Berglind Fjola Smaradottir

A scenario-based serious game for teaching about healthcare solutions was developed and tested in multiple iterations. The serious game captures the complexity of a real-world healthcare scenario, projecting it into a “scenario system” that can be accessed by the game participants to explore and experience the playthrough of a critical healthcare situation. The aim is to teach about existing health technology, and its use and interactions between healthcare professionals, technology and patients. The platform for the serious game is mobile, such that different locations can be chosen for different scenarios. Actions of the participants trigger further actions, tasks and storyline progress in the scenario so that a self-paced experience with defined dynamics can be created for the participants. The scenario-based serious game was tested with high school students and senior citizens in multiple iterations.

Health care service provision of individualised treatment to an ageing population prone to chronic conditions and multimorbidities is threatened. There is a need for digitally supported care, that is, (1) person-centred, (2) integrated, and (3) proactive. The research project 3P, Patients and Professionals in Productive Teams, aimed to validate and verify the prerequisites for health care systems run with patient-centred service models. This paper presents an explorative study of the digital support of a cross-organisational health care team in Norway, providing services to elderly frail people with multimorbidities in hospital discharge transition. Qualitative research methods were employed, with interviews and observations to map and evaluate the information flow and the digital support of collaborative work across organisations. The evaluation showed a lacking interoperability between the digital systems and a limited support for cross-organisational teamwork, causing raised manual efforts to maintain the information flow. Tools for coordination and planning across organisations were lacking. To enhance the situation, principles for a cloud-based health portal are proposed with a shared workspace, teamwork functionality for cross-organisational health care teams, and automatic back-end synchronisation of stored information. The main implications of this paper lie in the proposed principles which are transferable to a multitude of clinical contexts, where ad-hoc based access to shared medical information is of importance for decision-making and life-saving treatment.

Chronic pain patients constitute a large and heterogeneous patient group and it is important to build tools and methods that can identify efficient treatment options for each individual patient. It is estimated that 20-30% of the population has suffered from chronic pain and this imposes enormous costs on society and the national welfare programs. The research project Chronic Pain addresses the problem of how to provide patients and physicians with relevant, valid and adapted decision alternatives in a shared decision making tool. This paper presents the results from co-creation workshops early in the user-centred design process of the chronic pain mobile application. The end-users contributed in mapping the user needs and requirements, and made paper prototyping of the user interface. The main contribution lies on how a user-centred design methodology can be applied in a clinical development context.

Electronic glasses use advanced assistive technology that can improve function for persons with visual impairments. This paper presents work in progress in the SmartSight project, where existing versions of electronic glasses are adapted and tested for persons with the visual impairments; macular degeneration and retinitis pigmentosa. The project aims are to adapt and innovate electronic glasses for persons with impaired fields of vision and study the impact on the daily function and quality of life. In a pilot test of the electronic glasses, promising results were found that imply a big difference for persons with impaired vision. The outcome of the SmartSight project might change the clinical practise on treatment and rehabilitation of persons with impaired fields of vision, and on how the support services are organised.

The research project 3P- Patients and Professionals in Productive Teams has studied different patient-centred teamwork models for patients with chronic conditions and multi-morbidities. This paper presents outcomes from a qualitative study on the information flow and technology use in patient-centred care teams utilizing telemedicine, located in three health regions of Norway and Denmark. The aim was to identity barriers for collaborative work and propose models for the e-solutions of the future. The study showed fragmentation in information storage with limited interoperability causing that several systems had to be used for telemedicine follow-up and there was limited teamwork support functionality.

Warfarin for anticoagulation therapy is used by patients with specific cardiovascular diseases to control the ability of blood clotting. Traditional ways for self-management of the therapy are based on paper forms and procedures. This paper presents an algorithm developed for the smartphone application “Warfarin Guide”, which is a computer-assisted decision-support system used to help patients with self-management of their anticoagulation therapy related to International Normalized Ratio (INR) values. The algorithm was based on clinical guidelines for Warfarin therapy and it was adapted for the software application to address challenges with regular INR checks and adjustments for temporary fluctuations. An evaluation study with 14 participants showed that the patients evaluated the Warfarin Guide as useful for self-management of anticoagulation therapy, even though some issues could be improved.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multi-morbid elderly. International health organizations propose digitally supported complex transformations towards: 1) person-centered care (PCC), 2) integrated and 3) proactive care. However, considerable uncertainty regarding both the design and effects of such digitally supported care transformations remain. Previous reviews have found favorable but unstable impacts ofTo describe how the literature on whole system complex transformations directed at frail elderly reflect 1) operationalization of intervention, 2) maturity, 3) evaluation methodology, and 4) effect on outcomes. each key element, but the maturity and synergies of the combination of elements are unexplored. Objective: To describe how the literature on whole system complex transformations directed at frail elderly reflect 1) operationalization of intervention, 2) maturity, 3) evaluation methodology, and 4) effect on outcomes. Methods: We performed a systematic health service and e-health literature review of care transformations targeting frail elderly. Papers including 1) PCC, 2) integrated, 3) proactive care, 4) at least one digital support element and 5) an effect evaluation with patient, health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure condensed descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the idealized and empirical intervention descriptions to create a new “Maturity of PCC model” which outlines the generic elements of a mature digitally supported PCC system. The authors then reviewed each intervention regarding maturity, study design quality, and intervention effects. Results: Of 927 potentially eligible papers, ten papers fulfilled the inclusion criteria. PCC was an ideal, but only one intervention made “what mattered” to the person visible in the care plan. Other care plans were described mainly in professional terms. Care coordinators responsible for a whole person care-plan, shared electronically in some instances, was the primary strategy countering care fragmentation. No studies report monitoring of care delivery. Risk stratification and management are mostly digitally supported and is the main proactive strategy. No intervention included workflow optimization nor patient-reported outcomes. The “Maturity of PCC model” showed how most interventions had one mature domain only. After study methodology assessment we included four studies in the outcomes summary. Three studies reported no effects while the fourth study found a 30% significant reduction in emergency care utilization. Conclusions: The person-focus in this literature is growing, but patients are still not in charge. The understanding of the synergies and interdependencies between elements of care is weak. The support from digital tools was patchy, and a socio-technical design of patient pathways was difficult to find. We predict that consistent results from complex care transformation efforts for frail elderly will only be achieved when the individual care pathway reflects a synergetic PCC, integrated and pro-active approach.

The transformation and digitalization of health services foresees a need for recruiting individuals with the combined knowledge of technical and health sciences. Education of young people in the domain of eHealth is an important contribution in the on-going digital transformation process. In this context, the research project High School Students as Co-researchers in eHealth aims to introduce technology-supported health care scenarios and research methods to young students in the Southern region of Norway. As a part of the project, simulation of eHealth scenarios was made in a clinical research laboratory together with high school students and experienced researchers. In the simulation, role-play was used to carry out the scenarios. To inform the roles, the tasks and their associated actions, an interactive smartphone application was used. This paper presents the simulation procedure and how the interactive smartphone was developed and used to guide the scenarios.