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Background Patients’ online record access (ORA) enables patients to read and use their health data through online digital solutions. One such solution, patient-accessible electronic health records (PAEHRs) have been implemented in Estonia, Finland, Norway, and Sweden. While accumulated research has pointed to many potential benefits of ORA, its application in mental healthcare (MHC) continues to be contested. The present study aimed to describe MHC users’ overall experiences with national PAEHR services. Methods The study analysed the MHC-part of the NORDeHEALTH 2022 Patient Survey, a large-scale multi-country survey. The survey consisted of 45 questions, including demographic variables and questions related to users’ experiences with ORA. We focused on the questions concerning positive experiences (benefits), negative experiences (errors, omissions, offence), and breaches of security and privacy. Participants were included in this analysis if they reported receiving mental healthcare within the past two years. Descriptive statistics were used to summarise data, and percentages were calculated on available data. Results 6,157 respondents were included. In line with previous research, almost half (45%) reported very positive experiences with ORA. A majority in each country also reported improved trust (at least 69%) and communication (at least 71%) with healthcare providers. One-third (29.5%) reported very negative experiences with ORA. In total, half of the respondents (47.9%) found errors and a third (35.5%) found omissions in their medical documentation. One-third (34.8%) of all respondents also reported being offended by the content. When errors or omissions were identified, about half (46.5%) reported that they took no action. There seems to be differences in how patients experience errors, omissions, and missing information between the countries. A small proportion reported instances where family or others demanded access to their records (3.1%), and about one

The Nordic countries are, together with the United States, forerunners in online record access (ORA), which has now become widespread. The importance of accessible and structured health data has also been highlighted by policy makers internationally. To ensure the full realization of ORA’s potential in the short and long term, there is a pressing need to study ORA from a cross-disciplinary, clinical, humanistic, and social sciences perspective that looks beyond strictly technical aspects. In this viewpoint paper, we explore the policy changes in the European Health Data Space (EHDS) proposal to advance ORA across the European Union, informed by our research in a Nordic-led project that carries out the first of its kind, large-scale international investigation of patients’ ORA—NORDeHEALTH (Nordic eHealth for Patients: Benchmarking and Developing for the Future). We argue that the EHDS proposal will pave the way for patients to access and control third-party access to their electronic health records. In our analysis of the proposal, we have identified five key principles for ORA: (1) the right to access, (2) proxy access, (3) patient input of their own data, (4) error and omission rectification, and (5) access control. ORA implementation today is fragmented throughout Europe, and the EHDS proposal aims to ensure all European citizens have equal online access to their health data. However, we argue that in order to implement the EHDS, we need more research evidence on the key ORA principles we have identified in our analysis. Results from the NORDeHEALTH project provide some of that evidence, but we have also identified important knowledge gaps that still need further exploration., CC BY 4.0©Maria Hägglund, Anna Kharko, Annika Bärkås, Charlotte Blease, Åsa Cajander, Catherine DesRoches, Asbjørn Johansen Fagerlund, Josefin Hagström, Isto Huvila, Iiris Hörhammer, Bridget Kane, Gunnar O Klein, Eli Kristiansen, Jonas Moll, Irene Muli, Hanife Rexhepi, Sara Riggare, Peeter Ross, Isabella Scandurra, Saija Simola, Hedvig Soone, Bo Wang, Maedeh Ghorbanian Zolbin, Rose-Mharie Åhlfeldt, Sari Kujala, Monika Alise Johansen.Corresponding Author: Maria Hägglund, maria.hagglund@uu.seThis work was supported by the Citizen and Health Data Working Group in the European Federation for Medical Informatics (CHD WG, EFMI). This work was supported by NordForsk through the funding to Nordic eHealth for Patients: Benchmarking and Developing for the Future, NORDeHEALTH (project #100477), the Swedish Research Council for Health, Working Life and Welfare (FORTE) through the funding to Beyond Implementation of eHealth (project #2020-01229), the Strategic Research Council at the Academy of Finland (projects #352501 and #352503), and the Norwegian Centre for E-health Research. CB was supported by a Keane Scholar Award. The study funders played no role in the study design, data interpretation, writing of the results, or decision to submit the manuscript for publication., Nordic eHealth for Patients: Benchmarking and Developing for the Future, NORDeHEALTH

