eHealth development in Sweden : A study of prominent aspects and benefits from a multi-user perspective

Sammanfattning: The European health care is facing challenges with an increasing ageing population, with a higher frequency of chronic diseases, which have resulted in rising health care costs. Meanwhile, the trend shows how patients and citizens are becoming more active in their personal health care, with the number of existing doctors and nurses subsiding furthermore entailing problems. The area of eHealth, which involves information and communication technologies with health care, is hence seen as a partial long-term solution and is considered being a rapidly growing market both in Sweden, but also in Europe. eHealth services further consider to promote increased access, mobility and interoperability in the health care, but the lack of wholehearted commitment, financial support and complex EHR-systems in Sweden's municipalities and county councils might partially impeding down the development. The purpose of this report is therefore targeting to explore, identify and analyze prominent aspects for the continued development of the Swedish health care and eHealth services. The study also examines what subsequent benefits an implementation of an eHealth service entails, which also has been related to the identified prominent aspects. This master thesis is based on a thorough literature review extracted from a theoretical framework including an interoperability-, security-, mobility- and business-modeling perspective, which are used as a foundation for the building of a set of hypotheses, which are subsequently verified with the aid of gathered empirics. The empirics are obtained from 10 semi-structured qualitative interviews, as well as two case studies, which together resulted in key-findings and conclusions. Firstly, in relation to the interoperability perspective, it became clear how there should exist both a technical and social interoperability that communicate with each other. The EHR-systems of today are often considered difficult to learn, non-intuitive and lacking interfaces that are user-friendly designed for the end-user. Increased interoperability was also seen as enabling and simplifying the access to the patient’s medical history, which the EHR-system TakeCare evidently demonstrated. Furthermore, it was acknowledged how there is no correlation between the increased time spent by health care professionals with administrative tasks and documentation with an increased interoperability. It also emerged that patients and the dominant part of the population had either no or very limited knowledge regarding the underlying security and overall management of personal health information in health care. Patients instead often blindly trust the Swedish health care system being secure, and prioritizing other things during medical appointments. The knowledge of security issues in the health care is predicted to increase among patients if they in the future would obtain full access to their own medical records. There is also a general opinion among health care professionals and related instances how new security risks will arise alongside the eHealth wave, with a particular concern for the increasing involvement of mobile devices. Relationships between an increased interoperability also seem to favor increased mobility in health care, but security aspects often prevent the mobility development. Finally, it was unanimously espoused how non-financial values must not be ignored, where the on-going debate argues whether what real impact these non-financial values have, where inter alia strict budgets and large gaps between the decision-makers and end-users appeared as issues. Similar arguments were encountered regarding the actual impact of the opinions of patients in relation to business modeling, where a tripartite-problem and the patients’ limited access to their medical records was partly seen as a primary issue. Secondly, the case studies demonstrated how a transition to the EHR-system TakeCare generally did result in cost- and resource savings in terms of local servers, IT-maintenance and inventory management. The TakeCare implementation also led to an increased visibility among health care centers by enabling and simplifying the access to patient medical history. Increased communication, awareness, and more effective internal processes due to integrated modules and direct connections to ePrescriptions could also be accessed from the TakeCare transition. Finally, it emerged that relations existed between simplified access to the patient’s medical history and how it subsequently resulted in an increased interoperability. A correlation was also seen as the health care become generally more mobile due to increased interoperability.