0.8 and 0.09–0.3 for two behavior options, respectively. The percentages of exact matches and missing terms for soft cosine similarity scores exceeded those for cosine similarity scores. The average precision, recall, and F-measure were 0.59, 0.82, and 0.68 for exact matches, and 1.00, 0.53, and 0.69 for missing terms, respectively. Conclusion We demonstrated a systematic approach that provides objective and accurate evidence guiding MetaMap configurations for optimizing performance. Combining objective evidence and the current practice of using principles, experience, and intuitions outperforms a single strategy in MetaMap configurations. Our methodology, reference codes, measurements, results, and workflow are valuable references for optimizing and configuring MetaMap. [ABSTRACT FROM AUTHOR]

Background: Recently, there has been an increasing focus among healthcare organisations on implementing patient portals. Previous studies have mainly focussed on the experiences of patient portal use. Few have investigated the processes of deciding what content and features to make available, in particular for shared portals across healthcare domains. The aim of the study was to investigate views on content and experiences from the configuration process among participants involved in setting up a shared patient portal for primary and specialist health services.Methods: A qualitative study including 15 semi-structured interviews with persons participating in patient portal configuration was conducted from October 2019 to June 2020.Results: Whether a shared patient portal for all the health services in the region should be established was not questioned by any of the informants. It was experienced as a good thing to have numerous participants present in the discussions on configuration, but it also was said to increase the complexity of the work. The informants considered a patient portal to be of great value for patient care, among other things because it would lead to improvements in patient follow-up and increased patient empowerment. Nevertheless, some informants advocated caution as they thought the patient portal possibly could lead to an increase in healthcare providers' workloads and to anxiety and worries, as well as to inequality in access to health care among patients. The findings were categorized into the themes 'A tool for increased patient involvement', 'Which information should be available for the patient', 'Concerns about increased workload', 'Too complex to use versus not interesting enough', 'Involving all services' and 'Patient involvement'.Conclusions: Establishing a shared patient portal for primary and specialist health services was considered unproblematic. There was, however, variation in opinions on which content and features to include. This variation was related to concerns about increasing the workload for health care providers, causing anxiety and inequality among patients, and ensuring that the solution would be interesting enough to adopt. [ABSTRACT FROM AUTHOR]

In order to realise the potential benefits of eHealth, governments develop eHealth policies to define and prioritise initiatives, the strategic goals and the resulting benefits. During the 23 years with eHealth policies in Denmark only a few status reports with a systematic and transparent evaluation have been made. This paper advocates a more systematic approach to strategic planning of development and implementation of eHealth systems, by encouraging the concept of evidence-based policy making through analysis of how focus of the Danish eHealth policies have evolved. The Danish eHealth policies have very different framings following the different focus points for the policies. Interestingly, strategies for evaluating the devolopment of eHealth and eHealth policies were very sparcely noted in the policies. For the first time the deemphasising of evaluations of eHealth policies in Denmark has been empirically demonstrated, thus undermining the objective of obtaining evidence-based eHealth policies. [ABSTRACT FROM AUTHOR]

In order to realise the potential benefits of eHealth, governments develop eHealth policies to define and prioritise initiatives, the strategic goals and the resulting benefits. During the 23 years with eHealth policies in Denmark only a few status reports with a systematic and transparent evaluation have been made. This paper advocates a more systematic approach to strategic planning of development and implementation of eHealth systems, by encouraging the concept of evidence-based policy making through analysis of how focus of the Danish eHealth policies have evolved. The Danish eHealth policies have very different framings following the different focus points for the policies. Interestingly, strategies for evaluating the devolopment of eHealth and eHealth policies were very sparcely noted in the policies. For the first time the deemphasising of evaluations of eHealth policies in Denmark has been empirically demonstrated, thus undermining the objective of obtaining evidence-based eHealth policies. [ABSTRACT FROM AUTHOR]