BACKGROUND: The NORDeHEALTH project studies patient-accessible electronic health records (PAEHRs) in Estonia, Finland, Norway, and Sweden. Such country comparisons require an analysis of the sociotechnical context of these services. Although sociotechnical analyses of PAEHR services have been carried out in the past, a framework specifically tailored to in-depth cross-country analysis has not been developed. OBJECTIVE: This study aims to develop and evaluate a method for a sociotechnical analysis of PAEHRs that advances a framework for sociotechnical analysis of eHealth solutions first presented by Sittig and Singh. This first article in a series presents the development of the method and a cross-country comparison of the contextual factors that enable PAEHR access and use. METHODS: The dimensions of the framework for sociotechnical analysis were thoroughly discussed and extended in a series of workshops with international stakeholders, all being eHealth researchers focusing on PAEHRs. All countries were represented in the working group to make sure that important national perspectives were covered. A spreadsheet with relevant questions related to the studied services and the various dimensions of the sociotechnical framework was constructed and distributed to the 4 participating countries, and the project participants researched various national sources to provide the relevant data for the comparisons in the 10 sociotechnical dimensions. RESULTS: In total, 3 dimensions were added to the methodology of Sittig and Singh to separate clinical content from features and functions of PAEHRs and demonstrate basic characteristics of the different countries regarding national and regional steering of health care and information and communications technology developments. The final framework contained the following dimensions: metadata; hardware and software computing infrastructure; features and functions; clinical content shared with patients; human-computer interface; peop

Background: Although many surveys have been conducted on patients accessing their own health records in recent years, there is a limited amount of nationwide cross-country data available on patients’ views and preferences. To address this gap, an international survey of patient users was conducted in the Nordic eHealth project, NORDeHEALTH. Objective: We aimed to investigate the sociodemographic characteristics and experiences of patients who accessed their electronic health records (EHRs) through national patient portals in Norway, Sweden, Finland, and Estonia. Methods: A cross-sectional web-based survey was distributed using the national online health portals. The target participants were patients who accessed the national patient portals at the start of 2022 and who were aged ≥15 years. The survey included a mixture of close-ended and free-text questions about participant sociodemographics, usability experience, experiences with health care and the EHR, reasons for reading health records online, experience with errors, omissions and offense, opinions about security and privacy, and the usefulness of portal functions. In this paper, we summarized the data on participant demographics, past experience with health care, and the patient portal through descriptive statistics. Results: In total, 29,334 users completed the survey, of which 9503 (32.40%) were from Norway, 13,008 (44.35%) from Sweden, 4713 (16.07%) from Finland, and 2104 (7.17%) from Estonia. National samples were comparable according to reported gender, with about two-thirds identifying as women (19,904/29,302, 67.93%). Age distributions were similar across the countries, but Finland had older users while Estonia had younger users. The highest attained education and presence of health care education varied among the national samples. In all 4 countries, patients most commonly rated their health as “fair” (11,279/29,302, 38.48%). In Estonia, participants were more often inclined to rate their health positi

BACKGROUND: Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. OBJECTIVE: The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. METHODS: Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. RESULTS: Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non

