1
|
Wurster F, Di Gion P, Goldberg N, Hautsch V, Hefter K, Herrmann C, Langebartels G, Pfaff H, Karbach U. Roger's diffusion of innovations theory and the adoption of a patient portal's digital anamnesis collection tool: study protocol for the MAiBest project. Implement Sci Commun 2024; 5:74. [PMID: 39010236 PMCID: PMC11247801 DOI: 10.1186/s43058-024-00614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND German hospitals are legally obliged to implement digital patient portals within the next years. Systematic reviews show that the use of patient portals may be associated with improved patient-centeredness and workflows. However, mandatory digital healthcare innovations are sometimes not used by the target group as planned or even completely rejected. Based on Roger's theory of innovation diffusion, it can be assumed that the time factor is of particular importance for the adoption of the patient portal. The aim of the project is to assess determinants of patient portal adoption and to examine whether Roger's theory can be confirmed. METHODS The project investigates the use of the patient portal in three different clinics of a large academic teaching hospital in Germany using a longitudinal study design with three cross-sectional time points (pre, post, post). Doctors and patients are surveyed about factors that predict the use of the patient portal and whether the strength of these factors changes over time. They are also interviewed about possible barriers they experience when using the patient portal or about the reasons why the patient portal is not used. Regression models and content analyses are used to answer the research questions. DISCUSSION Determinants of patient portal use will be discussed under the light of the temporal component of Roger's theory. At the same time, it is expected that some determinants will remain unchanged over time. Identifying determinants independent of time allows targeting the groups, enabling specific communication strategies to empower these groups to use the patient portal, contributing to an equal health care system. TRIAL REGISTRATION The study was prospectively registered in the German register of clinical trials (DRKS00033125) in May 2024.
Collapse
Affiliation(s)
- Florian Wurster
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Paola Di Gion
- Department of Digital Clinical Systems, Clinical Affairs and Crisis Management Unit, University Hospital Cologne, Cologne, Germany
| | - Nina Goldberg
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Volker Hautsch
- Department of Digital Clinical Systems, Clinical Affairs and Crisis Management Unit, University Hospital Cologne, Cologne, Germany
| | - Klara Hefter
- Department of Digital Clinical Systems, Clinical Affairs and Crisis Management Unit, University Hospital Cologne, Cologne, Germany
| | - Christin Herrmann
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Langebartels
- Department of Digital Clinical Systems, Clinical Affairs and Crisis Management Unit, University Hospital Cologne, Cologne, Germany
| | - Holger Pfaff
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
2
|
Wurster F, Beckmann M, Cecon-Stabel N, Dittmer K, Hansen TJ, Jaschke J, Köberlein-Neu J, Okumu MR, Rusniok C, Pfaff H, Karbach U. The Implementation of an Electronic Medical Record in a German Hospital and the Change in Completeness of Documentation: Longitudinal Document Analysis. JMIR Med Inform 2024; 12:e47761. [PMID: 38241076 PMCID: PMC10837754 DOI: 10.2196/47761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/10/2023] [Accepted: 10/23/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Electronic medical records (EMR) are considered a key component of the health care system's digital transformation. The implementation of an EMR promises various improvements, for example, in the availability of information, coordination of care, or patient safety, and is required for big data analytics. To ensure those possibilities, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. OBJECTIVE This study aims to compare the completeness of documentation in paper-based medical records and EMRs and to discuss the possible impact of an EMR on the completeness of documentation. METHODS A retrospective document analysis was conducted, comparing the completeness of paper-based medical records and EMRs. Data were collected before and after the implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients for a 3-week period each. Unpaired, 2-tailed t tests, chi-square tests, and relative risks were calculated to analyze and compare the mean completeness of the 2 record types in general and of 10 specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, and weight). For this purpose, each of the 10 items received a dichotomous score of 1 if it was documented on the first day of patient care on the ward; otherwise, it was scored as 0. RESULTS The analysis consisted of 180 medical records. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t178=-2.469; P=.01; d=-0.428). When looking at the significant changes of the 10 items in detail, the documentation of diet (P<.001), height (P<.001), and weight (P<.001) was more complete in the EMR, while the documentation of diagnosis (P<.001), excretions (P=.02), and pain (P=.008) was less complete in the EMR. The completeness remained unchanged for the documentation of pulse (P=.28), blood pressure (P=.47), body temperature (P=.497), and reanimation status (P=.73). CONCLUSIONS Implementing EMRs can influence the completeness of documentation, with a possible change in both increased and decreased completeness. However, the mechanisms that determine those changes are often neglected. There are mechanisms that might facilitate an improved completeness of documentation and could decrease or increase the staff's burden caused by documentation tasks. Research is needed to take advantage of these mechanisms and use them for mutual profit in the interests of all stakeholders. TRIAL REGISTRATION German Clinical Trials Register DRKS00023343; https://drks.de/search/de/trial/DRKS00023343.
Collapse
Affiliation(s)
- Florian Wurster
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marina Beckmann
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Natalia Cecon-Stabel
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kerstin Dittmer
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till Jes Hansen
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Mi-Ran Okumu
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Rusniok
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|