Innovative Power of Health Care Organisations Affects IT Adoption: A bi-National Health IT Benchmark Comparing Austria and Germany

Digital Transformation in Healthcare: Technology Acceptance and Its Applications

Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.

Awareness of and interaction with physician rating websites: A cross-sectional study in Austria

To date, the digital assessment of service experiences represents a decisive process step of a feedback culture in numerous economic areas. In view of this digitalization of service assessments, the importance of Physician Rating Websites (PRWs) has also increased steadily in recent years. Even though these websites could be perceived as a powerful communication tool for the exchange of health specific information, the knowledge about whether and how different population segments use these portals has been limited so far. For this reason, our aim was to investigate the level of awareness regarding PRWs among the study population and to discover how users interact with this specific type of online portals. We performed an online survey including 558 participants. To ensure the attention and integrity of participants, attention checks were included in the questionnaire. Study participants who did not exceed the mentioned security levels were excluded from the study. Statistical analyses were carried out, using IBM SPSS Statistics 27. To illustrate the relationship between demographic variables and dependent variables, two tailed chi square tests were performed. Comparison of means and t-testing was used to investigate the relationship between psychographic variables and the dependent variables. In addition to that, the awareness levels regarding different rating portals were evaluated using descriptive methods. Our results suggest that the general awareness regarding PRWs is relatively high (75.6%, 423/558), especially among female (x21 = 9.880, P = .002), middle-aged (x29 = 26.810, P = .002), more highly educated (x24 = 19.038, P = .001), urban (x21 = 6.274, P = .012), digitally literate (t203 = 2.63, P = .009) individuals and particularly among respondents with a higher eHealth literacy (t203 = 2.37, P = .019). Even though more than three quarters of the respondents know that PRWs exist, compared to other rating platforms, they are only in the lower midfield. The upper ranks are taken by websites on which restaurant visits (98.9%, 552/558), hotel stays (97.7%, 545/558) or movies (95.5%, 533/558) can be rated. The most popular PRWs in Austria include Docfinder.at (31.3%, 175/558; 77.8%, 434/558) followed by the evaluation tools provided by Google.at (8.24%, 46/558; 70.3%, 392/558) and Herold.at (1.61%, 9/558; 44.8%, 250/558). In Austria, PRWs seem to be characterized by a high degree of interaction (89.2%, 498/558) with a wide variety of different types of interactions. While many respondents use PRWs to retrieve general information (83.2%, 464/558), there are significantly fewer who read physicians' reviews (60.9%, 340/558) and use this portal to select a physician (60.6%, 338/558). Respondents who have already rated a doctor themselves belong to the smallest group accounting for just 14.7% (82/558). Significant effects regarding the interaction with PRWs exist between different genders, ages, education levels, marital statuses, occupations and areas of living. In addition to that, respondents with better feelings towards the internet, greater digital literacy as well as a higher eHealth literacy were also characterized with a higher interaction rate regarding PRWs. According to the high level of awareness of and interaction with PRWs within our study population, PRWs appear to be a successful medium for health-related communication. Especially for female, middle-aged, more highly educated, urban and more technology savvy population segments, PRWs seem to represent an effective tool to support the health-specific decision-making process.

The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data

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 IQ_HIT 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 IQ_HIT 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 IQ_HIT 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.

Perceptions of Digital Health Education Among European Medical Students: Mixed Methods Survey

BACKGROUND

Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health.

OBJECTIVE

We aimed to assess European medical students' perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students' most pressing needs.

METHODS

The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach.

RESULTS

The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education.

CONCLUSIONS

This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties.

Clinical Information Systems - Seen through the Ethics Lens

OBJECTIVE

The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately.

METHODS

A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education.

RESULTS

By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders' attitudes, but not to evaluate specific implementations.

CONCLUSION

Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States

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.

Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

Background

In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s.

Objective

The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring.

Methods

This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff—5 physicians, 6 nurses, and 4 respiratory therapists—were recorded, transcribed, and analyzed using the grounded theory approach.

Results

Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies.

Conclusions

This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite.

Trial Registration

ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk)

All that Glitters is not Gold: Six Steps Before Selecting and Prioritizing e-Health Services

Since the market for e-health applications is constantly growing, it is getting an ever more complex endeavor to select and prioritize the right service offering given a particular situation. In examining the extant literature, it was revealed that little emphasis is actually placed on how to analyze contextual or environmental factors prior to the selection and prioritization of e-health services. With this paper, we therefore propose a formative framework consisting of six fundamental yet very pragmatic steps that may support decision makers in identifying the most important contextual pre-requisites that e-health services need to fulfill in order to be considered as effective for their environment to be implemented.