Health IT Adoption in German Hospitals: Could We See Any Changes Between 2017 and 2023?

INTRODUCTION: Increase in health IT adoption is often driven by financial support through the state. In 2020, the German Hospital Future Law passed Parliament with a schedule to see potential effects in 2023. The research question of the present study thus was if there were differences between 2017 and 2023 in selected application areas eligible for funding by the law. METHODS: Availability and percentage of use in clinical units was measured in a panel of 172 hospitals for these areas. A linear mixed model with repeated measures yielded a significant increase in "medication management" and "discharge management". RESULTS AND DISCUSSION: In "medication management", hospitals in a group as compared to single hospitals tripled the percentage of clinical units using IT systems for this purpose. Not-for-profit hospitals doubled their IT systems for "discharge management" when compared to for-profit hospitals. CONCLUSION: Whether these changes can be attributed to the Hospital Future Law is debatable due to severe delays in various fields, particularly in making funding available. There is room for speeding up particularly the administrative funding process and finally demonstrating results that are proportional to the government money invested.

Automation Bias in AI-Decision Support: Results from an Empirical Study.

INTRODUCTION: Automation bias poses a significant challenge to the effectiveness of Clinical Decision Support Systems (CDSS), potentially compromising diagnostic accuracy. Previous research highlights trust, self-confidence, and task difficulty as key determinants. With the increasing availability of AI-enabled CDSS, automation bias attains new attention. This study therefore aims to identify factors influencing automation bias in a diagnostic task. METHODS: A quantitative intervention study with participants from different backgrounds (n = 210) was conducted, employing regression analysis to analyze potential factors. Automation bias was measured as the agreement rate with wrong AI-enabled recommendations. RESULTS AND DISCUSSION: Diagnostic performance, certified wound care training, physician profession, and female gender significantly reduced false agreement rates. Higher perceived benefit of the system was significantly associated with promoting false agreement. Strategies like comprehensive diagnostic training are pivotal in the prevention of automation bias when implementing CDSS. CONCLUSION: Considering factors influencing automation bias when introducing a CDSS is critical to fully leverage the benefits of such a system. This study highlights that non-specialists, who stand to gain the most from CDSS, are also the most susceptible to automation bias, emphasizing the need for specialized training to mitigate this risk and ensure diagnostic accuracy and patient safety.

What Determines the Use of Clinical Decision Support Systems in Nursing? Results of a Multiple Regression Analysis.

INTRODUCTION: In nursing, professionals are expected to base their practice on evidence-based knowledge, however the successful implementation of this knowledge into nursing practice is not always assured. Clinical Decision Support Systems (CDSS) are considered to bridge this evidence-practice gap. METHODS: This study examines the extent to which evidence-based nursing (EBN) practices influence the use of CDSS and identifies what additional factors from acceptance theories such as UTAUT play a role. RESULTS AND DISCUSSION: Our findings from three regression models revealed that nursing professionals and nursing students who employ evidence-based practices are not more likely to use an evidence-based CDSS. The relationship between an EBN composite score (model 1) or is individual dimensions (model 2) and CDSS use was not significant. However, a more comprehensive model (model 3), incorporating items from the UTAUT such as Social Influences, Facilitating Conditions, Performance Expectancy, and Effort Expectancy, supplemented by Satisfaction demonstrated a significant variance explained (R2 = 0.279). Performance Expectancy and Satisfaction were found to be significantly associated with CDSS utilization. CONCLUSION: This underscores the importance of user-friendliness and practical utility of a CDSS. Despite potential limitations in generalizability and a limited sample size, the results provide insights into that CDSS first and foremost underly the same mechanisms of use as other health IT systems.

Automatic Classification of Wound Images Showing Healing Complications: Towards an Optimised Approach for Detecting Maceration.

This study aims to advance the field of digital wound care by developing and evaluating convolutional neural network (CNN) architectures for the automatic classification of maceration, a significant wound healing complication, in 458 annotated wound images. Detection and classification of maceration can improve patient outcomes. Several CNN models were compared and MobileNetV2 emerged as the top-performing model, achieving the highest accuracy despite having fewer parameters. This finding underscores the importance of considering model complexity relative to dataset size. The study also explored the role of image cropping and the use of Grad-CAM visualizations to understand the decision-making process of the CNN. From a medical perspective, results indicate that employing CNNs for classification of maceration may enhance diagnostic accuracy and reduce the clinicians' time and effort.

Recommended target audience, course content and learning arrangements for teaching health informatics competencies: A scoping review.

Background: As healthcare depends on health information technology, there is a growing need for Health Informatics competencies in daily practice. This review aimed to explore how the teaching of education in HI has been arranged. 28 publications, published in English between 2016 and 2020 and obtained from selected bibliographic databases, were reviewed. The data was analyzed using deductive content analysis with the following pre-formulated topics: target audience, course content and learning arrangements. The results highlight three key competencies: documentation and communication, management, and understanding of health information technology. It underlines a blended teaching method to improve the competencies of healthcare professionals, graduates, undergraduates, and suggests adding active interactions, multi-professional interactions, and hands-on skills. This study highlights the importance of adapting to changes in healthcare, improving HI competencies in healthcare, and fostering positive digital experiences. It underlined the need for practical training, in theory and hands-on sessions, including key competencies in documentation and communication, management and health information systems.

