The practice of using video conferencing systems for health care provider-patient meetings is becoming increasingly more important. Here, we reviewed literature on the subject, with the aim to provide a set of factors and perspective on what has been noted as important for the success/failure of the use of video in consultation meetings. Mostly, previous studies have focused on the outcomes, how well video works for the patient-care professional meeting, when it comes to affecting expected outcomes of the consultation. However, we focus on the contextual factors that have been noted in research on the topic and aim to gather these from a wide range of studies on video used in a home environment. We discuss the results of the study in the broader context of the implementation situation of video consultations systems, providing factors, barriers, and perspectives as well as a general context to use or non-use of the systems. Hence, we provide knowledge that can be taken into account by the designers and developers of such systems.

Ehealth solutions are in great need in the community of elderly in general, as patients or home carers, however a design approach that delivers this is illusive. In this research we present the experiences from a set of design processes targeting elderly’s needs of support or home care, based on a co-design approach. The purpose is to present guiding principles for how to work with elderly in a co-design process, to be used as basis for future set up of co-design processes.

The Internet of Things (IoT) plays a vital role in today’s medicine (Islam et al, 2015). In 2020, 40% of IoT-related technologies will be assigned to the health domain, which makes up around a 117 $ billion in the global market (Bauer, Patel & Veira, 2016). Adding to this the demographic changes will further set a significant challenge in Europe (Steinführer & Haase, 2007). Innovative techniques for supporting health systems and independent life for the aging population is therefore essential, not at least in relation to fall prevention and technology for promoting a good life throughout the lifespan. Further, participation from patients is a goal for healthcare worldwide (Lundgren, Sunesson & Tunved, 2014). For example according to the Health and Medical care act in Sweden (1982:763) it is described that the goal for health care “is good health and care on equal terms for the entire population”. In line with this challenge of integrated care the patient itself will be the most important resource for promotion of health, why Co Design is needed as a method for innovation in healthcare sector. It is important for the users ‘experiences and insights to contribution in improvements but not at least because it has been shown that increased involvement with the user in care reduces the number of hospital visits (Simpsons, 2007).

ICT projects, development and/or research driven, are sources of new innovative eHealth solutions. However, the rate of continued use is low and gaining sustainable benefits in daily operations is difficult (Warth et al.). This research looks at the barriers for the organizational implementation based on research driven projects. 

Three eHealth projects have been analyzed for aspects on the phenomenon, to gain a deeper understanding of the problem. Results are based on discussions between project participants, (professionals, decision makers, patients), and analysis of the project set ups and purposes. 

ResultsFactors that could be seen as important for lack of continued use includes: pure research setup of projects, lack of financial resources in the post projects time , lack of organizational competences for adoption of solutions, no organizational champion or CEO support, lack of fit to organizational processes or scheduling, professional resistance to change, among others. 

DiscussionProject set ups and working methods of the project might hamper the possibilities of effective knowledge transfer and organizational adoption. Experiences from mentioned projects show that a 360-degree co-design approach, which includes major stakeholder (for example, professionals, patients, researchers, patients, decisions makers) should be included. There is a need to prepare for knowledge transfer processes in post project phases, including competence development strategies for professionals and organizational change plans. 

Conclusions A holistic understanding of conditions and challenges is needed for paving the way for health organization to reap benefits from research projects. 

Lessons learned Projects need to include processes for engaging the stakeholders through 360 co-design, knowledge transfer plans and competence development strategies. 

Limitations The research is exploratory and based on analysis of past and ongoing eHealth projects. 

Suggestions for future researchBetter understanding for how to integrating competence development and organizational change as a part of eHealth project are needed. An investigation on digital competence among patients and healthcare personnel is planned, with the purpose of defining competence development strategies and requirements for IT-enabled cooperation and co-production.

IT solutions for rehab are seen as an opportunity to provide effective support for patients’ recovery process in their in-home environment, based on instructions from health care professionals. However, what factors in the context affect the usefulness of such systems lie beyond the training process as such. In this research, we followed a co-design process, where the design of a support packaged for home rehab is based on standard products. Through group interviews with teams of home rehab staff, a broader view of the subject was sought. Group discussions involving the initial demonstration and testing of technology provided a wide spectrum of factors that the staff considered important for success, related to issues on both the organizational and the patient levels. These findings were analyzed for success factors in an attempt to reach an understanding of the rehab process context which will have an effect on the usefulness of the support system. As a result, a checklist of aspects on the process that need to be taken into account in the design of a rehab support system is presented and discussed. The results could be used both in the design of solutions and in the selection and implementation of support systems regarding how to improve the actual use of the systems.

