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"The Record is Our Work Tool!"-Physicians' Framing of a Patient Portal in Sweden.

Grünloh C, Cajander Å, Myreteg G - J. Med. Internet Res. (2016)

Bottom Line: The professionals were strongly skeptical, and one reason was possible negative effects on their work environment.Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided.Supported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden. christiane.gruenloh@th-koeln.de.

ABSTRACT

Background: Uppsala County in Sweden launched an eHealth patient portal in 2012, which allows patients to access their medical records over the Internet. However, the launch of the portal was critically debated in the media. The professionals were strongly skeptical, and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians to understand their framing of the patient portal in relation to their work environment.

Objective: The study uses the concept of technological frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment.

Methods: A total of 12 semistructured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed.

Results: The thematic analysis revealed 4 main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within health care only. Considering effects on work environment, the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially the fact that patients might read their test results before the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians and increase or create a feeling of mistrust from patients. Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided.

Conclusions: Supported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment. Mostly, this is explained by the changing positions between the physicians and the patient: the latter can drive the process, which reduces the physicians' ability to guide the patient. (2) The physicians' experiences were expressed as worries: patients would not understand the content of the record and become unnecessarily anxious from misunderstandings. The concerns are to some extent based on a generalized view of patients, which might disregard those, who already actively participate in health care. This study hence reveals a need to provide physicians with information about the values for patients from using patient portals. (3) A change of work practices may be beneficial to increase patient participation, but such changes should preferably be designed and discussed with physicians. However, the strong resistance from the physicians made this challenging when launching the patient portal.

No MeSH data available.


Related in: MedlinePlus

Identified themes from interviews with physicians.
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Related In: Results  -  Collection

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figure1: Identified themes from interviews with physicians.

Mentions: The analysis revealed 4 themes, which are: Work Tool, Process, Workload, and Control (Figure 1). Related to the first 3 themes are the physicians’ concerns about patients (Figure 1), for example, patients misunderstanding or not comprehending the records; experiencing undue anxiety, and possibly being harmed by this. The concerns about patients are explicitly stated in relation to these 3 themes and thus presented here as a part of the respective theme instead of as a separate theme in itself.


"The Record is Our Work Tool!"-Physicians' Framing of a Patient Portal in Sweden.

Grünloh C, Cajander Å, Myreteg G - J. Med. Internet Res. (2016)

Identified themes from interviews with physicians.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940602&req=5

figure1: Identified themes from interviews with physicians.
Mentions: The analysis revealed 4 themes, which are: Work Tool, Process, Workload, and Control (Figure 1). Related to the first 3 themes are the physicians’ concerns about patients (Figure 1), for example, patients misunderstanding or not comprehending the records; experiencing undue anxiety, and possibly being harmed by this. The concerns about patients are explicitly stated in relation to these 3 themes and thus presented here as a part of the respective theme instead of as a separate theme in itself.

Bottom Line: The professionals were strongly skeptical, and one reason was possible negative effects on their work environment.Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided.Supported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden. christiane.gruenloh@th-koeln.de.

ABSTRACT

Background: Uppsala County in Sweden launched an eHealth patient portal in 2012, which allows patients to access their medical records over the Internet. However, the launch of the portal was critically debated in the media. The professionals were strongly skeptical, and one reason was possible negative effects on their work environment. This study hence investigates the assumptions and perspectives of physicians to understand their framing of the patient portal in relation to their work environment.

Objective: The study uses the concept of technological frames to examine how physicians in different specialties make sense of the patient portal in relation to their work environment.

Methods: A total of 12 semistructured interviews were conducted with physicians from different specialties. Interviews were transcribed and translated. A theoretically informed thematic analysis was performed.

Results: The thematic analysis revealed 4 main themes: work tool, process, workload, and control. Physicians perceive medical records as their work tool, written for communication within health care only. Considering effects on work environment, the physicians held a negative attitude and expected changes, which would affect their work processes in a negative way. Especially the fact that patients might read their test results before the physician was seen as possibly harmful for patients and as an interference with their established work practices. They expected the occurrence of misunderstandings and needs for additional explanations, which would consequently increase their workload. Other perceptions were that the portal would increase controlling and monitoring of physicians and increase or create a feeling of mistrust from patients. Regarding benefits for the patients, most of the physicians believe there is only little value in the patient portal and that patients would mostly be worried and misunderstand the information provided.

Conclusions: Supported by the study, we conclude: (1) The transfer of a paper-based health care process where patients read on paper into a digital process challenges current work practices and has consequences for the work environment. Mostly, this is explained by the changing positions between the physicians and the patient: the latter can drive the process, which reduces the physicians' ability to guide the patient. (2) The physicians' experiences were expressed as worries: patients would not understand the content of the record and become unnecessarily anxious from misunderstandings. The concerns are to some extent based on a generalized view of patients, which might disregard those, who already actively participate in health care. This study hence reveals a need to provide physicians with information about the values for patients from using patient portals. (3) A change of work practices may be beneficial to increase patient participation, but such changes should preferably be designed and discussed with physicians. However, the strong resistance from the physicians made this challenging when launching the patient portal.

No MeSH data available.


Related in: MedlinePlus