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Abstract Background Experience shows that the precondition for the development of successful health information technologies is a thorough insight into clinical work practice. In contemporary clinical work practice, clinical work and health information technology are integrated, and part of the practice is tacit. When work practice becomes routine, it slips to the background of the conscious awareness and becomes difficult to recognize without the context to support recall. This means that it is difficult to capture with traditional ethnographic research methods or in usability laboratories or clinical set ups. Observation by the use of the video technique within healthcare settings has proven to be capable of providing a thorough insight into the complex clinical work practice and its context - including parts of the tacit practice. The objective of this paper is 1) to argue for the video observation technique to inform and improve health-information-technology development and 2) to share insights and lessons learned on benefits and challenges when using the video observation technique within healthcare settings. Methods A multiple case study including nine case studies conducted by DaCHI researchers 2004–2011 using audio-visual, non-participant video observation for data collection within different healthcare settings. Results In HIT development, video observation is beneficial for 1) informing and improving system design 2) studying changes in work practice 3) identifying new potentials and 4) documenting current work practices. Conclusions The video observation technique used within healthcare settings is superior to other ethnographic research methods when it comes to disclosing the complexity in clinical work practice. The insights gained are far more realistic compared to traditional ethnographic studies or usability studies and studies in clinical set ups. Besides, the data generated through video recordings provide a solid basis for dialog between the health care professionals involved. The most important lessons learned are that a well considered methodology and clear formulated objectives are imperative, in order to stay focused during the data rich analysis phase. Additionally, the video observation technique is primarily recommended for studies of specific clinical work practices within delimited clinical settings. Overall, the video observation technique has proven to be capable of improving our understanding of the interwoven relation between clinical work practice and HIT and to inform us about user requirements and needs for HIT, which is a precondition for the development of more successful HIT systems in the future.

Abstract Background Experience has shown that for new health-information-technology (HIT) to be suc-cessful clinicians must obtain positive clinical benefits as a result of its implementation and joint-ownership of the decisions made during the development process. A prerequisite for achieving both success criteria is real end-user-participation. Experience has also shown that further research into developing improved methods to collect more detailed information on social groups participating in HIT development is needed in order to support, facilitate and improve real end-user participation. Methods A case study of an EHR planning-process in a Danish county from October 2003 until April 2006 was conducted using process-analysis. Three social groups (physicians, IT-professionals and administrators) were identified and studied in the local, present perspective. In order to understand the interactions between the three groups, the national, historic perspective was included through a literature-study. Data were collected through observations, interviews, insight gathered from documents and relevant literature. Results In the local, present perspective, the administrator's strategy for the EHR planning process meant that there was no clinical workload-reduction. This was seen as one of the main barriers to the physicians to achieving real influence. In the national, historic perspective, physicians and administrators have had/have different perceptions of the purpose of the patient record and they have both struggled to influence this definition. To date, the administrators have won the battle. This explains the conditions made available for the physicians' participation in this case, which led to their role being reduced to that of clinical consultants - rather than real participants. Conclusion In HIT-development the interests of and the balance of power between the different social groups involved are decisive in determining whether or not the end-users become real participants in the development process. Real end-user-participation is essential for the successful outcome of the process. By combining and developing existing theories and methods, this paper presents an improved method to collect more detailed information on social groups participating in HIT-development and their interaction during the development. This allows HIT management to explore new avenues during the HIT development process in order to support, facilitate and improve real end-user participation.

