Refine
Year of publication
Document Type
- Conference Proceeding (82)
- Article (55)
- Book (10)
- Part of a Book (7)
- Working Paper (7)
- Report (1)
Is part of the Bibliography
- yes (162)
Keywords
- COVID-19 (2)
- Evaluation (2)
- eHealth (2)
- health information technology (2)
- Bass model (1)
- CEO (1)
- CEO-CIO relationship (1)
- Clinical handover (1)
- Common ground (1)
- Communication (1)
Institute
- Fakultät WiSo (162) (remove)
Personal health records (PHR) are instruments to compile, store and present health and wellness related data digitally with proven effects on self-management of diseases. The aim of this study was to investigate whether there were differences in the intention to use (ITU) and perceived usefulness (PU) of two technologies allowing users to access the PHR, i.e. a kiosk system and a smart phone based app (access as usual). The study also aimed at modelling ITU and PU with multiple linear regressions. A total of 46 subject participated in the study who were randomly assigned to one of the two experimental groups (nkiosk = 22; napp = 24). The task for both groups was to digitise their “Medikationsplan” (medical record) and upload it to the PHR. There was no significant difference in ITU and PU between the two technologies. ITU could only be significantly explained by PU (R2 = .55, p < 0.001), while PU was determined by perceived ease of use and psychological factors (R2 = .64, p < 0.001). Severity of disease did not play any significant role. The German “Terminservice- und Versorgungsgesetz” underpins the importance and timeliness of this study. The assumption that both – the publicly accessible kiosk and the app – are equally acceptable for people of different gender, age and technology background demonstrates the opportunity to master a potential digital divide among the population and allows users to get access to their PHR in multiple ways.
Elektronisch unterstützte transsektorale Kommunikation im Gesundheitswesen ist eine der essentiellen Säulen von eHealth. Sie ist eine menschliche Handlung, die eine Verbesserung der Versorgung Einzelner und ganzer Bevölkerungsgruppen bewirken soll. Ethik bewertet menschliches Handeln in Bezug auf dessen Auswirkungen und die ihm zugrunde liegenden Werte und Normen. Dabei werden die Auswirkungen auf Individuen und Allgemeinheiten betrachtet. Im Gesundheits- und Sozialwesen gelten die Prinzipien der Autonomie, der Schadensverhütung, der Fürsorge und der Gerechtigkeit als Maßstäbe. Es gilt also die Fragen herauszuarbeiten, die an elektronische transsektorale Kommunikation aus ethischer Sicht gestellt werden müssen, um zu untersuchen, ob sie innerhalb der genannten Prinzipien ethischen Anforderungen genügt.
Aus den Ergebnissen einer systematischen Literaturrecherche wurden zunächst allgemein Aussagen zum Thema Information und Technologie im Zusammenhang mit Ethik extrahiert, und daraufhin geprüft, auf welche Fragen sie Antworten anbieten. Diese wurden innerhalb der genannten fünf Prinzipien als Fragen an elektronische transsektorale Kommunikation formuliert.
Aus den Aussagen der Literatur ließen sich sieben Fragen ableiten und den ethischen Prinzipien zuordnen, um mit ihnen elektronische transsektorale Kommunikation zu untersuchen. Auf diese Weise kann geprüft werden ob diese in der Lage sind, das Wohl Einzelner wie auch von Gemeinschaften im Gesundheitswesen zu fördern, wovon Betroffene, Professionelle und das Gesundheitssystem insgesamt profitieren könnten.
Going Mobile : An Empirical Model for Explaining Successful Information Logistics in Ward Rounds
(2018)
Background: Medical ward rounds are critical focal points of inpatient care that call for uniquely flexible solutions to provide clinical information at the bedside. While this fact is undoubted, adoption rates of mobile IT solutions remain rather low.
Objectives: Our goal was to investigate if and how mobile IT solutions influence successful information provision at the bedside, i.e. clinical information logistics, as well as to shed light at socio-organizational factors that facilitate adoption rates from a user-centered perspective.
Methods: Survey data were collected from 373 medical and nursing directors of German, Austrian and Swiss hospitals and analyzed using variance-based Structural Equation Modelling (SEM).
Results: The adoption of mobile IT solutions explains large portions of clinical information logistics and is in itself associated with an organizational culture of innovation and end user participation.
Conclusion: Results should encourage decision makers to understand mobility as a core constituent of information logistics and thus to promote close end-user participation as well as to work towards building a culture of 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.
Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources.
