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Due to the emerging evidence of health IT as opportunity and risk for clinical workflows, health IT must undergo a continuous measurement of its efficacy and efficiency. IT-benchmarks are a proven means for providing this information. The aim of this study was to enhance the methodology of an existing benchmarking procedure by including, in particular, new indicators of clinical workflows and by proposing new types of visualisation. Drawing on the concept of information logistics, we propose four workflow descriptors that were applied to four clinical processes. General and specific indicators were derived from these descriptors and processes. 199 chief information officers (CIOs) took part in the benchmarking. These hospitals were assigned to reference groups of a similar size and ownership from a total of 259 hospitals. Stepwise and comprehensive feedback was given to the CIOs. Most participants who evaluated the benchmark rated the procedure as very good, good, or rather good (98.4%). Benchmark information was used by CIOs for getting a general overview, advancing IT, preparing negotiations with board members, and arguing for a new IT project.
An Iterative Methodology for Developing National Recommendations for Nursing Informatics Curricula
(2016)
The increasing importance of IT in nursing requires educational measures to support its meaningful application. However, many countries do not yet have national recommendations for nursing informatics competencies. We thus developed an iterative triple methodology to yield validated and country specific recommendations for informatics core competencies in nursing. We identified relevant competencies from national sources (step 1), matched and enriched these with input from the international literature (step 2) and fed the resulting 24 core competencies into a survey (120 invited experts from which 87 responded) and two focus group sessions with a total of 48 experts (steps 3a/3b). The subsequent focus group sessions confirmed and expanded the findings. As a result, we were able to define role specific informatics core competencies for three countries.
Informatics competencies of the health care workforce must meet the requirements of inter-professional process and outcome oriented provision of care. In order to help nursing education transform accordingly, the TIGER Initiative deployed an international survey, with participation from 21 countries, to evaluate and prioritise a broad list of core competencies for nurses in five domains: 1) nursing management, 2) information technology (IT) management in nursing, 3) interprofessional coordination of care, 4) quality management, and 5) clinical nursing. Informatics core competencies were found highly important for all domains. In addition, this project compiled eight national cases studies from Austria, Finland, Germany, Ireland, New Zealand, the Philippines, Portugal, and Switzerland that reflected the country specific perspective. These findings will lead us to an international framework of informatics recommendations.
CIOs' innovation capability is regarded as a precondition of successful HIT adoption in hospitals. Based on the data of 142 CIOs, this study aimed at identifying antecedents of perceived innovation capability. Eight features describing the status quo of the hospital IT management (e.g. use of IT governance frameworks), four features of the hospital structure (e.g. functional diversification) and four CIO characteristics (e.g. duration of employment) were tested as potential antecedents in an exploratory stepwise regression approach. Perceived innovation capability in its entirety and its three sub-dimensions served as criterion. The results show that CIOs' perceived innovation capability could be explained significantly (R2=0.34) and exclusively by facts that described the degree of formalism and structure of IT management in a hospital, e.g. intensive and formalised strategic communication, the existence of an IT strategy and the use of IT governance frameworks. Breaking down innovation capability into its constituents revealed that “innovative organisational culture” contributed to a large extent (R2=0.26) to the overall result sharing several predictors. In contrast, “intrapreneurial personality” (R2=0.11) and “openness towards users” (R2=0.18) could be predicted less well. These results hint at the relationship between working in a well-structured, formalised and strategy oriented environment and the overall feeling of being capable to promote IT innovation.
Health IT and communication systems are indispensable in German hospitals for clinical as well as administrative process support. However, IT is often regarded as a “black box” for hospital CEOs. Thus, the question arises how can CEOs decide if they do not know what is in the box? In order to answer this question, half-structured interviews with 14 German hospital CEOs were conducted. They revealed three principle decision processes: the supported decision, the joint decision and the corporate level decision. In all cases, the hospital CEO and the CIO interacted to reach the final decision, most strongly in the joint decision mode and least strongly in the corporate decision mode. Only the joint decision mode definitely forced the CEO to open the “black box” of IT. In the era of digitalisation, however, CEOs must develop better competencies to decide over complex matters.
Der zunehmende Einsatz von Informations- und Kommunikationstechnologie im Gesundheitswesen verlangt auch von Angehörigen der Pflegeberufe Kompetenzen zur Nutzung der entsprechenden Systeme und Verfahren. Vor diesem Hintergrund haben sich die AG „Informationsverarbeitung in der Pflege“ der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS), die Österreichische Gesellschaft für Pflegeinformatik (ÖGPI) und die Schweizerische Interessensgruppe Pflegeinformatik (IGPI) innerhalb des Schweizer Berufsverband der Pflegefachfrauen und Pflegefachmänner (SBK) entschlossen, gemeinsame Empfehlungen für benötigte Kernkompetenzfelder in Pflegeinformatik zu erarbeiten. Auf Basis einer iterativen multimethodischen Vorgehensweise unter Einbeziehung von einer großen Anzahl von Fachexperten aus Deutschland, Österreich und der Schweiz (D-A-CH) wurden 24 notwendige Felder von Kernkompetenzen definiert und deren Relevanz für fünf typische Berufsfelder in der Pflege bewertet. Damit liegt erstmalig eine wissenschaftlich fundierte Empfehlung für zu vermittelnde Kernkompetenzfelder in der Pflegeinformatik für verschiedene pflegerische Berufsfelder vor. Sie richtet sich an alle Personen mit Verantwortung für die Planung von Studium, Lehre, Aus- und Weiterbildung in der Pflege.
