Research and projects at HIC

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At HIC the research focuses on clinical informatics in the areas Patient Centred Information Systems, Decision support and Decision making. The projects below are listed in alphabetical order.

MobEVAL – evaluation of mobile ICT in homecare

The introduction of electronic health records (EHRs), clinical decision support systems (CDSS) and other IT systems in primary health care have simplified the daily work but also resulted in increased time for administration. Yet, although IT has been used in health care for decades we still only use a fraction of the potential of modern information technologies. Employees in primary health care still depend on desktop computers in order to carry out documentation and other care related administrative work, despite a large part of primary care work is performed in the patient's home. Mobile EHRs have been shown to improve the documentation quality, yet knowledge about current adoption in the Swedish context and the impact of such tools remain low.

The purpose of this research project is to explore how the implementation of mobile IT-systems in home care affects the work of health care professionals. In order to achieve this aim, we will 
1. explore the current state of implementation of mobile IT-systems in home care, and
2. examine how the implementation of new mobile IT-systems affects healthcare professionals’ work situation, specifically focusing on administration time, working environment (mainly in terms of experienced stress) and healthcare professionals perception of patient safety in relation to documentation, access to information and communication tools in mobile work situations.

There are many different evaluation methods and tools to be applied, yet guidance on what approaches are most suitable to apply and what factors are most important to evaluate is limited. We believe that this has a negative impact on the number of evaluation studies performed of mobile IT-systems in homecare and their quality. In parallel with the evaluation study, we will therefore also develop a framework for evaluation of mobile IT-systems in healthcare, with the primary user group healthcare professionals.

Participating researchers:

Computer-interpretable guidelines through openEHR

Integration of computer-interpretable guidelines with openEHR

The focus of this research is to offer new ways of supporting clinical processes through the use of information technology that is based on reusable evidence-based data structures, models and components. In the long term this can lead to the creation of customizable e-services for patient-specific decision making in health care. In particular, computerisation of clinical practice guidelines will be explored using openEHR, a semantic technology for electronic health records.

The project is a collaboration between the KI departments LIME, MedSolna and Clinical Neuroscience as well as with the company Cambio Healthcare Systems. 

Project members are Sabine Koch, LIME; Michael Fored, MedSolna; Rong Chen, Cambio Healthcare Systems and LIME; Tiago Prazeres Moreira, Clinical Neuroscience.

 Publications

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR's Guideline Definition Language.
Anani N, Chen R, Prazeres Moreira T, Koch S
BMC Med Inform Decis Mak 2014 May;14():39

Early Experiences from a guideline-based computerized clinical decision support for stroke prevention in atrial fibrillation.
Chen R, Valladares C, Corbal I, Anani N, Koch S
Stud Health Technol Inform 2013 ;192():244-7

OpenEHR-based representation of guideline compliance data through the example of stroke clinical practice guidelines.
Anani N, Chen R, Prazeres Moreira T, Koch S
Stud Health Technol Inform 2012 ;180():487-91

Patient lead user

Patients who know, can and do more and a health care system that can meet their needs.

This Vinnova-project is based on the previous project ´Chronic know ledge´ and we now want to continue and create a center for lead patients, where training and education, regardless of diagnosis, will be delivered. A lead patient is a patient (or informal care giver) who develops strategies and methods to maximize their ´feel-w ell-time´, while living with a life-altering illness. We believe that self-care education and access to the right tools will result in more lead patients. The center will also contribute to increasing the interactions between patients and other stakeholders.

The project partners are geographically and organizationally diverse and include patient organizations, academia, the public sector, private healthcare providers and corporations. Together we represent a broad field of competences and a clear focus on the key issue of the project, which is to support patients' self-care and participation in healthcare improvement work. Our solution will contribute to radically improving the way healthcare meets the competences and expectations of patients in self-care and improvement work. Patients who are able to assume a greater responsibility for their own health will enable healthcare resources to be reallocated and used for those who need more help.

The potential is considerable, both regarding healthcare cost savings, new models for healthcare delivery and new business opportunities. 

Contact person: Sara Riggare

Heart Rate Variability Biofeedback Game

Reduced heart rate variability (HRV) is an indicator of a malfunctioning autonomic nervous system, which could be a cause or consequence of disease.
Resonant frequency breathing is a potential non-invasive means of intervention for improving the balance of the autonomic nervous system and increasing HRV. However, such breathing exercises are regarded as boring and monotonous tasks. The use of gaming elements (gamification) or even the creation of a full gaming experience is a well-recognised method for achieving higher motivation and engagement in various tasks. However, there is limited documented knowledge on how to design a game for health purposes, e.g., breathing exercises. In particular, the influence of additional interactive elements on the main course of training has not yet been explored.

In a collaboration with the School of Technology and Health, Royal Institute of Technology, we evaluated the satisfaction levels achieved using different game elements and how disruptive they were to the main task, i.e., paced breathing training. An Android flight game was developed with three game modes that differ in the degrees of multitasking they require. Design, development and evaluation were conducted using a user-centred approach, including context analysis, the design of game principle mock-ups, the selection of game principles through a survey, the design of the game mechanics and GUI mock-up, icon testing and the performance of a summative study through user questionnaires and interviews. A summative evaluation of the developed game was performed with healthy participants (ages 40-67) in a controlled setting.

