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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.
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.
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.
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.
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.
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.