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Medicines are important for well-being. Thus, medication errors can have severe consequences, even death. Transfers between professionals and levels of care are a challenge in terms of medicines management. Norwegian governmental strategies encourage communication and collaboration between levels of care, and several initiatives are invested in to improve digital medicine management. In the project Electronic Medicines Management (eMM), we established an arena for inter-professional discussions about medicines management. This paper provides an example of how the eMM arena contributed to knowledge sharing and development in current medicines management practices at a nursing home. Building on communities of practice as a method we carried out the first of several sessions, with nine inter-professional participants. The results illustrate how discussion and agreement were reached on a common practice across different levels of care, and how the knowledge required bringing this knowledge back to the local practices. [ABSTRACT FROM AUTHOR]

Most countries are facing a common challenge: a rise in the number of chronically ill patients and limited medical resources. The combination of digital support and the principles of person-centred, integrated, and proactive care (Digi-PIP care) services constitutes the most ambitious initiative for patients with long-term needs. While there is research on digital support, person-centred, integrated, and proactive care, the combination of these components has been less explored. The data set consisted of 29 qualitative interviews with healthcare professionals involved in four Nordic Digi-PIP care initiatives. Building on prevailing discourses on the modernisation of healthcare, we used discourse analysis to determine how the professionals discussed their perceptions and experiences of the care transformation initiatives. We identified four discourses illustrating that, despite challenges with adoption, the vision of Digi-PIP care was strongly embedded among participants across professions and contexts. In contrast to the discourses on their separate components, the emergent discourses on Digi-PIP care were surprisingly consistent. The new care model was found to be beneficial for patients, healthcare professionals, and society. Digitalisation may vitalise and even catalyse person-centred, integrated, and proactive practices. To the employees involved, Digi-PIP has moved beyond the point of no return; it is the future of modern healthcare. [ABSTRACT FROM AUTHOR]

Digital medicines management is a high priority in Norwegian e-health strategies. A key challenge is the existence of multiple electronic information sources and systems, which require multi-professional cooperation. Lack of communication, understanding and collaboration between pharmacies, hospitals and community caregivers is also a challenge. Communities of practices (CoPs) have been used to establish arenas for discussing issues challenging the workflow to reach a common agreement on successful work practices for electronic medicines management. The purpose of this paper is to explore: How can we establish communities of practice (CoPs) to gather new knowledge on the facilitators and challenges for electronic medicines management practices in Norway? The results show engagement in establishing the CoPs and a willingness for joint enterprise. The establishment of the CoPs was performed simply based on established forms of collaboration. For CoPs to be effective, established alliances need to be expanded and renewed to form new group dynamics and thus a basis for new knowledge about electronic medicines management. [ABSTRACT FROM AUTHOR]

Medication errors are a significant health problem and a serious threat to patient safety. In Norway, an estimated one-third of the elderly population has been exposed to potentially inappropriate medications. The Norwegian government has assumed a pivotal role in reducing medication errors and providing safer medication management for its citizens, particularly through the national eHealth system's eprescription and Summary Care Record. In the present study, we depart from the governmental eHealth initiatives and examine why access to pharmaceutical information is not sufficient to solve the problem with medication errors. Empirical data were collected from 2015 to 2019 through the conduction of 56 qualitative interviews that were transcribed, thematically coded and analysed. The results illustrate how eHealth systems are helpful, at the same time, we emphasise changed work practices and professional knowledge-sharing as a basis for solving the issue of medication errors. [ABSTRACT FROM AUTHOR]

Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery project addressed the problem of elective surgery cancellation at a Norwegian hospital and explored the potential to reduce surgery cancellation by providing a tool for secure online communication between the hospital and the patient. This communication would occur before surgery while the patient was still at home. The causes of elective surgery cancellation are divided into two major categories: hospital- and patient-related reasons. As part of the e-Team Surgery project, this study addressed patient reasons for cancelling surgery through qualitative interviews with 11 patients who fit these criteria. The study found that most patients called the hospital to reschedule, not to cancel, their upcoming surgery. The patient interviews had significant implications for the e-Team Surgery project. They affected the overall understanding of the surgery cancellation problem and made more clear the data and information needed when developing sustainable systems to reduce elective surgery cancellation. [ABSTRACT FROM AUTHOR]

