Cosmic Journal System Causes Increased Workload and Stress Among Swedish Medical Secretaries

The introduction of the Cosmic journal system across nine regions in Sweden, governed by the Sussa collaboration, has significantly impacted medical secretaries' work conditions, leading to increased workloads, stress, decreased efficiency, and concerns about patient safety. A comprehensive survey conducted by the Vision union, which garnered responses from 1,111 medical secretaries (a 43% response rate from 2,593 invited), reveals that 88% reported an increased workload since the system's implementation. Additionally, 83% experienced elevated stress levels, while 78% observed a decline in work efficiency, with over half indicating the decrease was significant.

Patient safety concerns are notably high, with 77% of respondents expressing worries that the new system has led to reduced safety standards. Challenges cited include difficulties in maintaining an overview, risks of misregistrations, and delays in workflow processes. These problems highlight the system's complexity and inefficiency compared to previous journal systems.

Veronica Magnusson, chairperson of the Vision union, criticized the Cosmic system, stating it has become a "major setback" rather than an improvement. She emphasized that medical secretaries, despite their strong competence in handling various systems, were overlooked during the rollout of Cosmic. Magnusson called for employers to accept responsibility for the deteriorating work environment and urged the government to sanction employers who fail to address the resulting stress and digital workplace deficiencies.

Anette Hägglund Sundin, operational manager for the Sussa regions' journal system, acknowledged the ongoing challenges faced by medical secretaries and affirmed that efforts are underway to improve their working conditions. She underscored the crucial role of professional pride and commitment to quality in their work.

The Cosmic system's rollout began in late 2024 with the final region, Blekinge, implementing it in November 2025. The persistent issues reported by medical secretaries indicate that the difficulties stem not only from adjusting to a new system but also from inherent flaws in Cosmic's design and operation, adversely impacting healthcare workflows and patient safety.