Information in Healthcare - From Data to Knowledge: Improving Data Literacy Competencies.

Digitalization in healthcare and the increasing availability of data demand data literacy competences of nurses and other healthcare professionals including technical, ethical and communication skills. The international Spring School 2023 "Information in Healthcare - From Date to Knowledge" aimed at these competences covering interoperability, data protection and security, data analytics and ethical issues. These topics were embedded in the overall case of data-driven quality improvement for diabetes patients in a region. The curriculum includes an online preparation-phase and a five-days attendance week, incorporating problem-based and group work approaches. According to the studentt's evaluation, the awareness of the importance of the topics was raised and theoretical as well as practical application skills were improved. The Spring School enhanced data literacy competences, critical thinking, problem-solving, interprofessional und intercultural skills among healthcare professionals. Such course offering can contribute to meeting the increasing challenges of digitalization in healthcare.

Dimensions of Evidence-Based Practice in Nursing: Results of a Factor Analysis.

Clinical decision support systems (CDSS) are capable of bridging evidence and practice. However, it is unclear what dimensions determine evidence-based practice under real world conditions. To answer this question, 126 registered nurses and nursing students from the Munich municipal hospital group filled in a systematically developed and validated questionnaire with 26 items. An exploratory factor analysis revealed the three dimensions "Knowledge", "Trust" and "Practice" which explain 56.5% of the total variance. They are corroborated by the literature and match findings about evidence-based practice in medicine. These results not only provide insights into the construct evidence-based practice but also give practical hints how to foster evidence-based daily work in nursing. A supportive clinical environment seems to be paramount to achieve this goal: access to evidence-based resources, team meetings to reflect the experience and the inclusion of the patients' needs.

Discovering the importance of health informatics education competencies in healthcare practice. A focus group interview.

BACKGROUND: As healthcare and especially health technology evolve rapidly, new challenges require healthcare professionals to take on new roles. Consequently, the demand for health informatics competencies is increasing, and achieving these competencies using frameworks, such as Technology Informatics Guiding Reform (TIGER), is crucial for future healthcare. AIM: The study examines essential health informatics and educational competencies and health informatics challenges based on TIGER Core Competency Areas. Rather than examine each country independently, the focus is on uncovering commonalities and shared experiences across diverse contexts. METHODS: Six focus group interviews were conducted with twenty-one respondents from three different countries (Germany (n = 7), Portugal (n = 6), and Finland (n = 8)). These interviews took place online in respondents' native languages. All interviews were transcribed and then summarized by each country. Braun and Clarke's thematic analysis framework was applied, which included familiarization with the data, generating initial subcategories, identifying, and refining themes, and conducting a final analysis to uncover patterns within the data. RESULTS: Agreed upon by all three countries, competencies in project management, communication, application in direct patient care, digital literacy, ethics in health IT, education, and information and knowledge management were identified as challenges in healthcare. Competencies such as communication, information and communication technology, project management, and education were identified as crucial for inclusion in educational programs, emphasizing their critical role in healthcare education. CONCLUSIONS: Despite working with digital tools daily, there is an urgent need to include health informatics competencies in the education of healthcare professionals. Competencies related to application in direct patient care, IT-background knowledge, IT-supported and IT-related management are critical in educational and professional settings are seen as challenging but critical in healthcare.

Differential effects of electronic patient record systems for wound care on hospital-acquired pressure injuries: Findings from a secondary analysis of German hospital data.

INTRODUCTION: Despite the improvements made in recent decades, the OECD regards hospital-acquired pressure injuries (HAPI) as high priority areas for actions to ensure patient safety. This study was aimed at investigating the degree of utilization of two types of electronic patient record systems for wound care on lowering HAPI rates. Furthermore, the effect of user satisfaction with the systems and perceived alignment with clinical processes should be studied. MATERIAL AND METHODS: A regression analysis of post-stratified data from German hospitals obtained from the Hospital Quality Reports (observed/expected HAPI ratio) and the IT Report Healthcare was performed. The sample comprised 319 hospitals reporting on digital wound record systems and 199 hospitals on digital nursing record systems for system utilization and the subset of hospitals using a digital system for user satisfaction and process alignment. RESULTS: The study revealed a significant effect of hospital ownership for both types of systems and a significant interaction of ownership and system utilization for digital wound record systems: Only the for-profit hospitals benefited from a higher degree of system utilization with a lower HAPI ratio. In contrast, non-profit hospitals yielded a reversed pattern, with increasing HAPI rates matching an increased system utilization. User satisfaction (significant) and the perceived alignment of the clinical process (trend) of the digital nursing record system were related with lower HAPI ratios. DISCUSSION: These findings point to a differential effect of system utilization on HAPI ratios depending on hospital ownership, and they demonstrate that those users who are satisfied with the system can act as catalysts for better care. The explained variance was small but comparable to other studies. Furthermore, it shows that explaining quality care is a complex undertaking. Sheer utilization has no effect while a differential perspective on the facilitators and barriers might help to explain the patient outcomes.

Lessons Learned from an Interprofessional European Summer School in Health Informatics.

The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students' evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.