The municipalities and the Regional Health Authorities in Central Norway have been assigned a mandate to implement a shared electronic health record, Helseplattformen, reflecting the visions set out in the national eHealth white paper 'One Citizen - One Record'. This study identifies and describe anticipated benefit streams of clinical decision support in 'One Citizen - One Record' and the user requirement specification documents of Helseplattformen. This study found that the benefit stream of clinical decision support translates from the health policy visions stated in 'One Citizen - One Record' into Helseplattformen. However, business changes, although a critical element of achieving benefits, were not emphasised in either. This calls for the programme of Helseplattformen to pay careful attention to how the information system and information technology requirements must be accompanied by enabling changes as well as business changes in order to achieve the identified benefits of 'One Citizen - One Record' and Helseplattformen. [ABSTRACT FROM AUTHOR]

The Nordic eHealth Research Network, a subgroup of the Nordic Council of Ministers eHealth group, is working on developing indicators to monitor progress in availability, use and outcome of eHealth applications in the Nordic countries. This paper reports on the consecutive analysis of National eHealth policies in the Nordic countries from 2012 to 2016. Furthermore, it discusses the consequences for the development of indicators that can measure changes in the eHealth environment arising from the policies. The main change in policies is reflected in a shift towards more stakeholder involvement and intensified focus on clinical infrastructure. This change suggests developing indicators that can monitor understandability and usability of eHealth systems, and the use and utility of shared information infrastructure from the perspective of the end-users - citizens/patients and clinicians in particular. [ABSTRACT FROM AUTHOR]

Coordination of perioperative work is challenging. Advancements in diagnostic and therapeutic possibilities have not been followed by similar advancements in the ability to coordinate care. In this paper, we report on a study that explored the nature of continuous coordination as practiced by perioperative staff in order to coordinate their own activities with respect to those of their colleagues. We conducted in-depth interviews ( n = 14), and combined observations and focused interviews ( n = 31) with perioperative staff (physicians, nurses, technicians, and cleaners) at a major university hospital in Norway. Data were analysed qualitatively with systematic text condensation. The results indicated that a surgical schedule was important for informing staff members about the cases and tasks they had been assigned. Staff also depended on ad hoc, explicit communication to ensure timeliness of particular perioperative activities. This, however, left little room for adjustments of other activities. Hence, to be able to proactively coordinate their own work some staff tried to predict future perioperative activities by observing the workplace, monitoring the surgical scheduling software for changes, and sharing their colleagues' progress updates and predictions. These findings could be important for those developing support for perioperative coordination. [ABSTRACT FROM AUTHOR]

Development of multinational variables for monitoring eHealth policy implementations is a complex task and requires multidisciplinary, knowledgebased international collaboration. Experts in an interdisciplinary workshop identified useful data and pitfalls for comparative variable development. The results are presented and discussed in this paper. [ABSTRACT FROM AUTHOR]

eHealth indicator and benchmarking activities are rapidly increasing nationally and internationally. The work is rarely based on a transparent methodology for indicator definition. This article describes first results of testing an indicator methodology for defining eHealth indicators, which was reported at the Medical Informatics Europe conference in 2012. The core elements of the methodology are illustrated, demonstrating validation of each of them in the context of Nordic eHealth Indicator work. Validation proved the importance of conducting each of the steps of the methodology, with several scientific as well as practical outcomes. The article is based on a report to be published by the Nordic Council of Ministers [4]. [ABSTRACT FROM AUTHOR]

eHealth indicators are needed to measure defined aspects of national eHealth implementations. However, until now, eHealth indicators are ambiguous or unclear. Therefore, an expert workshop 'Towards an International Minimum Dataset for Monitoring National Health Information System Implementations' was organized. The objective was to develop ideas for a minimum eHealth indicator set. The proposed ideas for indicators were classified based on EUnetHTA and De-Lone & McClean, and classification was compared with health IT evaluation criteria classification by Ammenwerth & Keizer. Analysis of the workshop results emphasized the need for a common methodological framework for defining and classifying eHealth indicators. It also showed the importance of setting the indicators into context. The results will benefit policy makers, developers and researchers in pursuit of provision and use of evidence in management of eHealth systems. [ABSTRACT FROM AUTHOR]