The results confirm the potential of video games for motivating players to engage in HRV biofeedback training. The highest training performance on the first try was achieved through pure visualisation rather than in a multitasking mode.  However, players had higher motivation to play the more challenging game and were more interested in long-term engagement. This project will be followed by recruiting people suffering from depression and stress to evaluate the games.  

Contact person: Aboozar Eghdam

IntegrIT

The goal of IntegrIT is to develop an infrastructure for patient-oriented clinical research that integrates data collection from patient records, research templates and patients' self-reporting. The aim is to promote clinical research in the regular care while reducing administrative time for both researchers and patients.

My Care Pathways

The project 'My Care Pathways' strives towards the vision to enable citizens to track their health by providing them online access to past history, current state and prospective future events regarding their personal care pathways. Read more about the project on it´s separate pages.

My Care Plan

My care plan is a study on supporting self-care and collaboration in stroke care through information and communication technology. The main purpose of our research is to examine how health information systems (in this context 'My care plan') used by patients with chronic or long-term illnesses should be designed to improve collaboration, patient participation, autonomy and self-care. In this project we will therefore develop a prototype 'My care plan' that will be a tool with a focus on care and rehabilitation planning as a means to improve collaboration between patients and healthcare staff and a tool to enable long-term reporting and monitoring of individual's health status.

This project is financed by the Health Informatics Centre (HIC). Project time: 2011-2016. Contact person: Maria Hägglund

National study of eHealth in ambulance care 

A questionnaire study to describe how information and communication technology (ICT) or eHealth is used in ambulance care is performed during 2016. The questionnaire was sent out to ambulance nurses, with the purpose to explore how eHealth supports the nurses information needs during the different phases of the ambulance workflow. The study was performed on behalf of the Swedish eHealth Agency (eHälsomyndigheten) in collaboration between the Swedish Association of Health Professionals (Vårdförbundet), Riksföreningen för ambulanssjuksköterskor and Karolinska Institutet.

Vårdförbundet coordinates the work and distributes the questionnaires to all ambulance nurses in their membership registry. Researchers from the Health Informatics Centre and Sektionen för Omvårdnad at Karolinska institutet are responsible to analyzing the data and reporting the results.

Read more about it at ehälsomyndigheten (in Swedish)

Read more about it at Dagens Medicin (in Swedish)

Participating researchers from HIC: Maria Hägglund and Therese Scott Duncan

Publication

Collaborative interaction points in post-discharge stroke care.
Davoody N, Koch S, Krakau I, Hägglund M
Int J Integr Care 2014 Oct;14():e032

PACESS

Patient-centred assessment of patients' online access to electronic health records (PACESS) is a 3 year research project financed by FORTE, starting in 2017. In Sweden, we are now in a unique position to explore how current eHealth trends can impact on, and even transform healthcare. In this research, we specifically want to explore the impact of patient accessible electronic health records (EHRs) on the areas of health- and self-care, and further explore how eHealth can be used to empower patients to become active participants in both their own care and in the transformation of healthcare. Patient accessible EHRs (PAEHRs) are often heralded as important means for patient empowerment - but we aim to further explore if and how this empowerment takes place. One hypothesis is that only patients who are already empowered use the service, leaving other patients without the potential benifits. Therefore we will explore the benifit of having online access to EHRs and how the design and use of these eHealth services can be improved to empower more people.

In order to harness the powers of eHealth, we need a better understanding of how roles, relationships and organizational structures are affected on micro, meso and macro levels through the introduction of such eHealth services. We also need to understand how the emergence of e-patients affects other roles and impacts on the transformation of healthcare. Therefore the main objective of this research is to explore the impact of information access and innovative eHealth on patients and healthcare.

2 work packages are planned;

  1. Long-term evaluation of the already implemented eHealth service in Swedish healthcare.
  2. Co-creation of innovative e-services that empower citizens.

Throughout the project we will establish a theoretical framework to explain how implementation of eHealth services impact different patient groups and healthcare on different levels of the health system. Furthermore, patient-centred quality indicators will be created to facilitate joint assessments of deployment and use of PAEHRs.

Project leader: Maria Hägglund, Karolinska Institutet
Collaborating researcher: Isabella Scandurra, Örebro University

Supporting persons with mild acquired cognitive impairments through e-services

The objective of this research is to present an overview of the mild/moderate acquired cognitive impairment (MACI) persons’ experience with e-services such as social media, mobile and assistive technology.

This project started with an exploratory study exploring the current assistive information and communication technology (ICT) as a systematic review of the existing literature about available ICT tools for MACI patients using 8 different medical, scientific, engineering, and physiotherapy library databases. The functionality of tools was analyzed using an analytical framework based on the International Classification of Functioning, Disability and Health (ICF). The research was followed by a postal self-administered questionnaire, asking a total of 600 members of a patient organization (Hjärnkraft) regarding the persons’ use of e-services and social media in addition to their cognitive failures level. The project will be followed by an evaluation of a public Facebook group established for people with fatigue after an injury to the brain in addition to a few focus groups meeting with a small number of persons with MACI. So far, the results of different studies of this project showed a lack of special ICT tools for supporting people with MACI in addition to what available services/tools have been used by them frequently (on their own). The results also indicated that communication is the most important aspect of e-services for them. 

Contact person: Aboozar Eghdam

Publication

Information and communication technology to support self-management of patients with mild acquired cognitive impairments: systematic review.
Eghdam A, Scholl J, Bartfai A, Koch S
J. Med. Internet Res. 2012 Nov;14(6):e159

Health Informatics