This prospective longitudinal study aims at better understanding eHealth success factors in different European nations, esp. the role of eHealth-legislation in Switzerland and Germany. Qualitative interviews with 39 matched experts from a large variety of institutions in both nations were conducted. The individual statements in the interviews and the overall satisfaction rating indicate a clear trend for a more optimistic attitude towards the law in Switzerland than in Germany. This result is not surprising given the history of a telematics infrastructure in Germany. Cross-country learning topics for German politicians are the inclusion of the inpatient sector and the focus on one major application. In a next step, interview results from Austria will be included and with that the scope of study findings enriched.
The establishment of successful clinical information logistics (CIL) within the care processes is one of the main objectives of strategic health IT management in hospitals. While technical realisations in terms of useful, usable and interoperable IT solutions are essential precursors of CIL, there is limited empirical research on what socio-organisational factors underlie an innovation-friendly culture and how they can affect successful information provision. We applied factor analysis on survey data from 403 clinical directors from Germany, Austria and Switzerland and used the dimensions identified to explain the level of CIL with ordered logistic regression analysis. The intensity of collaboration and exchange with the IT department as well as the degree of executive IT leadership showed to be strongly associated with better CIL while personal views and attitudes of clinical directors were not. Analysing country differences revealed the degree of the exchange with the IT department to be significantly lower in German hospitals. This points at a potential strategic lever for German hospital executives to focus on.
Health IT systems are employed to support continuity of care via information continuity, while management continuity is often neglected. This study aims at investigating issues of management continuity when developing a collaborative decision support system for chronic wounds. Thirty-three experts from a variety of professions and disciplines discussed problems and possible solutions in four workshops. The following topics emerged from the discussion: existing networks involving payers, responsibilities as well as good discharge management. These topics clearly address management continuity and are also relevant for the scenario of inter-professional wound care across different settings.
The workflow-oriented dissemination of electronic patient data is a central goal of IT deployment in hospitals. Against this background, the present study examines two research questions: (1.) Are there differences in the availability of electronic patient data (AEPD) between different clinical workflows and data types and (2.) which structural and organizational factors determine AEPD? Based on a Germany wide hospital survey, AEPD was assessed along six clinical workflows. While AEPD was lowest for ward rounds, discharge showed the highest AEPD with pre- and post-surgery processes ranging in between. With regard to the data types analyzed, patient demographics and observation findings obtained the highest AEPD scores. Electrophysiological results, checklists and warnings were less common electronically and received lower AEPD scores. Multiple linear regression analysis resulted in a significant model that explained 34.4% of the variance of AEPD. Large hospitals and those with a professional information management, a high health IT related innovation culture and a nursing informatics officer possess higher AEPD scores and thus have better clinical information logistics mechanisms at their command.
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.
Die Roboterfalle
(2018)
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.
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.
Angehörige der Gesundheitsberufe sehen sich vermehrt mit komplexen und neuen Aufgaben sowie einem veränderten Arbeitsumfeld konfrontiert. Gleichzeitig ist das Gesundheitswesen durch ein hohes Maß an Arbeitsteilung gekennzeichnet, die das nahtlose Zusammenwirken unterschiedlichster Gesundheitsberufe voraussetzt. Daher kommt der Entwicklung interdisziplinärer Kompetenzen eine hohe Bedeutung zu.
An der Hochschule Osnabrück werden im Rahmen des BMBF-geförderten Forschungsverbundprojekts „Kompetenzentwicklung von Gesundheitsfachpersonal im Kontext des Lebenslangen Lernens“ (KeGL) berufsbegleitende wissenschaftliche Zertifikatsangebote in den Bereichen Patientensicherheitsmanagement und Gesundheitsinformatik entwickelt und in interdisziplinär zusammengesetzten Gruppen erprobt. Im Mittelpunkt dieser Handreichung stehen die Ergebnisse und Erfahrungen aus der ersten Förderphase, in welcher neben einer Analyse von Kompetenzbedarfen, die Erarbeitung eines Lehr-Lern-Konzepts und die Erprobung zweier Pilotmodule erfolgt sind.
Teachers in health informatics have a broad variety of international and national educational recommendations to rely on when designing programmes, curricula, courses and educational material. However, in addition they often need very specific information for their setting, blue-prints, hands-on experience and encouragement to try something new. This workshop presents three case studies from European universities who have implemented inter-professional, technology enabled health informatics courses in undergraduate, postgraduate and open university settings. These approaches will be put into the context of the TIGER recommendation framework that includes priority ratings of health informatics competencies and case studies to illustrate them. The workshop attendees will have ample opportunity to exchange ideas with the presenters and start a mutual learning process for health informatics teachers.