BACKGROUND: Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care.

OBJECTIVE: The objective of our study was to describe health care staff's experience with a digital communication system intended for patient-staff encounters via a digital route in primary care.

METHODS: In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis.

RESULTS: While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient's voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service-at least for a while-if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers.

CONCLUSIONS: A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.

Background

eHealth solutions have often been considered favourable for improved effectiveness and quality in healthcare services for wound management. Staff engagement related to organisational changes is a key factor for successful development and implementation of a new eHealth solution, like a digital decision support systems (DDSS). It is essential to understand the engagement process in terms of sustainability, wellbeing in staff and efficiency in a long-term perspective. The aim of this study was to describe healthcare staff’s engagement during a 6-month test of an eHealth solution (DDSS) for wound management.

Methods

A qualitative design, including interviews conducted with healthcare staff working with wound management within primary, community and specialist care (n = 11) on two occasions: at the introduction of the solution and after 6 months, when the test period was over. Data were interpreted with qualitative content analysis.

Results

Healthcare staff’s descriptions from a 6-month test of an eHealth solution for wound management can be summarised as Engaging through meaning, but draining. The analysis revealed a result with three subcategories: Having a shared interest is stimulating, Good but not perfect and Exciting, but sometimes exhausting. The staff described their engagement as sustained through feelings of meaningfulness when using the eHealth solution, but limited by feelings of exhaustion due to heavy workload and lack of support and understanding from others.

Conclusions

The results indicate that the healthcare staff who tested the eHealth solution described themselves as individuals who easily become engaged when an idea and efforts felt meaningful. The staff needed resources to nourish engagement in their new role when implementing eHealth in the clinical everyday work of wound management. Allocating time and support are important to consider when planning for sustainable implementation of eHealth solutions in healthcare organisations.

Since the late nineteenth century, archaeological research on the ancient past in East-Central Europe has been impacted by the hunt for peoples assumed to be the one true ancestral population, continuously occupying the territory of the modern nation-state. In Romania, we see this with a myth of origin founded on the idea of firstly Roman, then Dacian, and finally Daco-Roman continuity, arguing that modern Romanians are directly descended from a population known from Antiquity. In Bulgaria and Hungary, we see myths of origin linked to the Bulgars and Magyars, respectively, deriving a national identity from the peoples who entered the region in Late Antiquity and the Early Medieval Period. These myths and the study of the past form a symbiotic relationship, creating and sustaining each other. This chapter focuses on Romania to illustrate how a regionally diverse past has been co-opted into a narrative supporting one nation's myth of origin. Using the same archaeological evidence from the region of modern Romania, I consider how we might construct archaeological narratives that give a similar sense of 'deep' belonging without supporting narratives of mythical autochthonous continuity.

Data mining approaches have proven to be successful in improving learners’ interaction with educational computer games. Despite the potential of predictive modelling in providing timely adaptive learning and gameplay experience, there is a lack of research on the early prediction of learners’ performance in educational games. In this research, we propose an early predictive modelling approach, called GameEPM, to estimate learners’ final scores in an educational game for promoting computational thinking. Specifically, the GameEPM approach models the sequence of learners’ actions and then uses a limited sequence of the actions to predict the final score of the game for each learner. The findings from our initial trials show that our approach can accurately and robustly estimate the learners’ performance at the early stages of the game. Using less than 50% of learners’ action sequences, the cross-validated deep learning model achieves a squared correlation higher than 0.8 with a relative error of less than 8%, outperforming a range of regression models like linear regression, random forest, neural networks, and support vector machines. An additional experiment showed that the validated deep learning model can also achieve high performance while tested on an independent game dataset, showing its applicability and robustness in real-world cases. Comparing the results with traditional machine learning methods revealed that, in the validation and application phases, up to 0.30 and 0.35 R2 gain is achieved in favor of the deep learning model, respectively. Finally, we found that while the lengths of action sequences influence the predictive power of the traditional machine learning methods, this effect is not substantial in the deep learning model

