[Security and user acceptance of an intelligent home emergency call system for older people living at home with limited daily living skills and receiving home care]. / Sicherheit und Nutzerakzeptanz eines intelligenten Hausnotrufsystems im Einsatz bei älteren pflegebedürftigen zu Hause lebenden Menschen mit eingeschränkter Alltagskompetenz.

BACKGROUND: Technically based support measures are becoming increasingly more important in an aging society. Such support measures can provide a self-determined life in familiar surroundings despite the need for care. An example for such a support measure is an intelligent home emergency call system (iHNR system), which automatically detects critical situations (e.g. falling down), transmits this information to an emergency call center and therefore initiates assistance faster. OBJECTIVE: The aim of this uncontrolled, two center observational study was to evaluate the security and acceptance of an iHNR system used by older people receiving home care. MATERIAL AND METHODS: The study was carried out based on 51 subjects with at least a 6-month observation period using the iHNR system. The iHNR system was installed in all homes of the participants. Interviews about acceptance, perceived and objective security, impact on independence and usability of the new iHNR system were conducted. Analysis was performed with particular respect to depression, quality of life, frailty and self-estimated need for assistance. RESULTS: A total of 39 complete records were collected and evaluated. The participants represented a vulnerable group of people with rather depressive moods, negative quality of life and a high level of frailty without significant changes over the observation period. Positive results were found regarding subjective and objective security and acceptance as well as ease of operation of the iHNR system. The fear of falling was only marginally influenced. CONCLUSION: Acceptance regarding the new iHNR system was high. The system provoked a stronger sense of security while at the same time leading to a reduced sense of control. The system seems to be able to detect critical events and can automatically and quickly alert the necessary help services. Therefore, people in need of care can remain longer in their own homes.

Cognitive Performance of Users Is Affected by Electronic Handovers Depending on Role, Task and Human Factors.

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.

The Benefits of a Formative Evaluation for Developing a Highly Innovative Software: The Case of the handoverEHR.

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.

Building a common ground on the clinical case: design, implementation and evaluation of an information model for a Handover EHR.

Handovers need a common ground on the clinical cases between the members of the successive shifts to establish continuity of care. Conventional electronic patient record systems (EHR) proved to be only insufficiently suitable for supporting the grounding process. Against this background we proposed a basic concept for a handover EHR that extends general EHRs in particular openEHR based systems. The resulting handover information model was implemented in a database and evaluated based on 120 clinical cases. The information items of these cases could be mapped successfully to the model, however, the new class "anticipatory guidance" needed to be introduced. The evaluation also demonstrated the importance of highly aggregated information on the clinical case, opinions and meta-information such as the relevance of an item during handovers. Based on these findings, in particular the handover database, handover EHR applications are currently developed to support the grounding process.

How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review.

INTRODUCTION: Establishing continuity of care in handovers at changes of shift is a challenging endeavor that is jeopardized by time pressure and errors typically occurring during synchronous communication. Only if the outgoing and incoming persons manage to collaboratively build a common ground for the next steps of care is it possible to ensure a proper continuation. Electronic systems, in particular electronic patient record systems, are powerful providers of information but their actual use might threaten achieving a common understanding of the patient if they force clinicians to work asynchronously. In order to gain a deeper understanding of communication failures and how to overcome them, we performed a systematic review of the literature, aiming to answer the following four research questions: (1a) What are typical errors and (1b) their consequences in handovers? (2) How can they be overcome by conventional strategies and instruments? (3) electronic systems? (4) Are there any instruments to support collaborative grounding? METHODS: We searched the databases MEDLINE, CINAHL, and COCHRANE for articles on handovers in general and in combination with the terms electronic record systems and grounding that covered the time period of January 2000 to May 2012. RESULTS: The search led to 519 articles of which 60 were then finally included into the review. We found a sharp increase in the number of relevant studies starting with 2008. As could be documented by 20 studies that addressed communication errors, omission of detailed patient information including anticipatory guidance during handovers was the greatest problem. This deficiency could be partly overcome by structuring and systematizing the information, e.g. according to Situation, Background, Assessment and Recommendation schema (SBAR), and by employing electronic tools integrated in electronic records systems as 23 studies on conventional and 22 articles on electronic systems showed. Despite the increase in quantity and quality of the information achieved, it also became clear that there was still the unsolved problem of anticipatory guidance and presenting "the full story" of the patient. Only a small number of studies actually addressed how to establish common ground with the help of electronic tools. DISCUSSION: The increase in studies manifests the rise of great interest in the handover scenario. Electronic patient record systems proved to be excellent information feeders to handover tools, but their role in collaborative grounding is unclear. Concepts of how to move to joint information processing and IT-enabled social interaction have to be implemented and tested.

The need for standardised documents in continuity of care: results of standardising the eNursing summary.

Continuity of care is a concept that is defined as the uninterrupted and coordinated care provided to a patient and that includes an informational dimension which describes the information exchange between the parties involved. In nursing, the nursing summary is the main instrument to ensure informational continuity of care. The aim of this paper is to present an HL7 Clinical Document Architecture based document standard for the eNursing Summary and to discuss the need for harmonizing these results at international level. The eNursing Summary proposed in this paper was developed on the basis of several internationally accepted concepts, primarily the nursing process, the ISO 18104 Reference Terminology Model for Nursing and various data sets. The standardisation process embraced several phases of involving nursing experts for validating its structure and content. It was finally evaluated by a network of 100 healthcare organizations. We argue that the eNursing Summary is a good starting point for standardising nursing discharge and transfer documents on a global level. However, further work is needed to bring together the different national and international strands in standardisation. .

IT adoption of clinical information systems in Austrian and German hospitals: results of a comparative survey with a focus on nursing.

BACKGROUND: IT adoption is a process that is influenced by different external and internal factors. This study aimed1. to identify similarities and differences in the prevalence of medical and nursing IT systems in Austrian and German hospitals, and2. 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.

ICT supporting nurses and physicians in hospitals: results of a comparative survey in Austria and Germany.

This study aimed to compare the use of clinical information systems, particularly for nursing, in Austria and Germany. In 2007, all acute care hospitals in both countries received questionnaires with identical questions. 12.4% in Germany and 34.6% in Austria responded. The surveys revealed a consistent higher usage of clinical IT in Austrian than in German hospitals. It also included a significant difference in the percentage of electronic nursing records in use. These findings correspond with a significantly higher number of PC workstations on the wards. Despite these differences, Austrian and German hospitals reported a nearly identical IT budget. Factors which might have influenced the wider use of clinical IT are a re-focus on clinical matters after rigorous organisational changes, legal constraints and a general IT-friendly climate in Austria.