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.
Für die Versorgungsforschung ist wichtig, dass verteilte und heterogene Daten so integriert werden, dass sie offen für neue Analyse-Anforderungen und leicht um neue Datenquellen erweiterbar sind. Für die Integration von Versorgungsdaten werden bislang hauptsächlich Data-Warehouses eingesetzt, die Daten dimensional oder als Entity-Attribute-Value-Struktur (EAV) modellieren. Diese Datenmodelle sind jedoch entweder unflexibel oder weisen ein zu geringes Maß an Datenorganisation auf, was longitudinale Analysen erschwert. Wir haben den EAV-Ansatz um die Data-Vault-Modellierung ergänzt und damit die Datenstrukturen der Krankenhaus-Qualitätsberichte des Gemeinsamen Bundesausschusses (G-BA) modelliert sowie die Daten der Jahre 2011 bis 2015 integriert. Dies ermöglicht eine Historisierung der Metadaten für Merkmale, insbesondere der Qualitätsindikatoren, sowie ein hohes Maß an Erweiterbarkeit gegenüber neuen heterogenen Datenquellen. Der vorgeschlagene Ansatz erlaubt es, den Abstraktionsgrad für die zu modellierenden Entitäten frei zu wählen, so dass auch ein vollständig generisches EAV-Modell mit historisierten Metadaten erstellt werden kann.
Background: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities.
Objectives: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS.
Methods: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions.
Results: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management).
Conclusions: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.
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.
Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning.
Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking.
Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist.
Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons.
Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.
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.
Patient handovers are cognitively demanding, crucial for information continuity and patient safety, but error prone. This study investigated the effect of an electronic handover tool, i.e. the handoverEHR, on the memory and care planning performance of nurse students (n=32) in a randomised, controlled cross-over design with the factors handover task and handover role. On a descriptive level, handover recipients could improve their memory performance with electronic support, handover givers their performance of writing care plans. Statistically meaningful differences occurred, however, only when the participants were givers. Without handover experience and with low fluency to word problems, givers performed badly in the most demanding of the handover tasks. Final recommendations, however, can only be made after replicating this study in a clinical setting with mixed groups.
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.
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.
IT und Emotion
(2017)
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.
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.
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.
Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond.
In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER.
Hintergrund: Mangelhafte Informationsübermittlung führt bei der Überleitung Pflegebedürftiger zu einer Gefährdung von Sicherheit und Lebensqualität. Elektronische Instrumente können diese Situation grundsätzlich verbessern, werden jedoch bislang kaum eingesetzt. Ein Grund ist die fehlende Umsetzung von IT Standards.
Ziel der Arbeit: Ziel dieser Studie ist daher die technisch-organisatorische Machbarkeit, die Gebrauchstauglichkeit, Nützlichkeit und Vollständigkeit einer elektronisch unterstützten standardisierten Pflegeüberleitung zu untersuchen.
Material und Methoden: Zu diesem Zweck wurde eine Test-Telematikinfrastruktur aufgebaut, die die elektronische Gesundheitskarte einbezog, sowie ein HL7 CDA basiertes Überleitungsinstrument entwickelt, das den Informationsaustausch zwischen einem Krankenhaus und Pflegeheimen ermöglichte. Die Anwender bewerteten die Gebrauchstauglichkeit des Überleitungsinstruments, sowie die Nützlichkeit und Vollständigkeit von elektronischen und papierbasierten Überleitungen.
Ergebnisse: Es zeigte sich, dass das elektronische Überleitungsinstrument auf Basis des HL7 CDA Standards im Rahmen der Test-Telematikinfrastruktur technisch umgesetzt und von den Anwendern als gebrauchstauglich eingeschätzt werden konnte. Im Vergleich lieferte die elektronische Überleitung vollständigere und nützlichere Daten als die Papierform. Die Anwendung der elektronischen Gesundheitskarte (eGK) wurde von den Anwendern als hemmend eingestuft.
Diskussion: Die Studie unterstreicht die Machbarkeit, Bedeutung sowie die Barrieren von elektronischen Überleitungen von Pflegebedürftigen. Pflegende aus dem Krankenhaus- und Langzeitpflegebereich können eine auf dem HL7 CDA Standard ePflegebericht basierende Anwendung in ihre Abläufe integrieren und erhalten dadurch bessere und vollständigere Informationen. Zur langfristigen Sicherstellung der Versorgungskontinuität sollte der HL7 CDA Standard ePflegebericht Teil der deutschen Telematik-Infrastruktur werden.
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.
