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Radiology has a reputation for having a high affinity to innovation – particularly with regard to information technologies. Designed for supporting the peculiarities of radiological diagnostic workflows, Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) developed into widely used information systems in hospitals and form the basis for advancing the field towards automated image diagnostics. RIS and PACS can thus serve as meaningful indicators of how quickly IT innovations diffuse in secondary care settings – an issue that requires increased attention in research and health policy in the light of increasingly fast innovation cycles. We therefore conducted a retrospective longitudinal observational study to research the diffusion dynamics of RIS and PACS in German hospitals between 2005 and 2017. Based upon data points collected within the “IT Report Healthcare” and building on Rogers’ Diffusion of Innovation (DOI) theory, we applied a novel methodological technique by fitting Bayesian Bass Diffusion Models on past adoption rates. The Bass models showed acceptable goodness of fit to the data and the results indicated similar growth rates of RIS and PACS implementations and suggest that market saturation is almost reached. Adoption rates of PACS showed a slightly higher coefficient of imitation (q = 0.25) compared to RIS (q = 0.11). However, the diffusion process expands over approximately two decades for both systems which points at the need for further research into how innovation diffusion can be accelerated effectively. Furthermore, the Bayesian approach to Bass modelling showed to have several advantages over the classical frequentists approaches and should encourage adoption and diffusion research to adapt similar techniques.
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.
Use of Emergency Departments by Frail Elderly Patients : Temporal Patterns and Case Complexity
(2019)
Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients’ case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.
Despite similar policy goals, the adoption of eHealth practices took different paths in Austria (AT), Switzerland (CH), and Germany (GER). We seek to provide a rigorous analysis of the current state of hospitals by focusing on three key eHealth areas: electronic patient records (EPR), health information exchange (HIE), electronic patient communication. For validation and in order to gain better contextual insight we applied a mixed method approach by combining survey results from clinical directors with qualitative interview data from eHealth experts of all three countries. Across countries, EPR adoption rates were reported highest (AT: 52%, CH: 78%, GER: 50%), HIE-rates were partly lower (AT: 52%, CH: 14%, GER: 17%), and electronic patient communication was reported lowest overall (AT: 17%, CH: 8%, GER: 19%). Amongst others, results indicate patient awareness about eHealth to be equally weak across countries, which thus may be an important focal point of future policy initiatives.
This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.
Although user participation may facilitate the realisation of IT innovations, various literature analyses show only minimal to moderate evidence for such effects possibly due to disregard of mediating factors. Against this background, this study examines the extent to which joint intrapreneurship of clinical leaders and IT leaders as well as a distinct innovation culture mediate the effect of user participation on hospitals’ IT innovativeness. IT innovativeness was measured by the availability and usability of IT functions and by the perceived ‘innovative power’ of a hospital. An empirical model was developed and tested with data from 168 clinical leaders and IT leaders who participated pairwise in a survey representing 84 German hospitals. Three parallel mediation analyses indicated that the participation of users could only lead to IT innovativeness if they were accompanied by intrapreneurial leadership on the part of clinical directors and IT leaders and if a pronounced innovation culture prevailed.