This paper explores information sharing in multidisciplinary clinical collaboration between three hospitals. Our study draws on qualitative interviews with surgeons and radiologists in two county hospitals and one university hospital. The analysis shows that the actors shared a restricted amount of information about the patients they have in common and that different actors used the shared information in different ways. However, much communication was still needed to clarify and negotiate the meaning of shared data and its implications for collaborative care. To conclude, while the arguments for a shared information space may appear convincing, the communication practice observed should illustrate that IS also needs to support the communicative process in clinical collaborative work. [ABSTRACT FROM AUTHOR]

Perioperative work requires the collaborative efforts of a multitude of actors. Coordinating such collaboration is challenging, and coordination breakdowns may be very expensive and jeopardize patient safety. We studied the needs for status information and projection of future status and events for key actors in the perioperative environment. We found that information and projection needs differed significantly between actors. While just-in-time notifications sufficed for some, others were dependent on projections to provide high quality and efficient care. Finally, information on current status and support in projecting the future unfolding of events could improve actors situated coordination capabilities. [ABSTRACT FROM AUTHOR]

Access control mechanisms might influence on the information seeking and documentation behavior of clinicians. In this study, we have surveyed healthcare professionals in nursing homes and hospitals on their attitudes to, and experiences with using access control mechanisms. In some situations, the access control mechanisms of the EHR system made clinicians postpone documentation work. Their practice of reading what others have documented was also influenced. Not all clinicians logged out of the system when they left a workstation, and some clinicians reported to do some of their documentation work in the name of others. The reported practices might have implications for the safety of the patient. [ABSTRACT FROM AUTHOR]

This paper reports on the experiences with establishing a multidisciplinary healthcare informatics research community at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. A multidisciplinary research group in healthcare informatics must maintain strong connections to computer science, social science, biomedicine and healthcare researchers. Those organizing the research must create a milieu that fosters true collaboration across disciplines. The researchers must have good access to healthcare institutions, to healthcare professionals as well as to patients. A healthcare informatics laboratory creates an arena for experiments as well as for validation of health-it technologies. [ABSTRACT FROM AUTHOR]

The evolving nature of surgical treatments creates gaps between evidence-based guidelines and actual clinical practice.This article addresses the emerging clinical practice of the EndoVascular Aneurysm Repair (EVAR), a surgical treatment of patients with Abdominal Aortic Aneurysm (AAA). Drawing on a qualitative study across three hospitals, we identified three interplaying expertise traits: the collective, the interpersonal and the technical, each being present to promote surgical work. The evolvement of EVAR is contextualized within technical artefacts and patient characteristics, along with a joint decision approach. The intertwinement between various expertise traits and contextual factors forms a ‘community of guidance’, nourishing further EVAR innovation without formalized institutions, evidence, training or guidelines. However, the lack of a shared context limits the transfer of evolving knowledge across hospital boundaries. [ABSTRACT FROM PUBLISHER]

Objective: To inform the design of IT support, the authors explored the characteristics and sources of process variability in a surgical care process that transcends multiple institutions and professional boundaries. Setting: A case study of the care process in the Abdominal Aortic Aneurysm surveillance programme of three hospitals in Norway. Design: Observational study of encounters between patients and surgeons accompanied by semistructured interviews of patients and key health personnel. Results: Four process variety dimensions were identified. The captured process variations were further classified into intended and unintended variations according to the cause of the variations. Our main findings, however, suggest that the care process is best understood as systematised analysis and mitigation of risk. Even if major variations accommodated for the flexibility needed to achieve particular clinical aims and/or to satisfy patient preferences, other variations reflected healthcare actors' responses to risks arising from a lack of resilience in the existing system. On this basis, the authors outlined suggestions for a resilience-based approach by including awareness in workflow as well as feedback loops for adaptive learning. The authors suggest that IT process support should be designed to prevent process breakdowns with patient dropouts as well as to sustain risk-mitigating performance. Conclusion: Process variation was in part induced by systemised risk mitigation. IT-based process support for monitoring processes such as that studied here should aim to ensure resilience and further mitigate risk to enhance patient safety. [ABSTRACT FROM AUTHOR]

