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Building on Rogers’ Diffusion of Innovation Theory, Bass models describe the diffusion processes distinguishing between innovation (p) and imitation (q). This study aimed at modelling the uptake of RIS, PACS and EHR systems in Germany and Finland. The Bass models revealed a quick and almost identical uptake process across all three systems for Finland. In contrast, the Bass models mirrored a slower uptake in Germany. Consequently, the Finnish “imitation” coefficients were larger than the German ones. While in Germany almost free market forces were driving the adoption through imitation but without tail wind from policy, the adoption process in Finland was centrally governed. This suggests that the diffusion process in Finland reflected a well-managed roll-out of the systems rather than imitation behaviour. Thus, in order for Bass model coefficients to be understood properly, additional contextual information is required.
With the start of the 21st century, patient safety as a topic of special interest has attracted increasing attention in both academia and clinical practice. As technology has continued to develop since then, questions and focal points surrounding the topic have also shifted. In particular, questions regarding the impact of digitalization on patient safety and its measurement are now of high interest. This work aims to develop a maturity assessment instrument in the form of a criteria set for measuring structural requirements for digital patient safety in hospitals. Based on the results of a literature review and a derivation of maturity objects (MO) from known maturity models, 64 criteria across 11 categories were developed. Written comments of two digital patient safety experts as well as subsequent interviews were used to evaluate and refine the criteria catalog. The resulting catalog offers hospitals guidance for detecting possible areas of structural improvements in their information systems with regard to patient safety and represents a unique instrument for assessing digital maturity in this particular area.
Einleitung: Whiteboards können als ein Instrument des Lean Managements zur Steuerung der Verweildauer auf Stationen eingesetzt werden, um aktuelle Patienteninformationen zu bündeln und in regelmäßigen strukturierten sowie interdisziplinären Besprechungen die Patientenversorgung zu steuern, die interdisziplinäre Zusammenarbeit zu optimieren und das Entlassungsmanagement zu verbessern. Das Ziel dieser Studie bestand darin, zu untersuchen, inwiefern die Einführung von Whiteboards in zwei Kliniken mit einer Veränderung der Verweildauer einherging.
Methode: Um die Forschungsfrage zu beantworten, wurden retrospektive Zeitreihen aus den DRG-Routinedaten vor und nach Installation der Whiteboards aus den beiden Kliniken in einem Interrupted Time Series Design genutzt. In der einen Klinik (Chirurgie) lagen 3.734 Fälle für den Zeitraum von Januar 2018 bis Dezember 2019 und in der anderen Klinik (Innere Medizin) 54.049 Fälle für den Zeitraum Juli 2013 bis Dezember 2019 vor.
Ergebnisse: In dem gemittelten Vergleich der Verweildauer (relative Verweildauerabweichung pro DRG von dem jeweiligen Verweildauermittel) konnte in der ersten Klinik kein signifikanter Unterschied zwischen den Werten vor und nach Einführung des Boards festgestellt werden. Am zweiten Klinikum zeigte sich sogar im Vorher-Nachher-Vergleich eine signifikante Verschlechterung der Verweildauer. Eine deskriptive Zeitreihenanalyse vor und nach Einführung zeigte in beiden Kliniken, dass kurz nach der Einführung der Boards sich die Verweildauer verschlechterte, anschließend jedoch verbesserte, d.h. dass die Patienten durchschnittlich früher entlassen wurden. Dieser Unterschied ging jedoch im Zeitverlauf wieder zurück.
Diskussion: Zusammenfassend lässt sich festhalten, dass keine Verbesserung in der Verweildauer im Zuge der Nutzung der Whiteboards durch einen reinen Vorher-Nachher-Vergleich nachweisbar war. In der anschließenden Zeitreihenbetrachtung zeigten sich starke Schwankungen, die zunächst mit einer kurzzeitigen Verschlechterung der Verweildauer nach der Implementierung einhergingen und dann zu einer Verbesserung führten. Im Zeitverlauf verblasste der Unterschied jedoch, sodass die Patienten wieder später entlassen wurden. Methodisch zeigt sich, dass im Gegensatz zu der reinen Vorher-Nachher-Analyse erst eine Zeitreihenbetrachtung einen Einblick in das Geschehen und seine Variabilität lieferte. Für die Praxis ergeben sich folgende Implikationen: Whiteboards können als ein hilfreiches Instrument von Lean Management zur Verweildauersteuerung angesehen werden, wie die zwischenzeitlichen Verbesserungen nahelegen. Dies erfordert jedoch eine kontinuierliche, unter Einbezug der Mitarbeiter durchgeführte Pflege der Informationen und einen erkennbaren Mehrwert. Perspektivisch empfiehlt sich zudem eine Digitalisierung der Boards, um den Nachteilen wie der manuellen Pflege entgegenzuwirken.