Digging Politics explores uses of the ancient past in east-central Europe spanning the fascist, communist and post-communist period. Contributions range from East Germany to Poland to Romania to the Balkans. The volume addresses two central questions: Why then and why there. Without arguing for an east-central European exceptionalism, Digging Politics uncovers transnational phenomena across the region that have characterized political wrangling over ancient pasts. Contributions include the biographies of famous archaeologists during the Cold War, the wrought history of organizational politics of archaeology in Romania and the Balkans, politically charged Cold War exhibitions of the Thracians, the historical re-enactment of supposed ancient Central tribes in Hungary, and the virtual archaeology of Game of Thrones in Croatia. Digging Politics charts the extraordinary story of ancient pasts in modern east-central Europe.

Background: The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective: This study aims to explore patients' experiences using a chat-based and automated medical history-taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods: Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history-taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results: The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history-taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one's time and reflect on one's situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions: Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service.

Objective: This study explored the Swedish digital health testbeds through the lens of complexity science.

Methods: The purposive sampling was used to identify 38 digital health testbed organizations to conduct interviews in written or audio-conferencing. The interview responses were aggregated and analyzed using thematic analysis. The themes were mainly generated through complexity theory and the principles of complex adaptive systems.

Results: Fifteen testbed organizations responded, comprising 13 written responses and two audio-conferencing. Five maintheoretical themes were generated: agents and diversity, connections and communication, adaptation and learning, perturbations,and path dependence. Agents and diversity depicted different types of testbeds, stakeholders and innovation, and the primary function and purpose of the testbeds. Various factors enhancing connections and communications among multiple stakeholders were identified, such as the quality of e-health solutions and the 2030 Agenda for Sustainable Development. Some adaptation and learning factors, such as internal reorganization, sharing and creating learning opportunities, and additional funding, guaranteed the sustainability of testbeds. Perturbations were characterized by two factors: non-linear interactions – lack of commitment and transparency in stakeholders’ engagement, and uncertainty about testbed definitions and concepts. Path dependence highlighted the importance of history, such as previous positive and negative experiences.

Conclusion: This study provided insights into testbeds’ organization, their functions, how various aspects were challenged,and how they adapted to overcome and improve the system issues. Identifying the stakeholders and relevant factors, commissioning an evaluation, backing up with a contingency plan, securing adequate funding, and disseminating the findings can improve the testbeds’ design and implementation.

This study aimed to examine health information technology-related incidents and identify risks associated with multiple patients' management. Sources of information comprised interviews with healthcare professionals and three small sets of local voluntary incident reports using two sampling strategies, purposive and snowball sampling. Incident reports, in the form of free-text narratives, were aggregated for analysis using the Health Information Technology Classification System and thematic analysis. Of 95 incidents, 176 issues were identified, comprising 77% (n=136) technical issues, and 23% (n=40) use or human-related issues. Human issues were over two times more likely to harm patients (OR 2.25, 95% CI 1.01 - 4.98) than technical issues. Incidents that affected multiple patients' care accounted for 70% (n=66) of the total sample, and large-scale events comprised 39% (n=26) of the incidents that affected multiple patients' care. Systematically identifying and characterizing such incidents should be prioritized for health information technology implementations.

Background: Chronic somatic health conditions are a global public health challenge. Being engaged in one's own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement. Objective: The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions. Methods: An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects-cognitive, behavioral and emotional, interactional, and the usage of mHealth-as part of the synthesis and analysis. Results: A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with health care professionals. Conclusions: mHealth solutions have the potential to support health care engagement for persons with chronic somatic conditions. More research is needed to further understand how, by which means, when, and among whom mHealth could further improve engagement for this population.

