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The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students’ evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.
In September 2022, the interprofessional European Summer School on the topic “Information in Healthcare – From Data to Knowledge” was held at the University of Porto. This Summer School included the topics Interoperability, Data Protection and Security and Data Analytics and consisted of an online preparation phase and an attendance phase in Porto. The didactic concept involved problem-based learning using a case study. A variety of course materials were developed and used to achieve the learning objectives. There are plans to continue the Summer School concept at participating institutions in the future, starting with a Spring School 2023 in Osnabrück.
IO6 is a report of the evaluation of the online courses and Summer School. The project plan of eHealth4all@EU guides the evaluation. The aim of the evaluation is to present the strengths and developing parts of the project. The main evaluation themes are eHealth, inter-professional education, and problem-based learning. For the funder’s perspective, evaluation focusing themes of digital support, lifelong learning, an active citizen, and the future. Evaluation of the project assign around all these themes and will find out students’ and teachers’ feelings of satisfaction, efficiency, and quality of the learning experience.
Interoperability, Data Protection and Security and Data Analytics are of high relevance for the future of eHealth and interprofessional care. Three online courses were therefore designed and delivered for these topics, all of which followed the same structure. A variety of materials were developed and different tools for knowledge transfer, communication and collaboration were used.
The University of Eastern Finland was the responsible partner of IO1: European eHealth Education: Policy and Practice Review. The aim of this intellectual output was to customize and validate the already existing international health informatics recom-mendations. Based on that the aim was also to describe the priorities of core compe-tencies and learning outcomes particularly in the fields addressed by this project. The methods used were a scoping review and focus group interviews. The aim of the scoping review was to explore how education in health informatics (HI) has been taught by evaluating the existing international frameworks and reported ed-ucations in HI. The scoping review was conducted based on the instructions of Joanna Briggs Institute to find English language publications published between 2016 and 2020. All publications found in the bibliographical database MEDLINE via PubMed, Scopus and Web of Sciences were included. The results indicated that education in HI is essential to everyone, and everyone needs skills and knowledge in both technical and non-technical skills in HI. Education in HI should be introduced already in the first year of the education and with time increase the knowledge to a more advanced level. The teaching methods can vary between lectures in class to a more hybrid method. The aim of the online focus group interview was to investigate the needs of HI compe-tencies in health care. To achieve the answers, two main questions were used as a base of the interview. The first question focused on how knowledge and competencies in health informatics could contribute to improving health care. The second question focused on which HI competencies are seen as important to learn and how to achieve them. Online focus group interviews were conducted in each of the three countries. The interviews were done the own languages (German, Portuguese, and Finnish) and later summarized and translated to English. The focus group interviews concluded that there are challenges and possibilities in health informatics. It also highlighted the com-petencies seen as important to have in daily working life. For example, skills in appli-cations in patient care, knowledge in IT-background and IT related management are considered important.
Problem-based learning (PBL) has become established as a successful didactic approach far beyond the field of medicine. Although there is no single concept of PBL, there is agreement on its objectives and implementation. Of central importance is the case that supports autonomous and reflective learning. Even before COVID-19, digital methods were used in traditional PBL. These served to support, for example, the provision of learning materials. As a result of university closures during the COVID-19 pandemic, technical solutions were made available at an unprecedented speed, which made it possible to implement the different requirements of traditional PBL in a digital PBL (DPBL). The present study results based on two scoping reviews demonstrated that PBL can be implemented digitally and that different digital methods, both asynchronous and synchronous, are available for the different steps. They show that DPBL not only leads to comparable student performance, but can also develop further competences, e.g. digital communication. With the findings, a concept for the implementation of DPBL as well as recommendations for the further development of DPBL are available.
This report summarizes and discusses the development, main achievements and overall progress of The Interprofessional European eHealth Programme in Higher Education (eHealth4all@EU) project. The project evolved through a strong partnership between members of the consortium, grounding its activities on previous initiatives like TIGER and taking them one step further while looking into the digital health competencies required by graduate students working in health and care and providing teaching approaches and other initiatives to extend further a set of core competencies: Health Information Systems Interoperability, Data Security and Privacy and Data Analytics. Although the project activities underwent during the pandemic period, a condition that forced reorganization and adaptation of the workplan, the main initiatives like the identification of significant areas of interest for digital health competencies and related relevant teaching methods that foster active learning paved the way for the construction of learning content structured around a syllabus aimed at distance learning and faceto- face learning moments developed with the intent for reuse and fostering the development of these set of competences in future Health Professionals. To this purpose, we are convinced that grounding steps have been taken with these eHealth4All@EU activities and initiatives.
Diabetic foot ulcer (DFU) is a chronic wound and a common diabetic complication as 2% – 6% of diabetic patients witness the onset thereof. The DFU can lead to severe health threats such as infection and lower leg amputations, Coordination of interdisciplinary wound care requires well-written but time-consuming wound documentation. Artificial intelligence (AI) systems lend themselves to be tested to extract information from wound images, e.g. maceration, to fill the wound documentation. A convolutional neural network was therefore trained on 326 augmented DFU images to distinguish macerated from unmacerated wounds. The system was validated on 108 unaugmented images. The classification system achieved a recall of 0.69 and a precision of 0.67. The overall accuracy was 0.69. The results show that AI systems can classify DFU images for macerations and that those systems could support clinicians with data entry. However, the validation statistics should be further improved for use in real clinical settings. In summary, this paper can contribute to the development of methods to automatic wound documentation.
