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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.

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.

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.

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.

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 de-emphasising of evaluations of eHealth policies in Denmark has been empirically demonstrated, thus undermining the objective of obtaining evidence-based eHealth policies.

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.

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.

Development of multinational variables for monitoring eHealth policy implementations is a complex task and requires multidisciplinary, knowledge-based 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.

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].

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.