Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Problems in the usability of health information systems (HIS) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HIS. Such questionnaires are needed not only for research, but also for developing usability of HIS from the viewpoint of end-user experiences. Objective: To develop and test the validity of questionnaire measuring National usability-focused HIS-scale (NuHISS) among nationally representative sample of Finnish physicians. Methods: We utilized two cross-sectional data collected from a random sample of Finnish physicians in 2014 (N = 3781; 61.9 % women) and 2017 (N= 4018; 64.8 % women). Exploratory factor analyses and structural equation modelling (SEM) were applied to test structural validity of the NuHISS. As the concurrent validity measure we used the self-reported overall quality of the electronic health record system (“school grade”) provided by the participants using marginal structural models. Results: The exploratory factor analyses with varimax rotation suggested that the seven-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and C2=2109.83 in 2017, both p<.001). Moreover, SEM analyses showed that 7 factor solution provided an acceptable fit in both samples (CFI= 0.92/ 0.91, TLI= 0.92/0.91, NFI= 0.92/0.91, RMSEA= 0.048/0.049, SRMR = 0.040/ 0.039). Also concurrent validity of this solution was shown to be acceptable. Especially the ease of use, but also all other dimensions were associated with overall quality reports independently of measured confounders. The 7 factor solution included dimensions Technical quality, Information quality, Feedback, Ease of use, Benefits, Internal collaboration, and Cross-organisational collaboration. Conclusions: NuHISS provides a useful tool for measuring usability of HIS among physicians and offers a valid measure for monitoring the long-term development of HIS on large scale. The relative importance of items needs to be assessed against national eHealth policy goals, and complemented with items that remained outside the NuHISS-scale from the questionnaire when appropriate.

Objectives: Patients’ experiences are increasingly gaining interest in multiple research fields. Researchers have applied various approaches to studying patient experience (PX); however, there is no commonly agreed-upon definition of PX. This scoping review focuses on PX from an eHealth perspective. Our aim was to: 1) describe how PX has been defined, 2) investigate which factors influencing PX and components of PX have been identified and researched, 3) explore the methods used in studying PX, and 4) find out the recent trends in PX research from an eHealth perspective. Methods: We selected six major journals covering the fields of health informatics, PX, and nursing informatics. Using the search terms “patient experience” and technology-related terms (e.g., digital, eHealth), we searched for articles published between 2019 and 2021. From 426 articles, 44 were included in the analysis. Results: Multiple concepts and meanings are used to refer to PX. Few articles include vague descriptions of the concept. Numerous eHealth factors are influencing PX, as well as components considering PX. The influencing factors were related to eHealth solutions’ type and quality, and care process, when the components of PX were related to communication, remote interaction, risks and concerns, and patients’ attitudes towards telehealth. Surveys were the main method used to study PX, followed by interviews. Conclusions: PX is a complex and multifaceted phenomenon, and it is described as a synonym for patient satisfaction and telehealth experiences. Further multidisciplinary research is needed to understand PX as a phenomenon and to outline a framework for the research.

Background: In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians’ work is needed. Objective: The aim of this study was to examine physicians’ perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. Methods: A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients’ active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Results: Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). Conclusions: The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians’ work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians’ work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

Many European countries are integrating healthcare and social welfare services; some also include joint information systems (ISs) in this process. Despite this, large national survey studies examining and comparing the experiences of the major professional groups regarding the usability of their health (HISs) and client information systems (CISs) are lacking. We combined the responses from three national cross-sectional surveys conducted among physicians and nurses in 2017, and social welfare professionals (SWPs) in 2019 in Finland. We selected the responses of 1,826 physicians and 774 nurses working in outpatient clinics in specialized and primary care, and 669 social workers and other SWPs working in open services. The questionnaires were adjusted from a validated instrument. In this study, we analyzed 11 usability-related statements. The healthcare professionals (HPs) were more critical of the stability and responsiveness of their ISs than the SWPs (27-48% vs 58-65% agreed). The physicians were most dissatisfied with IS support for routine tasks (24-26% agreed). Less than half of all respondents agreed with statements concerning the ease of documentation, arrangement of fields, and terminology. While the HPs were satisfied with IS support for collaboration and information exchange between professionals in the same organization, all professional groups were dissatisfied with cross-organizational support and communication with patients and clients. Almost half of the HPs considered that HISs improve the quality of care, but 80% of the SWPs disagreed that CISs help improve the quality of services. Overall, the physicians, nurses, and SWPs were dissatisfied with the usability of their HISs and CISs. Based on our findings, ISs should be further developed to support routine tasks, inter- and cross-organizational collaboration, and information exchange. ISs for the integration of care and services should be designed to accommodate various professional groups' different work contexts and needs.

Several researchers share the concern of healthcare information systems failing to support communication and collaboration in clinical practices. The objective of this paper is to investigate the current state of computer-supported patient information exchange and associated communication between clinicians. We report findings from a national survey on Finnish physicians’ experiences with their currently used clinical information systems with regard to patient information documentation, retrieval, management and exchange-related tasks. The questionnaire study with 3929 physicians indicated the main concern being cross-organisational patient information delivery. In addition, physicians argued computer usage increasingly steals time and attention from caring activities and even disturbs physician–nurse collaboration. Problems in information management were particularly emphasised among those physicians working in hospitals and wards. The survey findings indicated that collaborative applications and mobile or wireless solutions have not been widely adapted in Finnish healthcare and suggested an urgent need for adopting appropriate information and communication technology applications to support information exchange and communication between physicians, and physicians and nurses.