Evolving health information technology and the timely availability of visit diagnoses from ambulatory visits: a natural experiment in an integrated delivery system

Managing Directors' Perspectives on Digital Maturity in German Hospitals-A Multi-Point Online-Based Survey Study

BACKGROUND

The digitalization and integration of data are increasingly relevant for hospitals. Several methods exist to assess and structurally develop digital maturity. However, it is notable that German hospitals lag behind the European average with respect to digitalization.

OBJECTIVE

We hypothesized that: (a) the perspective of hospital managing directors regarding the state of digitalization in German hospitals plays an important role in the investigation of barriers, and (b) the Hospital Future Act in 2020 may help to surmount those barriers.

METHODS

Aligned with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), two online surveys were conducted, one in 2019 and one in 2021.

RESULTS

The first study covered 184/344 hospitals and the second, 83/344. The responsibility for deciding on the implementation of digitalization lay with the management (115/184; 62.5%). About 54.9% (101/184) of the managing directors desired digitally supported workflows, together with employees or users. In total, 74.7% (62/83) of hospital managing directors expressed an increase in digitization compared to 2019, with a percentage increase of 25.4% (SD 14.41). In some cases, we analyzed the data using an ANOVA, chi-squared test and Pearson's correlation, but there was no significant relation identified among the variables.

CONCLUSIONS

This online-based survey study demonstrated that the development of a digitalization strategy is still strongly tied to or dominated by the attitude of the management. One could assume a lack of acceptance among employees, which should be surveyed in future research. The Hospital Future Act, as well as the COVID-19 pandemic, has positively influenced the digital maturity of hospitals.

The adoption of a postoperative pain self-report tool, a qualitative study (Preprint)

Background

With electronic technologies, patients are provided with tools to easily acquire information and to manage and record their own health status. eHealth interventions are already broadly applied to perioperative care. In a similar way, we aimed to utilize a smartphone application to enable postoperative patients to partially self-manage their postoperative pain. The results of a previously performed proof-of-concept study regarding the application were promising, and nurses as well as patients were optimistic regarding this innovative mobile application. Nevertheless, in reality, it appears that the usage and overall implementation of this application have stagnated since its introduction. Problems with innovation adoption are not novel; various studies have been conducted to explore the reasons for low implementation success of eHealth applications and indicated that adoption is influenced by multiple organizational factors. This study investigated the influence of these organizational factors on the adoption process, aiming to provide more insight in the dos and don’ts for implementing eHealth in the working processes of hospital care.

Objective

This study aimed to provide insight in how to successfully implement a technological eHealth innovation in a general nonacademic hospital.

Methods

A qualitative study was conducted to explore organizational factors affecting the innovation adoption process. Data were collected by conducting semistructured one-on-one interviews with 11 stakeholders. The data were analyzed using thematic analysis identifying overarching themes.

Results

Absorptive capacity, referred to as an organization’s dynamic capability pertaining to knowledge creation and utilization that enhances an organization’s ability to gain and sustain a competitive advantage, was regarded as the most influential factor on the application’s adoption. Accordingly, it appeared that innovation adoption is mainly determined by the capability and willingness to assimilate and transform new information into productive use and the ability to absorb a novel innovation. Absorptive capacity was found to be influenced by the innovation’s benefit and the sense of ownership and responsibility. Organizational readiness and management support were also regarded as essential since absorptive capacity seemed to be mediated by these factors. The size of the hospital influenced eHealth adoption by the amount of resources available and by its organizational structure.

Conclusions

In conclusion, absorptive capacity is essential for eHealth adoption, and it is mediated by management support and organizational readiness. It is recommended to increase the degree of willingness and ability to adopt an eHealth innovation by enhancing the relevance, engaging stakeholders, and assigning appropriate leaders to offer guidance.

The next step towards making use meaningful: electronic information exchange and care coordination across clinicians and delivery sites

BACKGROUND

Care for patients with chronic conditions often requires coordination between multiple physicians and delivery sites. Electronic Health Record (EHR) use could improve care quality and efficiency in part by facilitating care coordination.

OBJECTIVE

We examined the association between EHR use and clinician perceptions of care coordination for patients transferred across clinicians and delivery sites.

RESEARCH DESIGN

Repeated surveys of primary care clinicians during the staggered implementation of an outpatient EHR (2005-2008), followed by an integrated inpatient EHR (2006-2010). We measured the association between EHR use stages (no use, outpatient EHR only, and integrated inpatient-outpatient EHR) and care coordination using logistic regression, adjusting for clinician characteristics, study year, and medical center.