The main goal of this chapter is twofold. First, we seek to investigate university students’ understanding of learning analytics (LA) practices in learning management systems (LMSs). Second, we examine students’ ethical stances when raising awareness of such practices through a data visualization dashboard. The empirical work carried out involved deploying a LA dashboard during the 2020 summer semester at a university in Sweden. The LA dashboard was designed to raise students’ awareness about LA practices by providing students with visualizations of the data collected by the LMS. Our findings indicate that the students rated values such as trust, privacy, transparency, and informed consent highly. Although most of the students appreciated the efforts made towards transparency through consent forms, and expected to be informed about the collected data, few students read the higher education institution’s (HEI’s) data collection policy documents. We also found that the students’ trust in their institution is a significant motivator for students’ willingness to share their data. However, we believe that this trust needs to be safeguarded by HEIs and not used as a sine qua non condition for collecting, visualizing, storing, and using students’ data. The findings concerning students’ trust highlight the importance of not breaking boundaries to maintain trust and respect among key educational stakeholders (Beattie S, Woodley C, Souter K, Creepy analytics and learner data rights. Rhetoric and reality: critical perspectives on educational technology. Proceedings ascilite, pp 421–425, 2014). Furthermore, we also observed that students’ attitudes towards data collection processes and data usage are highly related to the context of its use and with whom such data is shared. These findings are relevant for the LA community as they contribute with insights that may guide policymaking, implementation of LA at HEIs, and the design of data visualizations. We end the article by discussing the implications of our findings regarding the privacy paradox and contextual integrity (Nissenbaum, Washington Law Review, 79:119, 2004; Slade S, Prinsloo P, Khalil M, Learning analytics at the intersections of student trust, disclosure and benefit. In: Proceedings of the 9th International Conference on learning analytics & knowledge, pp 235–244, 2019), which are central concepts to consider when conceptualizing and designing LA dashboards.

Learning Analytics (LA) is an emerging practice at a very early stage of adoption especially inEurope [10]. In particular, LA, which incorporates Predictive Analytics (PA), is dependent on large and rich datasets for accuracy. Most LA solutions use data available from Learning Management Systems (LMS), and Student Information Systems (SIS). As such, the data used is limited to the student’s activities and interactions with these systems. This data might in turn be inadequate forbasing analysis and predictions on. Many LA solutions are therefore looking beyond these systemsto include data from other sources as well. Data such as social media analysis, library use, studentbehaviour based on access card swipes and IP address as well as other multimodal data from avariety of sensors etc could be included.

There are several motivations for integrating data such as scaling up LA projects, enabling improvements of new educational technologies, and making more accurate and fine-grained analyses based on a wider set of data.Recent research points to the limited focus on technical details of integrating data and the very limited use of data integration specifications [8]. This study,therefore, aims to help close this gap in current research by identifying limitations and issues in data integration based on previous research efforts to inform and propose an architecture to enable further development and opportunities when scaling up LA projects.

The proposed architecture enables data integration of different data types from various educational technologies used in the learning environment. Drawing on principles of clean architecture[6] the decoupling of business rules is informing the architecture design. As such a component is also independent of other external “layers” such as user interface, frameworks and database.

Background: eHealth solutions such as digital decision support systems (DDSSs) have the potential to assist collaborationbetween health care staff to improve matters for specific patient groups. Patients with hard-to-heal ulcers have long healing timesbecause of a lack of guidelines for structured diagnosis, treatment, and follow-up. Multidisciplinary collaboration in woundmanagement teams is essential. A DDSS could offer a way of aiding improvement within wound management. The introductionof eHealth solutions into health care is complicated, and the engagement of the staff seems crucial. Factors influencing andaffecting engagement need to be understood and considered for the introduction of a DDSS to succeed.

Objective: This study aims to describe health care staff’s experiences of engagement and barriers to and influencers of engagementwhen introducing a DDSS for wound management.

Methods: This study uses a qualitative approach. Interviews were conducted with 11 health care staff within primary (n=4),community (n=6), and specialist (n=1) care during the start-up of the introduction of a DDSS for wound management. Theinterviews focused on the staff’s experiences of engagement. Content analysis by Burnard was used in the data analysis process.

Results: A total of 4 categories emerged describing the participants’ experiences of engagement: a personal liaison, a professionalcommitment, an extended togetherness, and an awareness and understanding of the circumstances.

Conclusions: This study identifies barriers to and influencers of engagement, reinforcing that staff experience engagementthrough feeling a personal liaison and a professional commitment to make things better for their patients. In addition, engagementis nourished by sharing with coworkers and by active support and understanding from leadership.