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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.
Objectives: This study aimed at the construction of what the core of eHealth policy making is, offering new perspectives about high priority procedures along the policy making process
Methods: Following Grounded Theory methodology, 59 qualitative telephone interviews with a broad variety of stakeholders from Austria, Switzerland and Germany were conducted
Results: The findings hinted at five priorities of eHealth policy making: strategy, consensus-building, decision-making, implementation and evaluation that emerged from the stakeholders’ perception of the eHealth policy. Hereby strategy, consensus-building and implementation gained the highest attention
Conclusions: These findings suggest three high priorities in eHealth policy: 1) developing and pursuing a consistent eHealth strategy, 2) investing time and resources into consensus-building to clear up difficulties early on in the process, 3) governing implementation towards serving patient care through systems fit for practice.
Public Interest Summary: Digitalisation is playing an increasingly crucial role in providing high quality health care. However, different countries have pursued different political paths. In this study, we wanted to know how the stakeholders perceived the political process in their country to identify strengths and weaknesses. We, therefore, conducted interviews about digital health policy with experts from Austria, Switzerland and Germany covering the full spectrum of stakeholders. The findings suggest three political musts: 1) a convincing and coherent strategy followed throughout the entire process, 2) consensus- building among the stakeholders, 3) using “fit for practice” as the yardstick to measure political success.
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.
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.
Background:
Chronic health conditions are on the rise and are putting high economic pressure on health systems, as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT).
Objective:
This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions.
Methods:
A clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections.
Results:
The developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in moderate reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections general medical condition (55/66, 83%), wound assessment (18/24, 75%), and wound status (37/57, 65%), showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%).
Conclusions:
The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical conditions and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.
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.
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.
Background: IT adoption is a process that is influenced by different external and internal factors. This study aimed
1. to identify similarities and differences in the prevalence of medical and nursing IT systems in Austrian and German hospitals, and
2. to match these findings with characteristics of the two countries, in particular their healthcare system, and with features of the hospitals.
Methods: In 2007, all acute care hospitals in both countries received questionnaires with identical questions. 12.4% in Germany and 34.6% in Austria responded.
Results: The surveys revealed a consistent higher usage of nearly all clinical IT systems, especially nursing systems, but also PACS and electronic archiving systems, in Austrian than in German hospitals. These findings correspond with a significantly wider use of standardised nursing terminologies and a higher number of PC workstations on the wards (average 2.1 PCs in Germany, 3.2 PCs in Austria). Despite these differences, Austrian and German hospitals both reported a similar IT budget of 2.6% in Austria and 2.0% in Germany (median).
Conclusions: Despite the many similarities of the Austrian and German healthcare system there are distinct differences which may have led to a wider use of IT systems in Austrian hospitals. In nursing, the specific legal requirement to document nursing diagnoses in Austria may have stimulated the use of standardised terminologies for nursing diagnoses and the implementation of electronic nursing documentation systems. Other factors which correspond with the wider use of clinical IT systems in Austria are: good infrastructure of medical-technical devices, rigorous organisational changes which had led to leaner processes and to a lower length of stay, and finally a more IT friendly climate. As country size is the most pronounced difference between Germany and Austria it could be that smaller countries, such as Austria, are more ready to translate innovation into practice.
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.
Introduction: Handovers are a central process for ensuring information continuity in patient care and, therefore, possess a major influence on patient safety as errors due to poor handovers can lead to life-threatening events. Education to improve handovers and ensure safe patient care can be supported by using critical incident reporting systems (CIRS). The aim of the study is to perform a content analysis of a national CIRS-database with regard to identifying adverse events in handovers situations and to derive competencies for the development of continuing education from these findings.
Methods: A meta model served as a research framework to merge the empirical findings with the London protocol of analysing critical events and the Canadian framework of safety competencies. Relevant cases to be investigated were searched in a freely accessible German CIRS database.
Results: A total of 253 case descriptions were found and analysed. Team factors emerged as the most frequently reported influencing factors following the analysis of the London protocol. Communication errors and missing information as well as a lack of appropriate standards and processes appeared to be the main reasons for critical events to occur. Most of the events happened in units involving surgery and intensive care. A mapping of patient safety competences with the reasons for critical events was conducted in order to determine the practical, concrete and handover related competencies.
Conclusion: Data from a CIRS database and theoretical frameworks can be combined to extract meaningful information about patient safety risks in handover situations. The results are useful for developing curricula to improve handovers based on patient safety competencies.
Einleitung: Whiteboards können als ein Instrument des Lean Managements zur Steuerung der Verweildauer auf Stationen eingesetzt werden, um aktuelle Patienteninformationen zu bündeln und in regelmäßigen strukturierten sowie interdisziplinären Besprechungen die Patientenversorgung zu steuern, die interdisziplinäre Zusammenarbeit zu optimieren und das Entlassungsmanagement zu verbessern. Das Ziel dieser Studie bestand darin, zu untersuchen, inwiefern die Einführung von Whiteboards in zwei Kliniken mit einer Veränderung der Verweildauer einherging.