Background: IT is getting an increasing importance in hospitals. In this
context, major IT decisions are often made by CEOs who are not necessarily IT
experts. Objectives: Therefore, this study aimed at a) exploring different types of IT
decision makers at CEO level, b) identifying hypotheses if trust exists between these
different types of CEOs and their CIOs and c) building hypotheses on potential
consequences regarding risk taking and innovation. Methods: To this end, 14
qualitative interviews with German hospital CEOs were conducted to explore the
research questions. Results: The study revealed three major types: IT savvy CEOs,
IT enthusiastic CEOs and IT indifferent CEOs. Depending on these types, their
relationship with the CIO varied in terms of trust and common language. In case of
IT indifferent CEOs, a potential vicious circle of lack of IT knowledge, missing trust,
low willingness to take risks and low innovation power could be identified.
Conclusion: In order to break of this circle, CEOs seem to need more IT knowledge
and / or greater trust in their CIO.
Das Informationsmanagement steht im Zentrum erfolgreicher eHealth-Innovationsprozesse von Krankenhäusern. Im Kontext komplexer, zum Teil tradierter Krankenhausstrukturen kann die Gestaltungsfähigkeit des Informationsmanagements durch eine ausgeprägte Intrapreneurship-Kultur erhöht werden, wovon vermutlich auch der Digitalisierungsgrad der Einrichtungen profitiert. Vor diesem Hintergrund verfolgte die vorliegende Studie zwei Forschungsfragen: (1.) Welche Effekte hat Intrapreneurship auf den Digitalisierungsgrad der Krankenhäuser und (2.) inwiefern werden diese Effekte durch das Informationsmanagement beeinflusst? Zur Beantwortung der Forschungsfragen wurde ein konzeptionelles Untersuchungsmodell entwickelt, welches mit Daten von 224 IT-Leitern evaluiert wurde. Die Ergebnisse bestätigen, dass Intrapreneurship die Umsetzung von eHealth-Anwendungen positiv beeinflussen kann. Die identifizierten Effekte waren jedoch vorwiegend indirekter Art, vermittelt durch den Professionalisierungsgrad des Informationsmanagements. So kann Intrapreneurship auf IT-Leiter-Ebene und auf Ebene der Gesamtorganisation zu einer Professionalisierung des strategischen Informationsmanagements führen. Auf Ebene der IT-Abteilung profitiert vor allem das operative Informationsmanagement von einer ausgeprägten Intrapreneurship-Kultur.
As health IT supports processes along the entire patient trajectory and involves different types of professional groups, eHealth is inter-professional by nature. The aim of this study, therefore, is to investigate which competencies are at the intersection of the individual groups of health professionals. 718 international experts provided relevance ratings of eHealth competencies for different professional roles in an online survey. Communication and leadership proved to be important competencies across all professions, not only for executives. None or very little differences between professions were found between physicians and nurses, between IT experts at different levels and between IT experts and executives. However, there were a number of competencies rated differently when contrasting direct patient care specialists with executives. These findings should encourage organisations issuing educational recommendations to specify areas of shared competencies more extensively.
Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework.
Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings.
Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics.
Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas.
Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.
Die Verbreitung von Informationstechnologien (IT) im Gesundheitswesen sowie deren Einflussgrößen sind Betrachtungsobjekt der Adoptions- und Diffusionsforschung. Neues Wissen aus diesen Studien wird dabei häufig als summative Umfrageergebnisse disseminiert. Mit dem in diesem Beitrag vorgestellten Web-Portal werden die individuellen Umfrageergebnisse im Vergleich zu einer Referenzgruppe präsentiert. Das erfolgt in flexibler Form unter Verwendung von reliablen und validen Kennzahlen der IT-Prozessunterstützung, die in einer hierarchischen Struktur angeordnet sind. Es werden die Entwicklung des Web-Portals als Benchmarking Instrument, seine Anwendung und eine initiale Evaluation vorgestellt. Es zeigte sich, dass das Web-Portal anhand aktueller Benchmarking-Ergebnisse von 197 Krankenhäusern einsetzbar ist, seine Anwendung als nützlich und die Indikatoren als verständlich eingeschätzt werden.
Das Ausmaß der Digitalisierung im Gesundheitswesen bemisst sich daran, wie gut die vorhandene IT Informationslogistik bedienen kann. Der IT-Report Gesundheitswesen ist eine Umfragereihe, die seit 16 Jahren den Digitalisierungsgrad in Krankenhäusern untersucht und eine Familie von Composite Scores bereitstellt, insbesondere den Workflow Composite Score (WCS) zur Messung der klinischen Informationslogistik. Dieser lag mit durchschnittlich 56 von 100 Punkten im Jahr 2017 nur knapp über der Marke von 50 Punkten. Weitere Sub-Scores wie z. B. der für den Aufnahmeprozess lagen mit 44 Punkten sogar darunter. Dieses Ergebnis zeigt, dass es ein großes Potenzial zur Verbesserung gibt, das ausgeschöpft werden muss, soll Digitalisierung ihren Effekt der Vernetzung, Transparenz, Datenanalytik und Wissensgenerierung entfalten.
This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.
Background:
Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.
Objective:
The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved.
Methods:
We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.
Results:
The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.
Conclusions:
The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.