Background: Patient-accessible electronic health records (PAEHRs) hold promise for empowering patients, but their impact may vary between mental and somatic health care. Medical professionals and ethicists have expressed concerns about the potential challenges of PAEHRs for patients, especially those receiving mental health care. Objective: This study aims to investigate variations in the experiences of online access to electronic health records (EHRs) among persons receiving mental and somatic health care, as well as to understand how these experiences and perceptions vary among those receiving mental health care at different levels of point of care. Methods: Using Norwegian data from the NORDeHEALTH 2022 Patient Survey, we conducted a cross-sectional descriptive analysis of service use and perceptions of perceived mistakes, omissions, and offensive comments by mental and somatic health care respondents. Content analysis was used to analyze free-text responses to understand how respondents experienced the most serious errors in their EHR. Results: Among 9505 survey participants, we identified 2008 mental health care respondents and 7086 somatic health care respondents. A higher percentage of mental health care respondents (1385/2008, 68.97%) reported that using PAEHR increased their trust in health care professionals compared with somatic health care respondents (4251/7086, 59.99%). However, a significantly larger proportion (P<.001) of mental health care respondents (976/2008, 48.61%) reported perceiving errors in their EHR compared with somatic health care respondents (1893/7086, 26.71%). Mental health care respondents also reported significantly higher odds (P<.001) of identifying omissions (758/2008, 37.75%) and offensive comments (729/2008, 36.3%) in their EHR compared with the somatic health care group (1867/7086, 26.35% and 826/7086, 11.66%, respectively). Mental health care respondents in hospital inpatient settings were more likely to identify errors, NORDeHEALTH

RESEARCH HIGHLIGHTS: center dot A qualitative study of Global Virtual Teams (GVTs) and their challenges during the Covid-19 Pandemic. center dot GVT members became proactive in dealing with the challenges of 100% remote working. center dot GVTs adapt their methods of working and the tools available to them. center dot Communication failures, building trust and relationships, and resolving conflict are significant challenges. center dot Lack of informal communication opportunities adversely affects relationships in GVTs. center dot Further investigation of gender differences in attitudes and practices are prompted; and the associations between trust and conflict resolution in virtual relationships. Virtual work introduces distinct challenges when compared to face-to-face or on-site work. Communication and collaboration are key factors in team development and in team performance. When teamwork is of a global nature, imposed because of a pandemic, then additional variables are introduced into the equation. The challenges that global virtual teams (GVTs) encounter when communicating and developing in the context of the Covid-19 pandemic impacts how work is structured and teams develop. This qualitative study was conducted just over 1 year after the start of the Covid-19 pandemic when working from home became mandatory and particular challenges for GVTs became apparent. Data are gathered through an online anonymous survey and followed by semi-structured video-mediated interviews with staff in a large multinational software development company. Findings show that GVTs encounter a number of distinct challenges than face-to-face teams. However, individuals are actively adapting to the situation in which they find themselves and are learning to deal with the challenges by being proactive. Even though the tools used previously may not be entirely suitable for virtual work, GVTs learn to change how tools are used to be more productive and collaborative. Challenges continue to

The Nordic countries are forerunners in online record access (ORA) which has now become widespread. The importance of accessible and structured health data has also been highlighted by policymakers internationally. To ensure the full realization of ORA’spotential in the short and long term, there is a pressing need to study ORA from a cross-disciplinary, technical, clinical, humanistic, and social sciences perspective that looks beyond strictly technical aspects. In this viewpoint paper, we explore the policy changes in the European Health Data Space (EHDS) proposal to advance ORA across the European Union, and introduce a Nordic-led research project that carries out the first of its kind, large-scale international investigation of patients’ ORA; NORDeHEALTH. We argue that the EHDS proposal will pave the way for patients to access and control third-party access to their electronic health records (EHRs). This will have implications within Europe and globally as it will further extend the boundaries for accessing and using EHRs for primary and secondary data use. Research such as that led by the NORDeHEALTH project is essential in guiding the design and implementation of solutions to meet the requirements of the EHDS proposal. Further international collaboration and research are needed to ensure that socio-technical and contextual factors are considered to ensure successful and secure implementation., This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Background and purpose: Working collaboratively as a multidisciplinary team in the treatment and care of cancer patients is proven effective in increasing the quality of patient care. A multidisciplinary team (MDT) meeting (MDTM) is the main vehicle that facilitates this collaborative work between different healthcare specialities, and an appropriate meeting record is essential to communicate the meeting's outcomes. There is limited research to date regarding MDTM documentation, and here we report on a sample of healthcare professional's perspectives on current practices. Methodology: A survey, distributed to a purposive snowball sample, is used to collect the perceptions on record-keeping at MDTMs from involved healthcare workers. The survey is descriptive and exploratory in nature and uses closed and open-ended questions offered in both English and Swedish. Results: With a response of 37 healthcare workers, several commonly understood practices of MDTMs are confirmed, documentation is mostly electronic, encompasses suggested information, and the record is mostly acceptable in quality. The issues of responsibility, registering attendance, and verification of documentation can be improved. Conclusion: Electronic documentation is a laudable step that shows advancement in MDTM record-keeping. The highlighted quality of the records suggests that MDTM proceedings are reasonably well documented. There remain some important questions, with regard to standardization, centralization, and the responsibility for record-keeping at MDTMs.