SUBJECTS

Adult primary care clinicians in a large Integrated Delivery System.

MEASURES

Three measures of clinician-reported care coordination for patient care transferred across clinicians (eg, from specialist to primary care team) and across delivery sites (eg, from the hospital to outpatient care).

RESULTS

Outpatient EHR use was associated with higher reports of access to complete and timely clinical information and higher agreement on clinician roles and responsibilities for patients transferred across clinicians, but not for patients transferred across delivery sites. Use of the integrated outpatient-inpatient EHR was associated with higher reports of access to timely and complete clinical information, clinician agreement on the patient's treatment plan for patients transferred across delivery sites, and with all coordination measures for patients transferred across clinicians.

CONCLUSION

Use of an integrated EHR with health information exchange across delivery settings improved patient care coordination.

Organizational decision to adopt hospital information system: an empirical investigation in the case of Malaysian public hospitals

OBJECTIVES

This study mainly integrates the mature Technology-Organization-Environment (TOE) framework and recently developed Human-Organization-Technology (HOT) fit model to identify factors that affect the hospital decision in adopting Hospital Information System (HIS).

METHODS

Accordingly, a hybrid Multi-Criteria-Decision-Making (MCDM) model is used to address the dependence relationships of factors with the aid of Analytic Network Processes (ANP) and Decision Making Trial and Evaluation Laboratory (DEMATEL) approaches. The initial model of the study is designed by considering four main dimensions with 13 variables as organizational innovation adoption factors with respect to HIS. By using DEMATEL, the interdependencies strength among the dimensions and variables are tested. The ANP method is then adopted in order to determine the relative importance of the adoption factors, and is used to identify how these factors are weighted and prioritized by the public hospital professionals, who are wholly familiar with the HIS and have years of experience in decision making in hospitals' Information System (IS) department.

RESULTS

The results of this study indicate that from the experts' viewpoint "Perceived Technical Competence" is the most important factor in the Human dimension. In the Technology dimension, the experts agree that the "Relative Advantage" is more important in relation to the other factors. In the Organization dimension, "Hospital Size" is considered more important rather than others. And, in the Environment dimension, according to the experts judgment, "Government Policy" is the most important factor. The results of ANP survey from experts also reveal that the experts in the HIS field believed that these factors should not be overlooked by managers of hospitals and the adoption of HIS is more related to more consideration of these factors. In addition, from the results, it is found that the experts are more concerned about Environment and Technology for the adoption HIS.

CONCLUSIONS

The findings of this study make a novel contribution in the context of healthcare industry that is to improve the decision process of innovation in adoption stage and to help enhance more the diffusion of IS in the hospital setting, which by doing so, can provide plenty of profits to the patient community and the hospitals.

The association between EHRs and care coordination varies by team cohesion

OBJECTIVE

To examine whether primary care team cohesion changes the association between using an integrated outpatient-inpatient electronic health record (EHR) and clinician-rated care coordination across delivery sites.

STUDY DESIGN

Self-administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 (N=565), 2006 (N=678), and 2008 (N=626) during the staggered implementation of an integrated EHR (2005-2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of EHR use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement.

PRINCIPAL FINDINGS

Among clinicians working in teams with higher cohesion, EHR use was associated with significant improvements in reported access to timely and complete information (53.5 percent with EHR vs. 37.6 percent without integrated-EHR), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all p<.05). We found no statistically significant association between use of the integrated-EHR and reported care coordination in less cohesive teams.

CONCLUSION

The association between EHR use and reported care coordination varied by level of team cohesion. EHRs may not improve care coordination in less cohesive teams.

A bricolage perspective on healthcare information systems design

Pressured by escalating costs, continual demand for high quality, and the speed of technological advances, the need for change and improvisation has become a critical priority for the healthcare industry. Now society demands that healthcare providers offer better patient care through the careful use of information technologies. For that, practitioners are urged to expand the boundaries of innovative IS design strategies. Unfortunately, research on healthcare information systems (HIS) improvisation remains relatively underdeveloped. Thus, this study uses the organizational improvisation and bricolage theoretical lenses, from the perspective of a case study, to examine how strategic improvisation might give rise to fruitful HIS novel design performances. Theoretically, we provide an inductively derived strategic conceptual model of improvisation that couples with network, structure, and institutional bricolage to execute a 'resource-time-effort' model. This enables us to improvise a superior HIS that offers quality patient-centric healthcare delivery and a valuable improvisation model. Professionally, this study contributes three key insights for IS improvisation in the healthcare industry.