DOME · eHealth · Medical Records Online

Presentation at Medical Informatics Europe about differences between county councils in Sweden regarding information access in patient accessible electronic health records


My last blog post was about a forthcoming presentation about the effect of patient accessible electronic health records (PAEHRs), at Medical Informatics Europe. This post is about the second full paper that was accepted to the same conference. The main author of that paper is Maria Hägglund and I’m a co-author together with Rose-Mharie Åhlfeldt and Isabella Scandurra. The title of this paper is “Timing it right – patients’ online access to their record notes in Sweden”.

This second paper also focuses on patient accessible electronic health records, but from a different angle: waiting times before new information (e.g. notes from a doctor’s visit or lab results) is accessible through Journalen. There are numerous differences between the implementation of Journalen in different county councils. For example, different types of information is accessible in different county councils. When Journalen was introduced in Region Uppsala in 2012 the patients could get access to almost all types of information (visit notes, diagnoses, lab results, log list, referral tracking, vaccinations, care contact history,…) except radiology images, pathology results and psychiatry records. This is still the case for those who have received care in that region. Those who have received care in Region Skåne (the second county countil in Sweden to implement Journalen), however, can only see visit notes, diagnoses and care contact history.

Two other big differences can be seen when it comes to when information is accessible in Journalen and if patients can access unsigned information (results and notes which the physician has not yet validated). Currently, the applied rules differ between county councils in Sweden:

  • Immediate access to signed notes (17/20) county councils)
  • Immediate access to unsigned notes (7/20 county councils) – in this case the patient decides if s(he) wants direct access to unsigned notes or not.
  • No access to unsigned notes (1/20 county councils)
  • Access to signed notes after a waiting period of 14 days (3/20 county councils)
  • Access to unsigned notes after 14 days (12/20 county councils)

In the paper we show which rules are applied by the different county councils and discuss the rules and their implications more thoroughly. We also discuss the different implementations in relation to some of the results from the national patient survey in Sweden regarding general attitudes towards Journalen and expectations on waiting times.

Here is the abstract:

In Sweden, and internationally, there is an ongoing debate about the effects of national implementations of Patient Accessible Electronic Health Records (PAEHRs). The purpose of this paper was to describe the current situation in Sweden and compare this with the expectations on reasonable waiting time for information access of users of the Swedish PAEHR. Data were collected from publicly available resources regarding current implementation in the 21 county councils, contrasted with patient experiences, gathered from a national online survey. The results indicate that patients have high expectations on immediate access to information, while this varies greatly in implementation across Sweden.

DOME · eHealth · Medical Records Online

Presentation about the effect of patient accessible electronic health records on nurses’ work environment at Medical Informatics Europe


I haven’t been blogging for a while due to, among other things, the research grant and job applications I wrote about here. Some things have been submitted now, and I will come back to those shortly. Now, I want to concentrate on accepted papers, workshops and presentations to Medical Informatics Europe (MIE) and Vitalis in Gothenburg in the next couple of posts. The reason is that I got several confirmation letters about final acceptance last Friday. I have already mentioned the conditionally accepted papers here. We submitted revised versions of all of them accept for the short communication on psychiatry records – we decided to go for a journal article instead later on during the spring.

The first paper that was submitted to this year’s MIE conference was about the effect of patient accessible electronic health records (PAEHRs) on the nurses’ work environment. It reports on a rather small interview study at a clinic and was originally performed as a master’s thesis project by the Uppsala University students Sara Englund and Anastasia Hansman. Åsa Cajander, who was also the supervisor of the students, is the main author of the conference paper and I am one of the co-authors since I also helped in writing the paper. The title of this paper is “Medical Records Online for Patients and Effects on the Work Environment of Nurses”.

One of the reasons why the study reported in the paper focuses on nurses is that most studies about the effect of PAEHRs focus on physicians and their work environment or their interaction with patients (See for example the newly published paper ““Why Do They Need to Check Me?” Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study” by my some of my colleagues in the DOME consortium). This is also one of the reasons why we include nurses in the large interview/observation/survey study which I’m leading at the oncology department at Uppsala University Hospital. In the MIE paper, results regarding the following themes are discussed: Altered contacts, Increases workload, Creates uncertainty and Requires new knowledge.

Here is the abstract:

In 2012 Patients Accessible Electronic Health Records (PAEHR) was introduced in Region Uppsala, Sweden. When PAEHR was introduced heath care professionals were very concerned especially in relation to potential negative effects on their work environment. However, few studies exist that investigate in what way work environments have been affected, and no studies have focused on the nurses’ working in primary care. Hence, the purpose of this study was to fill this gap through seven interviews with primary care nurses that were transcribed and thematically analysed. The study shows that the nurses’ experiences an altered contact as patients accessing PAEHR came prepared to meetings with more informed questions. They also experienced that the service had increased their work load and that it creates uncertainty for nurses who do not know when to inform the patient about test results etc. Finally, some implications are discussed in relation to the patients’ role in shared decision making.

The schedule for the conference is not finalized yet, so I cannot give any information about when the paper is going to be presented. The only thing I know is that it will be one of the days April 24-26. I will write a new post about the specific presentation times for our accepted papers and the workshop as soon as they have been decided.

Grant application · Group work · Haptics

Recently submitted a project proposal to this year’s Forte junior research grant!


A few weeks ago I wrote a blog post about the spring of opportunities, which basically contained lists of possible research grant and job opportunities that were open or should open during the spring term. Just before lunch today, I submitted the first of my planned project proposals! This one went to Forte and their grants for junior researchers.

The proposed project relates to work that I performed while I was still working at KTH as a Ph.D. student and the content was also inspired by the application that I sent to VR last year (see this blog post). The project is based on the fact that today’s assistive technologies that visually impaired pupils use in the classroom are not really designed for collaborative situations – the technology could sometimes be a hindrance when doing group work with sighted peers. Our hope is that the planned activities will really shed light on the problems this is causing and show how one can make use of modern technology, based on haptic and audio feedback, to find ways ahead. I have already done a few studies in this area which you e.g. can read about in this article (note that this is a pre-print version). I will write more about this when I get an answer from Forte about the draft later on in April.

My co-applicant is Eva-Lotta Sallnäs Pysander from KTH, who was also my main supervisor there. If we get the grant, we will hopefully be able to add a Ph.D. student to the research team as well.

I must say that it’s nice to have this proposal submitted. I really believe in the ideas in it and I also think that the project could make a real difference. Since I’m generally very interested in multimodal interaction and learning, this is also one of the areas I really want to focus on in my research in the future. The other area is eHealth and as I have written before there are quite a few funding opportunities in that area as well during this spring. But right now I’m just enjoying that I have one application out there, just as the razorbill in the image above probably enjoys sitting on a cliff looking out over the ocean…