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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.
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.
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.
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.
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.
Building on Rogers’ Diffusion of Innovation Theory, Bass models describe the diffusion processes distinguishing between innovation (p) and imitation (q). This study aimed at modelling the uptake of RIS, PACS and EHR systems in Germany and Finland. The Bass models revealed a quick and almost identical uptake process across all three systems for Finland. In contrast, the Bass models mirrored a slower uptake in Germany. Consequently, the Finnish “imitation” coefficients were larger than the German ones. While in Germany almost free market forces were driving the adoption through imitation but without tail wind from policy, the adoption process in Finland was centrally governed. This suggests that the diffusion process in Finland reflected a well-managed roll-out of the systems rather than imitation behaviour. Thus, in order for Bass model coefficients to be understood properly, additional contextual information is required.