Background Rapid infant weight gain (RIWG) is strongly related to childhood overweight and obesity, and prevention of RIWG is an approach to early years obesity prevention. This systematic review aimed to explore effectiveness, deliverers' and recipients' experiences of involvement, and key intervention components and processes of such prevention activities. Methods Key databases and websites were searched systematically for quantitative and qualitative studies covering intervention effectiveness, experiences with intervention involvement or process outcomes. After duplicate screening and quality assessment, papers were analyzed through narrative synthesis, thematic synthesis and intervention component analysis. Results Seven quantitative and seven qualitative studies were eligible for inclusion. Most intervention studies reported small, but significant results on infant weight gain. More significant results were measured on weight gain during the first compared with the second year of life. A weak evidence base made elaboration of the relationship between intervention effectiveness and content challenging. Home-delivered interventions may be more relevant for parents. Contextual factors, such as social norms, beliefs and professional identity should be considered during intervention development. Stakeholder involvement can be key to increase intervention acceptability and feasibility. Conclusions The field of RIWG prevention is new and evolving, but more research is needed before further conclusions about intervention effectiveness and intervention content can be drawn. Future interventions should take parents, health professionals and other contextual needs into account to improve chances of success. More research on long-term effects on overweight and obesity is needed. [ABSTRACT FROM AUTHOR]

Denmark have unique health informatics databases e.g. 'The Children's Database', which since 2009 holds data on all Danish children from birth until 17 years of age. In the current set-up a number of potential sources of errors exist - both technical and human-which means that the data is flawed. This gives rise to erroneous statistics and makes the data unsuitable for research purposes. In order to make the data usable, it is necessary to develop new methods for validating the data generation process at the municipal/regional/national level. In the present ongoing research project, two research areas are combined: Public Health Informatics and Computer Science, and both ethnographic as well as system engineering research methods are used. The project is expected to generate new generic methods and knowledge about electronic data collection and transmission in different social contexts and by different social groups and thus to be of international importance, since this is sparsely documented in the Public Health Informatics perspective. This paper presents the preliminary results, which indicate that health information technology used ought to be subject for redesign, where a thorough insight into the work practices should be point of departure. [ABSTRACT FROM AUTHOR]

Experience shows that to achieve a successful implementation of EHR clinicians must obtain joint ownership of the decisions made during the EHR-process. The EHR planning process in the Region of North Jutland, Denmark was studied with the aim of answering the question; “Why are not all Danish physicians overjoyed by the introduction of EHR? A case study was carried out from Oct. 2003 till April 2006 using process analysis. The EHR project management's strategy meant that there was no workload reduction. This was seen as one of the main barriers for the physicians to achieve real influence. History shows that clinician's on the one hand and administrators on the other have different perceptions of the purpose of the patient record and that they both have struggled to influence this definition. To date, the administrators have won the battle. This was the major reason for the approach chosen for the EHR planning process in North Jutland, Denmark. It explains the conditions made available for the physicians, which led to their role being reduced to clinical consultants – rather than real participants. [ABSTRACT FROM AUTHOR]

The Change readiness research method (CRR) has become a well- known method in Denmark to identify issues needed to be discussed on a hospital ward before implementation of a new IT-system and to start a dialogue. A precondition for a constructive dialogue, however, is a high degree of participation. The latest experiences of the CRR method were gained from its use in eight wards in the Danish Gepka project during 2003-4 (The Gepka project was established by The Danish Ministry of the Interior and Health, The National Board of Health, the County Council Society and H:S. Its purpose is to validate the “Basic Structure for The Electronic Health Record” (B-EHR) using prototypes. http://medinfo.dk/epj/proj/gepka/). In the Gepka project the participation varied from 33.3% to 78.9%. The objective of this study is to set out themes by which this variation can be studied. A qualitative explorative research design has been applied, where four instructions from the “Instruction for use” (Instructions for using the CRR method. Can be downloaded the Internet: (http://www.epjobservatoriet.dk/publikationer/forandringsparathed.pdf)) have been studied as themes. The methods used have been telephone interviews and direct observations. The results showed that the seven wards (one was excluded) followed the “Instructions for use” to different degrees. It was found that one instruction, in particular, seems to be especially important to follow to motivate the employees on a ward to participate in the CRR; the management of the ward must be engaged/actively involved in the project, as they are key figures when it comes to motivating the other ward employees. The aim of this study is not to prove a causal relationship between the degree to which the “Instructions for use” are followed and the degree of participation – it is to suggest a qualitative relationship between the two. Neither does this study try to generalize the results, as further research on more wards would be needed to do so. This study does, however, set out themes that can be a useful tool in future CRR projects in order to maximize the degree of participation. In a modified way, these themes can probably be used as a tool in other studies of human – machine interactions. [ABSTRACT FROM AUTHOR]