The diabetic foot ulcer, which 2% – 6% of diabetes patients experience, is a severe health threat. It is closely linked to the risk of lower extremity amputation (LEA). When a DFU is present, the chief imperative is to initiate tertiary preventive actions to avoid amputation. In this light, clinical decision support systems (CDSS) can guide clinicians to identify DFU patients early. In this study, the PEDIS classification and a Bayesian logistic regression model are utilised to develop and evaluate a decision method for patient stratification. Therefore, we conducted a Bayesian cutpoint analysis. The CDSS revealed an optimal cutpoint for the amputation risk of 0.28. Sensitivity and specificity were 0.83 and 0.66. These results show that although the specificity is low, the decision method includes most actual patients at risk, which is a desirable feature in monitoring patients at risk for major amputation. This study shows that the PEDIS classification promises to provide a valid basis for a DFU risk stratification in CDSS.
Der primäre Einsatzzweck von Reifegradmodellen besteht zumeist in der reinen Inventarisierung der vorhandenen IT-Komponenten. Das vorliegende Kapitel gibt IT-Entscheider*innen in Krankenhäusern Empfehlungen, wie Reifegradmodelle für eine kontinuierliche Weiterentwicklung, Umsetzung und Evaluation von Digitalisierungsstrategien eingesetzt werden können. Als Prüfschema für die Auswahl geeigneter Verfahren werden neun Anforderungen an die Entwicklung und den Einsatz von Reifegradmodellen formuliert. Entlang von drei strategischen Handlungsfeldern – dem klinischen Anwendungsfeld, dem Informationsmanagement und dem organisatorischen Umfeld – werden dem Leser generische Digitalisierungsziele und dazugehörige Beispielindikatoren zur Erfolgskontrolle bereitgestellt.
Apps have been attested to empower patients regarding disease self-management through numerous studies. However, it is still unclear what factors determine the perception of patients whether an app is a useful tool for this purpose. A multiple regression model that was informed by the Technology Acceptance Model (TAM 2) was tested based on the answers of 235 app users with Diabetes type 1 or 2. The model accounted for 59.2% of the variance of the perceived degree of self-management. Factors belonging to the relevance-usefulness-quality complex as well as factors reflecting the patient’s self-control were found to be significant in the model. Patient demographics, i.e. age, gender, app experience and type of Diabetes did not play any significant role. In conclusion, this study raises the question whether apps should be designed to strengthen self-management in the sense of self-control (e.g. own measurements, diary) as opposed to guiding and advice giving.
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.
Venous leg ulcers and diabetic foot ulcers are the most common chronic wounds. Their prevalence has been increasing significantly over the last years, consuming scarce care resources. This study aimed to explore the performance of detection and classification algorithms for these types of wounds in images. To this end, algorithms of the YoloV5 family of pre-trained models were applied to 885 images containing at least one of the two wound types. The YoloV5m6 model provided the highest precision (0.942) and a high recall value (0.837). Its mAP_0.5:0.95 was 0.642. While the latter value is comparable to the ones reported in the literature, precision and recall were considerably higher. In conclusion, our results on good wound detection and classification may reveal a path towards (semi-) automated entry of wound information in patient records. To strengthen the trust of clinicians, we are currently incorporating a dashboard where clinicians can check the validity of the predictions against their expertise.
This new edition of the classic textbook on health informatics provides readers in healthcare practice and educational settings with an unparalleled depth of information on using informatics methods and tools. However, this new text speaks to nurses and -- in a departure from earlier editions of this title -- to all health professionals in direct patient care, regardless of their specialty, extending its usefulness as a textbook. This includes physicians, therapists, pharmacists, dieticians and many others. In recognition of the evolving digital environments in all healthcare settings and of interprofessional teams, the book is designed for a wide spectrum of healthcare professions including quality officers, health information managers, administrators and executives, as well as health information technology professionals such as engineers and computer scientists in health care. The book is of special interest to those who bridge the technical and caring domain, particularly nurse and medical informaticians and other informaticians working in the health sciences. Nursing Informatics: An Interprofessional and Global Perspective contains real-life case studies and other didactic features to illustrate the theories and principles discussed, making it an ideal resource for use within health and nursing informatics curricula at both undergraduate and graduate level, as well as for workforce development. It honors the format established by the previous editions by including a content array and questions to guide the reader. Readers are invited to look out of the box through a dedicated global perspective covering health informatics applications in different regions, countries and continents.
Digitalisierung, Künstliche Intelligenz und Big Data als Motor für Wandel in Pflege und Gesellschaft
(2022)
This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.
Communication deficits belong to the most frequent errors in patient handovers calling upon specialized training approaches to be implemented. This study aims to harness problem-based learning (PBL) methods in handover education and evaluated the learning process. A digitally enabled PBL course was developed and implemented at Klinikum Osnabrück from which eight nurses participated in the course. They agreed on the stimulating effect of the setting regarding self-directed learning and on the potential to translate the new knowledge and skills into the daily clinical practice. In conclusion, the findings are promising that a digitally enabled PBL course is a suitable learning format for handover education.
Background:
Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide.
Objective:
Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps. This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information.
Methods:
We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features. These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach.
Results:
Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories: (1) background information (open-source code, public information, and collaborators); (2) purpose and workflow (secondary data use and warning process design); (3) technical information (protocol, tracing technology, exposure notification system, and interoperability); (4) privacy protection (the entity of trust and anonymity); and (5) availability and use (release date and the number of downloads). Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup.
Conclusions:
We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries.
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.