This paper sums up some of the findings from a national survey on the diffusion and use of Electronic Health Record (EHR) systems in the Norwegian health sector. The survey shows that almost all hospitals and GPs use their EHR systems on a daily basis, while the municipalities are lagging behind, All three view costs and missing functionality as the most important challenges. The GPs are very concerned with the complexity of the daily operation of the systems, while the hospitals are mostly concerned with costs of daily operations, maintenance and further development of the systems. Better integration with support systems is requested. User involvement and ownership seem to have contributed to the development and diffusion of the most successful EHR systems. National diffusion processes require good planning and are time consuming. It has taken 15 years from the first EHR systems were introduced until 90% of the actors used the systems. This has to be taken into account in national strategy processes in the health sector. [ABSTRACT FROM AUTHOR]

Since operating room departments are among the costliest resources at a hospital, much attention is devoted to maximize their utilization. Operating room activities are however notoriously hard to plan in advance. This has to do with the unpredictable, problem-solving nature of the work and that the work is carried out by a multidisciplinary team of health personnel, members of which also have commitments outside the operating room department. We assume that operating room teams have the capacity to coordinate themselves and that coordination might be facilitated by visualizing relevant information on wall-mounted boards. To characterize clinical situations that require coordination and re-planning of the teams' work, we have developed a realistic scenario. We analyse and discuss the information security challenges that follow from displaying information on the whereabouts of other teams, actors and patients on wall-mounted boards in the operating rooms. Information security threats could be mitigated by de-identification techniques. Information demands could thereby be met without sacrificing the privacy of those whose information is displayed. [ABSTRACT FROM AUTHOR]

Objective: To identify factors influencing variations in clinical work in the care of patients with abdominal aortic aneurism. Method: Ethnographic observations of 26 meetings between surgeons and patients in two community hospitals and one university hospital. Observations data were abstracted into scenarios that describe the typical clinical workflow. Characterizations of features of the scenarios were performed. Results: When comparing the university hospital and the community hospitals we find large variations in patient trajectories, and in the relation between actors' and roles. Conclusion: Given a clinical domain distinguished by an unrelenting search for new and improved surgical techniques, workflow system requirements should reflect that healthcare planning not only is conducted with the purpose of providing care but also with purpose of developing new or maintaining existing surgical skills. [ABSTRACT FROM AUTHOR]

Background: It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment. Methods: Qualitative study based on 18 semi-structured interviews with physicians in two Norwegian hospitals. Results: Ten different but related characteristics of work within the EMR-based practice were identified; (1) there was closer clinical and administrative cooperation during the implementation processes; (2) there were greater benefits when everybody used the system; (3) systems supported freshmen better than experienced physicians; (4) the EMR was useful in regard to professional learning; (5) new users were given an introduction to the system by experienced; (6) younger clinicians reported different attitudes than senior clinicians, but this might be related to more than age and previous experience with computers; (7) the EMR made it easier to generate free-text notes, but this also created a potential for information overflow; (8) there is little or no support for mobile work; (9) instances of downtime are still experienced, and this influenced the attitude towards the system and (10) clinicians preferred EMR-only compared to combined paper and electronic systems. Conclusion: Despite the removal of paper-based records from clinical workflow (a change that hospital clinicians perceived as highly useful), many of the old routines remained unchanged, limiting the potential of the EMR system. Thus, there is a need to not only remove paper in the physical sense, but also to established routines to fully achieve the benefits of an EMR system. [ABSTRACT FROM AUTHOR]