Methode: Um die Forschungsfrage zu beantworten, wurden retrospektive Zeitreihen aus den DRG-Routinedaten vor und nach Installation der Whiteboards aus den beiden Kliniken in einem Interrupted Time Series Design genutzt. In der einen Klinik (Chirurgie) lagen 3.734 Fälle für den Zeitraum von Januar 2018 bis Dezember 2019 und in der anderen Klinik (Innere Medizin) 54.049 Fälle für den Zeitraum Juli 2013 bis Dezember 2019 vor.
Ergebnisse: In dem gemittelten Vergleich der Verweildauer (relative Verweildauerabweichung pro DRG von dem jeweiligen Verweildauermittel) konnte in der ersten Klinik kein signifikanter Unterschied zwischen den Werten vor und nach Einführung des Boards festgestellt werden. Am zweiten Klinikum zeigte sich sogar im Vorher-Nachher-Vergleich eine signifikante Verschlechterung der Verweildauer. Eine deskriptive Zeitreihenanalyse vor und nach Einführung zeigte in beiden Kliniken, dass kurz nach der Einführung der Boards sich die Verweildauer verschlechterte, anschließend jedoch verbesserte, d.h. dass die Patienten durchschnittlich früher entlassen wurden. Dieser Unterschied ging jedoch im Zeitverlauf wieder zurück.
Diskussion: Zusammenfassend lässt sich festhalten, dass keine Verbesserung in der Verweildauer im Zuge der Nutzung der Whiteboards durch einen reinen Vorher-Nachher-Vergleich nachweisbar war. In der anschließenden Zeitreihenbetrachtung zeigten sich starke Schwankungen, die zunächst mit einer kurzzeitigen Verschlechterung der Verweildauer nach der Implementierung einhergingen und dann zu einer Verbesserung führten. Im Zeitverlauf verblasste der Unterschied jedoch, sodass die Patienten wieder später entlassen wurden. Methodisch zeigt sich, dass im Gegensatz zu der reinen Vorher-Nachher-Analyse erst eine Zeitreihenbetrachtung einen Einblick in das Geschehen und seine Variabilität lieferte. Für die Praxis ergeben sich folgende Implikationen: Whiteboards können als ein hilfreiches Instrument von Lean Management zur Verweildauersteuerung angesehen werden, wie die zwischenzeitlichen Verbesserungen nahelegen. Dies erfordert jedoch eine kontinuierliche, unter Einbezug der Mitarbeiter durchgeführte Pflege der Informationen und einen erkennbaren Mehrwert. Perspektivisch empfiehlt sich zudem eine Digitalisierung der Boards, um den Nachteilen wie der manuellen Pflege entgegenzuwirken.
Background
Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic.
Methods
The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app.
Results
The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034).
Conclusions
Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.
Background
Diabetes mellitus is a major global health issue with a growing prevalence. In this context, the number of diabetic complications is also on the rise, such as diabetic foot ulcers (DFU), which are closely linked to the risk of lower extremity amputation (LEA). Statistical prediction tools may support clinicians to initiate early tertiary LEA prevention for DFU patients. Thus, we designed Bayesian prediction models, as they produce transparent decision rules, quantify uncertainty intuitively and acknowledge prior available scientific knowledge.
Method
A logistic regression using observational collected according to the standardised PEDIS classification was utilised to compute the six-month amputation risk of DFU patients for two types of LEA: 1.) any-amputation and 2.) major-amputation. Being able to incorporate information which is available before the analysis, the Bayesian models were fitted following a twofold strategy. First, the designed prediction models waive the available information and, second, we incorporated the a priori available scientific knowledge into our models. Then, we evaluated each model with respect to the effect of the predictors and validity of the models. Next, we compared the performance of both models with respect to the incorporation of prior knowledge.
Results
This study included 237 patients. The mean age was 65.9 (SD 12.3), and 83.5% were male. Concerning the outcome, 31.6% underwent any- and 12.2% underwent a major-amputation procedure. The risk factors of perfusion, ulcer extent and depth revealed an impact on the outcomes, whereas the infection status and sensation did not. The major-amputation model using prior information outperformed the uninformed counterpart (AUC 0.765 vs AUC 0.790, Cohen’s d 2.21). In contrast, the models predicting any-amputation performed similarly (0.793 vs 0.790, Cohen’s d 0.22).
Conclusions
Both of the Bayesian amputation risk models showed acceptable prognostic values, and the major-amputation model benefitted from incorporating a priori information from a previous study. Thus, PEDIS serves as a valid foundation for a clinical decision support tool for the prediction of the amputation risk in DFU patients. Furthermore, we demonstrated the use of the available prior scientific information within a Bayesian framework to establish chains of knowledge.
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.
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.
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.
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.
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.