CC BY 4.0Creative Commons Attribution License (CC BY)Copyright © 2022Correspondence: Maria Hägglund maria.hagglund@kbh.uu.se

Understanding demand on healthcare services is critical to inform resourcing decisions for service demands. We ask two questions: 1) Can out-patient (OPD) demand for the plastic and reconstructive services be forecast? 2) Can we predict theatre requirements in terms of volume, type or complexity? The use of Time Series Analysis (TSA), simulation modelling, data-driven methods including data mining are reviewed to address the questions. Starting with a knowledge-discovery in databases methodology, Autoregressive integrated moving average (ARIMA) TSA is applied to forecast OPD referral demand. Monte Carlo simulation (MCs) is used to forecast the theatre requirements in terms of type, complexity, volume, and duration. The ARIMA modelling forecasts 4,151 OPD referrals in the coming 12 months, which results in the requirement for 499 theatre sessions with intensive care facilities (total of 671 surgical intervention procedures); 301 minor theatre sessions (total of 1,836 procedures) and 206 theatre sessions (total of 761 procedures). Surgical intervention (procedure) types and theatre requirements form the research output that predicts an increase in theatre capacity is required to keep pace with demand in the short term. The insight provided into issues allows informed strategy development and decision-making. Our methodology can be easily adapted and applied to other surgical specialities with similar datasets.

The graphical and interactive design of a consent form helps individuals to keep control and pay attention to the information that they are disclosing. In the context of mobile apps we propose and test alternative interaction design solutions for selecting personal information on permission dialogues, namely using checkboxes, a drag-and-drop selection, and a swiping action. We test each proposed design and compare the results in terms of their usability and effectiveness in helping users to be more attentive and aware of their data flow, in other words, to provide their informed consent. This study demonstrates that checkboxes while speedy do not engage the user as much as drag-and-drop or swiping. User satisfaction is positively impacted by these newer ways of giving consent.

Electronic prescription (e-Prescription) is a digital way to manage medical prescriptions and reduce inconsistencies in the communication between doctors, patients, and pharmacies. Smart contracts allow the automation of tasks and business rules in a decentralized architecture (i.e., without the need for an intermediary or central authority). Platforms such as Ethereum and Hyperledger Fabric support smart contracts development through a consensus mechanism such as Proof-of-Work or another criterion among the network's participating nodes. This paper explores Tendermint, a Byzantine Fault Tolerant (BFT) based consensus mechanism that has not yet been widely adopted for smart contracts platforms. We apply our devised model to the healthcare application domain, more precisely in the field of e-prescription, and our results demonstrate that smart contracts can be implemented on a BFT-based platform. To the best of our knowledge, this is the first study investigating the implementation of smart contracts in a BFT-based platform such as Tendermint. We exploit this domain as there can exist some conflicting interests of profit-taking. For example, pharmacists can increase the medication dosage above the one prescribed by doctors for profit-taking. Such a scenario can occur particularly in countries where healthcare is free of charge and offered as a public service (e.g., Brazil). We show that smart contracts in BFT-based blockchain can help in solving problems in these application scenarios. Finally, our two key contributions in this paper are two-fold: (i) exploit smart-contracts in BFT-based platforms where they (smart contracts) are not very established yet in the blockchain domain; (ii) provide a smart-contract-based e-prescription solution to reduce the costs (no need for a central authority) and scams particularly in countries where the medical service is free and public.