Objective: Many Norwegian hospitals that are equipped with an electronic medical record (EMR) system now have proceeded to withdraw the paper-based medical record from clinical workflow. In two previous survey-based studies on the effect of removing the paper-based medical record on the work of physicians, nurses and medical secretaries, we concluded that to scan and eliminate the paper based record was feasible, but that the medical secretaries were the group that reported to benefit the most from the change. To further explore the effects of removing the paper based record, especially in regard to medical personnel, we now have conducted a follow up study of a hospital that has scanned and eliminated its paper-based record. Design: A survey of 27 physicians, 60 nurses and 30 medical secretaries was conducted. The results were compared with those from a previous study conducted three years earlier at the same department. Measurements: The questionnaire (see online Appendix) covered the frequency of use of the EMR system for specific tasks by physicians, nurses and medical secretaries, the ease of performing these tasks compared to previous routines, user satisfaction and computer literacy. Results: Both physicians and nurses displayed increased use of the EMR compared to the previous study, while medical secretaries reported generally unchanged but high use. Conclusion: The increase in use was not accompanied by a similar change in factors such as computer literacy or technical changes, suggesting that these typical success factors are necessary but not sufficient. [ABSTRACT FROM AUTHOR]

Objective: a) To document the presence and use of clinical department systems (CDS) in a university hospital that implemented a hospital-wide electronic health record (EHR) in 1999 and b) To compare clinical use of the CDS with that of the EHR. Method: Identification of CDSs in use by contacting leaders and senior physicians at clinical departments at the hospital. Identification of key properties of each CDS by interviewing users. Results: We identified a total of 60 CDSs, of which 53 fell in one of four categories; Journal or documentation system tailored to a department or medical specialty (19 systems), Software bundled with electronic medical equipment (control/ storage/ presentation) (14 systems), Logistics/ administration/ planning/ appointments (10 systems) and Database for medical research (10 systems). Many CDSs were described to outperform the EHR system with regard to ability to provide better patient overview and better support for registering patient data. CDSs are not integrated with the EHR and thus contain islands of data. Conclusion: CDSs continue to fill important roles and there is no tendency towards that the hospital-wide EHR makes CDSs obsolete. [ABSTRACT FROM AUTHOR]

Several Norwegian hospitals have, plan, or are in the process of removing the paper-based health record from clinical workflow. To assess the impact on usage and satisfaction of electronic health record (EHR) systems, we conducted a survey among physicians, nurses and medical secretaries at selected departments from six Norwegian hospitals. The main feature of the questionnaire is the description of a set of tasks commonly performed at hospitals, and respondents were asked to rate their usage and change of ease compared to previous routines for each tasks. There were 24 tasks for physicians, 19 for nurses and 23 for medical secretaries. In total, 64 physicians, 128 nurses and 57 medical secretaries responded, corresponding to a response rate of 68%, 58% and 84% respectively. Results showed a large degree of use among medical secretaries, while physicians and nurses displayed a more modest degree of use. Possibly suggesting that the EHR systems among clinicians still is considered more of an administrative system. Among the two latter groups, tasks regarding information retrieval were used more extensively than tasks regarding generating and storing information. Also, we observed large differences between hospitals and higher satisfaction with the part of the system handling regular electronic data than scanned document images. Even though the increase in use among clinicians after removing the paper based record were mainly in tasks where respondents had no choice other than use the electronic health record, the attitude towards EHR-systems were mainly positive. Thus, while removing the paper based record has yet to promote new ways of working, we see it as an important step towards the EHR system of tomorrow. Several Norwegian hospitals have shown that it is possible. [ABSTRACT FROM AUTHOR]