Background To assist small hospitals in providing advanced stroke treatment, the Norwegian Directorate of Health has recommended telemedicine services. Telestroke enables specialists to examine patients via videoconferencing supplemented by teleradiology and to provide decision support to local health care personnel. There is evidence that telestroke increases thrombolysis rates. In Norway, telemedicine has mainly been used in non-critical situations. The first telestroke trials took place in 2008. The aim of this paper is to present an overview of telestroke trials and today's status with telestroke in Norway. Based on the divergent experience from two health regions in Norway, the paper discusses crucial factors for the integration of telestroke in clinical practice. Methods This is a descriptive study based on multiple methods to obtain an overview of the practice and experience with telestroke in Norway. A Web and literature search for 'telestroke in Norway' was performed and compared with a survey of telemedicine services at the country's largest hospitals. These findings were supplemented by interviews with key personnel involved in telestroke in two of four health regions, as well as hospital field observations and log data of telestroke transmissions from five of the hospitals involved. Results In Norway, experience in telemedicine for acute stroke care is limited. At the beginning of 2014, three of four regional health authorities were working with telestroke projects and services. Integration of the service in practice is challenging, with varying experience. The problems are not attributed to the technology in itself, but to organization (availability of staff on duty 24/7 and surveillance of the systems), motivation of staff, logistics (patient delay), and characteristics of the buildings (lack of space). Conclusions Prerequisites for successful integration of telestroke in clinical practice include realization of the collaboration potential in the technology with consistent procedures for training and triage, availability of the equipment, and providing advice beyond questions concerning thrombolysis. [ABSTRACT FROM AUTHOR]

The potential for information technologies (ITs) to contribute to a struggle against social inequalities in health is discussed in contemporary policy and research. Expectations are on IT to facilitate access to health expertise and knowledge, and hence result in improved health practices and outcomes for individuals. In this article, the authors argue that this currently dominant understanding of the relation between IT and social inequalities in health is constraining as well as insufficient to explain the persistence of health inequalities in digitalized western societies. Human action is reduced to be about rational choice, and technology is expected to be a passive tool to be employed by implementers and policy-makers. Drawing on case studies from two telemedicine projects in Norway, this analysis combines perspectives from sociology concerned with structural inequalities on the one hand, with science technology studies on the other. It reveals how the practice and performance of IT is tied to the practice and performance of local differences, and this might be important to a discussion of the social distribution of health. Combining these two perspectives allows for an alternative understanding of how IT and social inequalities in health interact. [ABSTRACT FROM AUTHOR]

Considerable effort has been invested in telemedicine and e-health, but relatively few applications have endured beyond the research and development phase. Research within different academic disciplines points to the significance of established working and organizational relations within healthcare in shaping the outcome of particular projects, whether successful or otherwise. Even so, the findings appear as disparate and discrete observations which make it difficult for those involved in the field to get an overview of ICT in healthcare work and organization or to interpret the implications of the studies. The aim of our article is to demonstrate the importance and value of situating ICT initiatives within a sociological framework of healthcare work and organization and to show how this enables us to carry out systematic analysis across a range of ICT initiatives in different clinical settings. [ABSTRACT FROM AUTHOR]

What might new information and communication technologies (ICTs) at work do for gender? This question is explored here through an empirical study that traces the introduction of one ICT application—an electronic patient record (EPR)—into nursing and medical work in a University hospital in Norway. Health care work is well documented as a highly gendered field, where normalizing gender practices have dominated. The aim of this article is to explore emergent configurations of gender, ICT, and health care work following the introduction of the EPR. Drawing on Judith Butler's conceptualization of performativity, where gender is produced only as it is cited in everyday practice, we pay attention to both the normative and the disruptive moments of these configurations. In order to understand gender in modern health care we suggest an analysis of the performative co-constitution of gender, technology, and work as it is done on a daily basis at the hospital. We explore the gender effects of this co-constitution, also as gender norms are challenged and new ways of performing professional identities in health care are moved beyond the familiar categories of the past. [ABSTRACT FROM AUTHOR]