Background:
Chronic health conditions are on the rise and are putting high economic pressure on health systems, as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT).
Objective:
This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions.
Methods:
A clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections.
Results:
The developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in moderate reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections general medical condition (55/66, 83%), wound assessment (18/24, 75%), and wound status (37/57, 65%), showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%).
Conclusions:
The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical conditions and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.
Background and purpose:
Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score.
Methods:
Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice.
Results:
We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were “flow of data and information”, “mobility”, “clinical decision support and patient safety”, “electronic patient record” and “integration and distribution”. The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach.
Conclusion:
Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness.
Background:
While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches – particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR).
Objective:
To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US.
Materials and methods:
All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007–2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation.
Results:
While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303).
Discussion:
These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders.
Conclusion:
Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.
Benchmarking, sprich die Vergleichsanalyse von Prozessen mit festgelegtem Bezugswert, findet zunehmend Einzug in die Welt der Gesundheits-IT. Dabei spielen jedoch viele Faktoren zusammen, die einen einfachen Vergleich von IT-Kosten bei Weitem übersteigen. Eine Forschungsgruppe der Hochschule Osnabrück hat mit dem IT-Benchmark Gesundheitswesen ein Analysetool vorgelegt, das auch einen Länder- vergleich ermöglicht.
Das Thema Digitalisierung ist in aller Munde – gerade auch im Bereich Krankenhaus. Allerdings noch nicht zuverlässig und im großen Stile valuiert sind die Fragen: Wie digitalisiert ist die Gesamtheit der deutschen Krankenhäuser tatsächlich? Wie entwickelt sich der Digitalisierungsgrad über die Zeit und im Vergleich zu anderen Nationen? Welchen Maßstab sollte man anlegen? Die Autoren stellen im folgenden Artikel ihren Ansatz für eine bundesweite Erfassung der Krankenhausdigitalisierung vor. Im Ergebnis weisen die betrachteten Krankenhäuser deutliche Optimierungspotenziale auf. Diese reichen von der mobilen Verfügbarkeit elektronischer Patientendaten und IT-Funktionen bis hinzu Fragen der Integration und Interoperabilität der im Einsatz befindlichen Systeme.
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.
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.
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.
Bei der Umsetzung der digitalen Transformation bewegt sich das ITManagement in Krankenhäusern in einem Spannungsfeld aus historischkulturellen Vorbedingungen und den besonderen Herausforderungen wissensintensiver Expertenorganisation. Um zu untersuchen, wie professionell das ITManagement vor diesem Hintergrund ist, wurde in der vorliegenden Studie der Professionalisierungsgrad des IT-Managements als Beschreibungsgröße vorgeschlagen. Darüber hinaus wurden Ausprägungen der IT-Governance und des IT-Entrepreneurships als mögliche Determinanten des Professionalisierungsgrades konzeptionalisiert. Ein entsprechend aufgestelltes, hypothesengeleitetes Untersuchungsmodell wurde anhand der Daten von 164 CIOs deutscher Krankenhäuser überprüft. Die Ergebnisse der Studie deuten auf Professionalisierungspotenziale des IT-Managements im strategischen und evaluierenden Bereich hin. Etablierte Kommunikationskanäle zwischen CIO und Krankenhausleitung sowie eine ausgewiesene IT-Budgetverantwortungen wirkten sich positiv auf den Professionalisierungsgrad aus. Zudem Das agierte das ITManagement umso professioneller, je stärker der IT-Entrepreneurship auf organisatorischer und individueller Ebene ausgeprägt war. Die Ergebnisse können den theoretischen Erkenntnisstand über die Wirkungsweise von IT-Governance und IT-Entrepreneurship erweitern und auf ähnliche, wissensintensive Expertenorganisationen übertragen werden.