Both secretory and cytosolic phospholipase A2 enzymes have been implicated in the pathogenesis of arthritis in animal models, but the exact expression patterns of the enzymes in diseased human joint tissue are uncertain. We investigated the messenger RNA expression of group Ila, lVα and V phospholipase A2 and localized the presence of group Ila and lVα phospholipase A2 at protein levels in articular catilage from patients with rheumatoid arthritis, osteoarthritis and patients with non-arthritic joints. Both group Ila phospholipase A2 messenger RNA and protein were detected in all samples independent of diagnosis, but were far more prominent in cartilage from rheumatoid arthritis samples. In cartilage with rheumatoid arthritis, the enzyme was detected both within the chondrocytes and in the extracellular matrix, whereas only few osteoarthritic cartilage samples showed positive staining in the matrix. In the cartilage matrix of non-arthritic controls, group Ila phospholipase A2 was totally absent. Messenger RNA for the group lVα and V phospholipase A2 was, except for one osteoarthritic cartilage sample, exclusively detected in rheumatoid arthritic cartilage. For group lVα phospholipase A2 this was also confirmed at the protein level. These results suggest that each phospholipase A2 enzyme has distinct roles in both healthy and diseased joint tissue, and that the diversity and amount of enzyme correlate with the grade of inflammation and disease severity. [ABSTRACT FROM AUTHOR]

Background: Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results: The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions: Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS. [ABSTRACT FROM AUTHOR]

Background: Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the electronic medical records (EMR) system. It is believed that such evaluations should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems. Methods: We have developed a task-oriented questionnaire for evaluating EMR systems from the clinician's perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. It is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The task list appears in two separate sections, about EMR use and task performance using the EMR, respectively. By combining these sections, the evaluator may estimate the potential impact of the EMR system on health care delivery. The results may also be compared across time, site or vendor. This paper describes the development, performance and validation of the questionnaire. Its performance is shown in two demonstration studies (n = 219 and 80). Its content is validated in an interview study (n = 10), and its reliability is investigated in a test-retest study (n = 37) and a scaling study (n = 31). Results: In the interviews, the physicians found the general clinical tasks in the questionnaire relevant and comprehensible. The tasks were interpreted concordant to their definitions. However, the physicians found questions about tasks not explicitly or only partially supported by the EMR systems difficult to answer. The two demonstration studies provided unambiguous results and low percentages of missing responses. In addition, criterion validity was demonstrated for a majority of task-oriented questions. Their test-retest reliability was generally high, and the nonstandard scale was found symmetric and ordinal. Conclusion: This questionnaire is relevant for clinical work and EMR systems, provides reliable and interpretable results, and may be used as part of any evaluation effort involving the clinician's perspective of an EMR system. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. Design: Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. Setting: 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. Participants: 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. Main outcome measures: Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. Results: Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. Conclusions: Doctors used electronic medical records systems for far fewer tasks than the systems supported. [ABSTRACT FROM AUTHOR]

Friend leukemia complex (FLC) is known to induce immunosuppression but the use of FLC in studies of immune cells function is disadvantageous since the immunosuppression always is accompanied by an acute erythroleukemia. To obtain immunosuppressive variants of FLC with reduced leukemogenic potential, we isolated T-helper cells from FLC infected mice, and passed lysates of the cells to recipient uninfected mice. A group of these mice developed a condition distinct from the disease induced by FLC. A viral stock prepared from these mice, designated Fd-MIV for friend derived murine immunodefiency virus, induced a profound suppression of the primary antibody response without acute transformation in adult NMRI mice. Terminally a wasting disease with weight loss, atrophy of the thymus and lymph nodes and renal disease was observed in some mice. Analysis of viral DNA and RNA from infected NIH 3T3 cells showed that Fd-MIV contained at least two viral components, a 8.4 kb friend murine leukemia virus (F-MuLV) and a 7.4kb mink cell focus (MCF) / xenotropic virus related genome. The 7.4 kb genome was not detected in Fd-MIV infected, immunocompromised mice indicating that the 8.4kb genome might be responsible for the disease. [ABSTRACT FROM AUTHOR]