[Strategies for digitalizing the hospital of the future]

The association of hospital profitability and digital maturity - An explorative study using data from the German DigitalRadar project

INTRODUCTION

German hospitals largely rely on public investments for digitization. As these have been insufficient, hospitals had to use own profits to foster digital transformation. Thus, we assess if profitability affects digital maturity, and what other factors might be influential.

METHODS

We use digital maturity data from the DigitalRadar (DR) project (2021) and financial statement data from the Hospital Rating Report from 2017 to 2019 (n = 860). We run linear regressions with the DR-score (continuous variable from 0 to 100) as dependent and three-year average EBITDA margin as independent variable. Besides, we conduct subgroup analyses stratifying by chain size.

RESULTS

A one percentage point EBITDA margin increase is associated with a 0.359 points DR-score increase (p<0.01). This relationship holds in significance and holds or increases in magnitude for all specifications except when adding chain beds (0.212 point DR-score increase, p<0.05). Besides, chain membership and chain size are positively and significantly associated with hospitals' DR-score. EBITDA margins of the subgroups "large chains" and "Big 3″, i.e., the three largest chains, were strongly associated with the DR-score (2.685 and 3.197 points DR-score increase respectively, p<0.01).

CONCLUSIONS

Higher profitability is associated with higher digital maturity. Larger chains are digitally more mature, because (1) they might follow a chain-wide IT-strategy, (2) can standardize IT-architecture, and policies and (3) might cross-finance investments.

Digitaler Reifegrad der Krankenhausversorgung – Ausgangssituation und Handlungsoptionen für eine forcierte digitale Transformation in österreichischen Krankenhäusern

Zielsetzung Die stationäre Patientenversorgung in österreichischen Krankenhäusern wird bestimmt durch arbeitsteilige, interdisziplinäre und komplexe Leistungsprozesse, die durch eine Vielzahl an unterschiedlichen Fachdisziplinen und Abteilungen erbracht werden. Die wissensbasierten Gesundheitsdienstleistungen werden dabei durch einen Mix aus Arbeitsleistungen sowie Hard- und Software-Einsatz dominiert. Aufgrund der verstärkten branchenübergreifenden Digitalisierung von Leistungsprozessen stellt sich die Frage: Wie sollte die Digitalisierung zur Verbesserung der zukünftigen Wertschöpfung und Ressourcennutzung in österreichischen Krankenhäusern aus Sicht der Entscheidungs- und Führungsverantwortlichen (Kollegiale Führung) ausgestaltet und weiterentwickelt werden?

Methodik Mittels einer semi-strukturierten Literaturrecherche sowie einer Online-Umfrage unter Entscheidungs- und Führungsverantwortlichen (Kollegiale Führung) in österreichischen Krankenhäusern (N=374; n=49, rr=13,1%) wurden der aktuelle Reifegrad sowie die unterschiedlichen Zielsetzungen, Herausforderungen und Lösungsansätze der Digitalisierung im Krankenhauswesen aus der Perspektive der Kollegialen Führung, erhoben und analysiert.

Ergebnisse Es wird deutlich, dass die übergreifende Digitalisierung im Krankenhaus durch eine Vielzahl an Akteuren, Professionen, Aktivitäten, Ressourceneinsätzen sowie wissensbasierten Dienstleistungen bestimmt sowie mit unterschiedlichen Herausforderungen konfrontiert wird. Der aktuelle Reifegrad der Digitalisierung im Krankenhaus erreicht nach Auffassung der befragten Entscheidungsverantwortlichen ein mittleres Niveau. Wesentliche Verbesserungspotenziale und Anwendungsmöglichkeiten werden insbesondere hinsichtlich der Nutzung von Big Data und Künstliche Intelligenz (KI)-Technologien, dem Asset-Tracking sowie der Anwendung von Mobile-Health-Lösungen gesehen.