Telepflege
(2017)
Telepflege ist eine Anwendung von Informations- und Kommunikationstechnologie im Gesundheitswesen, die Pflegekräfte mit Vertretern der eigenen Berufsgruppe oder anderer Berufsgruppen sowie mit Patienten und ihren Angehörigen insbesondere über räumliche Grenzen hinweg in Verbindung treten lässt. Ziel der Telepflege ist es, Menschen in das eigene professionelle Handeln einzubeziehen, die anderweitig nicht erreichbar sind. Häufig werden dabei nicht nur textliche Nachrichten übermittelt, sondern auch Bilder (z. B. Fotos einer Wunde), Signale (z. B. EKG) oder Vitalwerte (z. B. Körpergewicht). In seiner einfachsten Form ist das Hausnotrufsystem eine Realisierung von Telepflege. Komplexere Formen stellen beispielsweise eine über ein Videokonferenzsystem ermöglichte Fallbesprechung unterschiedlicher Berufsgruppen an unterschiedlichen Standorten dar oder eine Videoverbindung zwischen Pflegekraft und Patient (Telekonsultation). Eine weitere Form von Telepflege bietet die Vitalwertüberwachung von Risikopatienten (Telemonitoring). Die Entwicklung des Internets der Dinge wird weitere Anwendungsfälle bereitstellen. Telepflege ist ein Instrument, das den persönlichen Kontakt nicht ersetzt, sondern den eigenen Handlungsradius erweitert. Aus diesem Grund wird Telepflege in ländlichen Gebieten mit unzureichender Gesundheitsversorgung erfolgreich zum Einsatz gebracht.
Background: Clinical information logistics is the backbone of care workflows inside and outside of hospitals. Due to the great potential of health IT to support clinical processes its contribution needs to be regularly monitored and governed. IT benchmarks are a well-known instrument to optimise the availability and use of IT by guiding the decision making process. The aim of this study was to translate IT benchmarking results that were grounded on a hierarchical workflow scoring system into an appropriate visualisation concept.
Methods: To this end, a three-dimensional multi-level model was developed, which allowed the decomposition of the highly aggregated workflow composite score into score views for the individual clinical workflows concerned and for the descriptors of these workflows. Furthermore this multi-level model helped to break down the score views into single and multiple indicator views.
Results: The results could be visualised per hospital in comparison to the results of organisations of similar size and ownership (peer reference groups) and in comparison to different types of innovation adopters. The multi-level model was implemented in a benchmark of 199 hospitals and evaluated by the chief information officers. The evaluation resulted in high ratings for the comprehensibility of the different types of views of the scores and indicators.
Conclusions: The implementation of the multi-level model in a large benchmark of hospitals proved to be feasible and useful in terms of the overall structure and the different indicator views. There seems to be a preference for less complex and familiar views.
Background: The majority of health IT adoption research focuses on the later stages of the IT adoption process: namely on the implementation phase. The first stage, however, which is defined as the knowledge-stage, remains widely unobserved. Following Rogers’ Diffusion of Innovation Theory (DOI) this paper presents a research framework to examine the possible lack of shared IT awareness-knowledge, i.e. an information gradient, of two crucial stakeholders, the Chief Information Officer (CIO) and the Director of Nursing (DoN). This study shall answer the following research questions: (1.) Does this gradient exist? (2.) Which direction does it have? (3.) Are certain health IT (HIT) attributes associated with a potential gradient? (4.) Which determinants of diffusion go along with this gradient?
Method: Results of two surveys that focused on the topic “IT support of clinical workflows” from the viewpoint of CIOs and DoNs with corresponding datasets from 75 hospitals were used in a secondary data analysis. The gradient was operationalised by measuring the disagreement of CIOs and DoNs on the availability and implementation status of 29 IT functions. HIT attributes tested were relevance and market penetration of the IT functions, determinants of diffusion were inter-professional leadership and IT service density.
Results: The analysis revealed a significant disagreement on the availability of 9 out of 29 HIT functions. In 23 HIT functions, the CIOs reported a higher implementation status than the DoNs, which pointed to a trend for a unidirectional gradient. The disagreement was significantly lower when the relevance of the IT function was high. Both determinants of diffusion correlated significantly negative with the degree of disagreement.
Conclusion: This is the first study to empirically examine shared awareness-knowledge of two IT-stakeholders that are crucial for triggering IT adoption on the frontline level in hospitals. It could be shown that a gradient and thus a lack of shared awareness-knowledge existed and was associated with certain factors. In conclusion, hospitals should implement improved cooperation between IT staff and clinicians and IT service density when establishing the prerequisites for successful IT adoption processes.