Hospital CIOs play a central role in the adoption of innovative health IT. Until now, it remained unclear which particular conditions constitute their capability to innovate in terms of intrapersonal as well as organisational factors. An inventory of 20 items was developed to capture these conditions and examined by analysing data obtained from 164 German hospital CIOs. Principal component analysis resulted in three internally consistent components that constitute large portions of the CIOs innovation capability: organisational innovation culture, entrepreneurship personality and openness towards users. Results were used to build composite indicators that allow further evaluations.
Multinational health IT benchmarks foster cross-country learning and have been employed at various levels, e.g. OECD and Nordic countries. A bi-national benchmark study conducted in 2007 revealed a significantly higher adoption of health IT in Austria compared to Germany, two countries with comparable healthcare systems. We now investigated whether these differences still persisted. We further studied whether these differences were associated with hospital intrinsic factors, i.e. the innovative power of the organisation and hospital demographics. We thus performed a survey to measure the “perceived IT availability” and the “innovative power of the hospital” of 464 German and 70 Austrian hospitals. The survey was based on a questionnaire with 52 items and was given to the directors of nursing in 2013/2014. Our findings confirmed a significantly greater IT availability in Austria than in Germany. This was visible in the aggregated IT adoption composite score “IT function” as well as in the IT adoption for the individual functions “nursing documentation” (OR = 5.98), “intensive care unit (ICU) documentation” (OR = 2.49), “medication administration documentation” (OR = 2.48), “electronic archive” (OR = 2.27) and “medication” (OR = 2.16). “Innovative power” was the strongest factor to explain the variance of the composite score “IT function”. It was effective in hospitals of both countries but significantly more effective in Austria than in Germany. “Hospital size” and “hospital system affiliation” were also significantly associated with the composite score “IT function”, but they did not differ between the countries. These findings can be partly associated with the national characteristics. Indicators point to a more favourable financial situation in Austrian hospitals; we thus argue that Austrian hospitals may possess a larger degree of financial freedom to be innovative and to act accordingly. This study is the first to empirically demonstrate the effect of “innovative power” in hospitals on health IT adoption in a bi-national health IT benchmark. We recommend directly including the financial situation into future regression models. On a political level, measures to stimulate the “innovative power” of hospitals should be considered to increase the digitalisation of healthcare.
Health IT adoption research is rooted in Rogers' Diffusion of Innovation theory, which is based on longitudinal analyses. However, many studies in this field use cross-sectional designs. The aim of this study therefore was to design and implement a system to (i) consolidate survey data sets originating from different years (ii) integrate additional secondary data and (iii) query and statistically analyse these longitudinal data. Our system design comprises a 5-tier-architecture that embraces tiers for data capture, data representation, logics, presentation and integration. In order to historicize data properly and to separate data storage from data analytics a data vault schema was implemented. This approach allows the flexible integration of heterogeneous data sets and the selection of comparable items. Data analysis is prepared by compiling data in data marts and performed by R and related tools. IT Report Healthcare data from 2011, 2013 and 2017 could be loaded, analysed and combined with secondary longitudinal data.
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.
Current frameworks postulate the success of health IT innovations to be determined by the professionalism of the information management (PIM). Still, empirical knowledge about PIM is scarce up until today. This study seeks to answer three research questions: (1.) How can PIM be measured in a reliable and valid way, (2.) how pronounced is PIM in German hospitals and (3.) do hospital characteristics have an impact on the degree of PIM? Based on the results of an expert workshop and frameworks for information management (IM) items for a PIM inventory were developed and the inventory sent to 1349 chief information officers of German hospitals. A principle component analysis based on the responses of 196 hospitals confirmed the three components that had been proposed by the frameworks: the strategic, the tactical and the operational level. The full inventory implied satisfying reliability and allowed a PIM composite-score to be calculated. The PIM scores for strategic and tactical IM were found to be far lower than for operational IM which hints at strong deficits in these areas. A stepwise regression model indicated that the degree of PIM significantly increased with the size of the hospital, which had been expected and hints the validity of the PIM inventory. This tool offers potentials for hospitals to classify and improve their IM.