Schlussfolgerungen Neben der Weiterentwicklung der wissensbasierten und qualifizierten medizinisch-pflegerisch-therapeutischen Patientenversorgung gilt es, zukünftig verstärkt die Digitalisierung im Krankenhaus zu forcieren. Ziel ist es, bei zunehmender Nachfrage und gesteigerten Patientenerwartungen sowie verstärkt limitierter Ressourcenverfügbarkeit, sowohl die Versorgungssicherheit (z. B. niederschwelliger, zeit- und wohnortnaher Zugang) als auch die Versorgungsqualität (z. B. Evidence Based Health Care), sicherzustellen.

The Impact of Digital Transformation on Inpatient Care: A Mixed Design Study (Preprint)

BACKGROUND

In the context of the digital transformation of all areas of society, health care providers are also under pressure to change. New technologies and a change in patients' self-perception and health awareness require rethinking the provision of health care services. New technologies and the extensive use of data can change provision processes, optimize them, or replace them with new services. The inpatient sector, which accounts for a particularly large share of health care spending, plays a major role in this regard.

OBJECTIVE

This study examined the influences of current trends in digitization on inpatient service delivery.

METHODS

We conducted a scoping review. This was applied to identify the international trends in digital transformation as they relate to hospitals. Future trends were considered from different perspectives. Using the defined inclusion criteria, international peer-reviewed articles published between 2016 and 2021 were selected. The extracted core trends were then contextualized for the German hospital sector with 12 experts.

RESULTS

We included 44 articles in the literature analysis. From these, 8 core trends could be deduced. A heuristic impact model of the trends was derived from the data obtained and the experts' assessments. This model provides a development corridor for the interaction of the trends with regard to technological intensity and supply quality. Trend accelerators and barriers were identified.

CONCLUSIONS

The impact analysis showed the dependencies of a successful digital transformation in the hospital sector. Although data interoperability is of particular importance for technological intensity, the changed self-image of patients was shown to be decisive with regard to the quality of care. We show that hospitals must find their role in new digitally driven ecosystems, adapt their business models to customer expectations, and use up-to-date information and communications technologies.

Change Management and Digital Innovations in Hospitals of Five European Countries

The objective of the paper is to evaluate the quality of systemic change management (CHM) and readiness for change in five Central European countries. The secondary goal is to identify trends and upcoming changes in the field of digital innovations in healthcare. The results show that all compared countries (regardless of their historical context) deal with similar CHM challenges with a rather similar degree of success. A questionnaire distributed to hospitals clearly showed that there is still considerable room for improvement in terms of the use of specific CHM tools. A review focused on digital innovations based on the PRISMA statement showed that there are five main directions, namely, data collection and integration, telemedicine, artificial intelligence, electronic medical records, and M-Health. In the hospital environment, there are considerable reservations in applying change management principles, as well as the absence of a systemic approach. The main factors that must be monitored for a successful and sustainable CHM include a clearly defined and widely communicated vision, early engagement of all stakeholders, precisely set rules, adaptation to the local context and culture, provision of a technical base, and a step-by-step implementation with strong feedback.

Therapies for rare diseases: therapeutic modalities, progress and challenges ahead

Most rare diseases still lack approved treatments despite major advances in research providing the tools to understand their molecular basis, as well as legislation providing regulatory and economic incentives to catalyse the development of specific therapies. Addressing this translational gap is a multifaceted challenge, for which a key aspect is the selection of the optimal therapeutic modality for translating advances in rare disease knowledge into potential medicines, known as orphan drugs. With this in mind, we discuss here the technological basis and rare disease applicability of the main therapeutic modalities, including small molecules, monoclonal antibodies, protein replacement therapies, oligonucleotides and gene and cell therapies, as well as drug repurposing. For each modality, we consider its strengths and limitations as a platform for rare disease therapy development and describe clinical progress so far in developing drugs based on it. We also discuss selected overarching topics in the development of therapies for rare diseases, such as approval statistics, engagement of patients in the process, regulatory pathways and digital tools.