Innovation braucht Freiraum
(2016)
Innovationen sind positiv besetzt. Deshalb reicht es nicht aus, dass etwas „neu“ ist, es muss „innovativ“ sein. Viele verbinden das mit etwas Sensationellem, das große Aufmerksamkeit auf sich lenkt und das revolutionäre Veränderungen mit sich bringt – am besten schlagartig. Gerne werden auch alle technischen Neuerungen als Innovationen bezeichnet. Aber stimmt das denn auch?
Dienstleister oder Diktator?
(2016)
Die IT in der Rolle eines Dienstleisters zu sehen, ist an unseren Krankenhäusern leider selten Realität. Denn der IT-Diktator zieht gerne in Form überbordender IT-gestützter Dokumentation durch die Arzt- und Stationszimmer. Das sei dann dem „Diktat der DRG" geschuldet, so die Begründung. Aber muss das so sein?
Innovations are typically characterised by their relative newness for the user. In order for new eHealth applications to be accepted as innovations more criteria were proposed including “use” and “usability”. The handoverEHR is a new approach that allows the user to translate the essentials of a clinical case into a graphical representation, the so-called cognitive map of the patient. This study aimed at testing the software usability. A convenience sample of 23 experienced nurses from different healthcare organisations across the country rated the usability of the handoverEHR after performing typical handover tasks. All usability scales of the IsoMetricsL questionnaire showed positive values (4 “I agree”) with the exception of “error tolerance” (3 “neutral statement”). A significant improvement was found in self-descriptiveness as compared to an initial usability testing prior to this study. Different subgroups of users tended to rate the usability of the system differently. This study demonstrated the benefits of formative evaluations in terms of improving the usability of an entirely new approach. It thus helps to transform a novel piece of software towards becoming a real innovation. Our findings also hint at the importance of user characteristics that could affect the usability ratings.
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.
This workshop will review the history of the TIGER initiative in order to set the framework for an understanding of international informatics competencies. We will include a description of clinical nursing informatics programs in 37 countries as well as the results of a recent survey of nursing competencies in order to further discussions of internationally agreed-upon competency definitions. These two surveys will provide the basis for developing a consensus regarding the integration of core competencies into informatics curriculum developments. Expected outcomes include building consensus on core competencies and developing plans toward implementing intra- and inter-professional informatics competencies across disciplines globally.
The TIGER Initiative
(2016)
Hochschule und Universität Osnabrück haben mit regionalen Partnern (Stadt, Landkreis, Bistum, evangelisch-lutherischem Kirchenkreis, Kompetenzzentrum Gesundheitswirtschaft) die Grundsatzvereinbarung unterzeichnet, in Osnabrück einen Gesundheitscampus zu etablieren. Das Ziel ist, einen Ort zu schaffen, an dem Wissenschaft, Unternehmen der Gesundheitsversorgung, Träger von Gesundheitseinrichtungen und Politik zusammenkommen, um innovative Versorgungskonzepte für die Region zu erproben. „ROSE – das Lernende Gesundheitssystem in der Region Osnabrück-Emsland“ ist ein Großprojekt im Rahmen des Gesundheitscampus Osnabrück, das von dem Niedersächsischen Ministerium für Wissenschaft und Kultur (MWK) über 5 Jahre gefördert wird. Dabei wird das Prinzip des Lernens durch Feedback angewendet. Das bedeutet, dass durch Forschung in und mit der Praxis Evidenz im Sinne von practice-based evidence erzeugt wird, d.h. Evidenz für eine bessere Versorgungspraxis unter Berücksichtigung städtischer und ländlicher Strukturen. Dies hat zur Konsequenz, dass der Transferprozess zwischen Hochschule und Versorgungspraxis nicht am Ende sondern bereits am Anfang steht. Mit dem Ansatz einer wiederkehrenden Abfolge von Forschungsfragen und Analysen von Daten aus der Versorgungspraxis rekurriert ROSE auf das Prinzip des „Learning Health Care System“ (IOM, 2007). Im Rahmen von ROSE stimmen sich Hochschule und Universität Osnabrück ab, um die Ziele des Gesundheitscampus zu erreichen. Die geplante Umsetzung wird anhand eines Modells mit fünf Maßnahmen vorgestellt. Diese bauen auf der Vielfalt von bereits bestehenden Gesundheitsstudiengängen in Osnabrück auf und bringen Forschung, Nachwuchsförderung und Translation von Forschungsergebnissen zusammen.
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.
Background: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.
The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.