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“The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden
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 nega...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940602/ https://www.ncbi.nlm.nih.gov/pubmed/27349531 http://dx.doi.org/10.2196/jmir.5705 |
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author | Grünloh, Christiane Cajander, Åsa Myreteg, Gunilla |
author_facet | Grünloh, Christiane Cajander, Åsa Myreteg, Gunilla |
author_sort | Grünloh, Christiane |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4940602 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-49406022016-07-20 “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden Grünloh, Christiane Cajander, Åsa Myreteg, Gunilla J Med Internet Res Original Paper 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. JMIR Publications 2016-06-27 /pmc/articles/PMC4940602/ /pubmed/27349531 http://dx.doi.org/10.2196/jmir.5705 Text en ©Christiane Grünloh, Åsa Cajander, Gunilla Myreteg. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 27.06.2016. https://creativecommons.org/licenses/by/2.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/ (https://creativecommons.org/licenses/by/2.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Grünloh, Christiane Cajander, Åsa Myreteg, Gunilla “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden |
title | “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden |
title_full | “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden |
title_fullStr | “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden |
title_full_unstemmed | “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden |
title_short | “The Record is Our Work Tool!”—Physicians’ Framing of a Patient Portal in Sweden |
title_sort | “the record is our work tool!”—physicians’ framing of a patient portal in sweden |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940602/ https://www.ncbi.nlm.nih.gov/pubmed/27349531 http://dx.doi.org/10.2196/jmir.5705 |
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