Denmark has unique health informatics databases such as "The Children's Database" (CDB), which since 2009 has held data on all Danish children from birth until 17 years of age. In the current set-up a number of potential sources of error exist - both technical and human - which means that the data is flawed. The objective of this paper is both to clarify errors in the database and to enlighten the underlying mechanisms causing these errors. This is done through an ethnographic study using participant observations, interviews and workshops. Errors are documented through statistical analysis. The data show redundant records. This redundancy can be explained by multiple transmissions conducted by end users or systems, or a lack of validation methods in the National CDB. In our results three types of cases are presented: from health visitors at school, from health visitors visiting families and from health visitors at central health offices.

Experience shows that to achieve a successful implementation of EHR clinicians must obtain joint ownership of the decisions made during the EHR-process. The EHR planning process in the Region of North Jutland, Denmark was studied with the aim of answering the question; "Why are not all Danish physicians overjoyed by the introduction of EHR? A case study was carried out from Oct. 2003 till April 2006 using process analysis. The EHR project management's strategy meant that there was no workload reduction. This was seen as one of the main barriers for the physicians to achieve real influence. History shows that clinician's on the one hand and administrators on the other have different perceptions of the purpose of the patient record and that they both have struggled to influence this definition. To date, the administrators have won the battle. This was the major reason for the approach chosen for the EHR planning process in North Jutland, Denmark. It explains the conditions made available for the physicians, which led to their role being reduced to clinical consultants--rather than real participants.

The Change readiness research method (CRR) has become a well- known method in Denmark to identify issues needed to be discussed on a hospital ward before implementation of a new IT-system and to start a dialogue. A precondition for a constructive dialogue, however, is a high degree of participation. The latest experiences of the CRR method were gained from its use in eight wards in the Danish Gepka project during 2003-4 (The Gepka project was established by The Danish Ministry of the Interior and Health, The National Board of Health, the County Council Society and H:S. Its purpose is to validate the "Basic Structure for The Electronic Health Record" (B-EHR) using prototypes. http://medinfo.dk/epj/proj/gepka/). In the Gepka project the participation varied from 33.3% to 78.9%. The objective of this study is to set out themes by which this variation can be studied. A qualitative explorative research design has been applied, where four instructions from the "Instruction for use" (Instructions for using the CRR method. Can be downloaded the Internet: (http://www.epjobservatoriet.dk/publikationer/forandringsparathed.pdf)) have been studied as themes. The methods used have been telephone interviews and direct observations. The results showed that the seven wards (one was excluded) followed the "Instructions for use" to different degrees. It was found that one instruction, in particular, seems to be especially important to follow to motivate the employees on a ward to participate in the CRR; the management of the ward must be engaged/actively involved in the project, as they are key figures when it comes to motivating the other ward employees. The aim of this study is not to prove a causal relationship between the degree to which the "Instructions for use" are followed and the degree of participation--it is to suggest a qualitative relationship between the two. Neither does this study try to generalize the results, as further research on more wards would be needed to do so. This study does, however, set out themes that can be a useful tool in future CRR projects in order to maximize the degree of participation. In a modified way, these themes can probably be used as a tool in other studies of human-machine interactions.

Over the past years researchers at Aalborg University have been developing a method for examining change readiness of hospital staff during the implementation of new IT-systems. (CRR; Change readiness-research). The aim is to provide the hospital-management with a tool that will lead to an optimal implementation of new IT-systems. The method has recently been used in department Y at Skejby Hospital, Skejby, Denmark. 81% out of 241 employees answered the distributed questionnaire, and the results showed, that the employees have some expectations to the new EHR-system, which are important to either confirm or reject; on the other hand a great part of the employees lack basic computer skills. Thus the CRR-method has provided the Organization with important information before the implementation of the new EHR-system.