How digital health affects the patient-physician relationship: An empirical-ethics study into the perspectives and experiences in obstetric care

Nurses' and physicians' perceptions of the impact of eHealth and information systems on the roles of health care professionals: A qualitative descriptive study

The increased use of eHealth and information systems impacts health care work broadly, including cultural and social aspects of work such as the roles of health care professionals. This qualitative descriptive study examined the perceptions of health care professionals in terms of how eHealth and information systems have changed their roles. The data was collected via 15 semi-structured thematic interviews and analysed using content analysis with an inductive approach. The analysis indicated mainly unconscious changes in the roles of professional groups. The professionals perceived that the role of digitally competent professionals in the working community was important. Moreover, high digital competency was seen to have led to an increase or change in work tasks. Professionals' own working environments and job opportunities were seen to have affected to their roles when using information systems. eHealth was perceived to have created inequalities in work tasks, increased skills gaps and complicated work. However, eHealth made cooperation between professionals easier than before. Organisations should pay more attention to equal opportunities to increase professional's digital competency, even out workloads between professionals, and provide equal access to eHealth and information systems.

Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review

BACKGROUND

The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact.

OBJECTIVE

The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools.

METHODS

We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs.

RESULTS

Of the 1175 unique primary studies, we identified 17 (1.45%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59%) focused on clinical decision support tools, followed by 6 (35%) studies focusing on electronic health records and 1 (6%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality.

CONCLUSIONS

Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users.

TRIAL REGISTRATION

PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj.

"Nothing works without the doctor:" Physicians' perception of clinical decision-making and artificial intelligence

Introduction

Artificial intelligence-driven decision support systems (AI-DSS) have the potential to help physicians analyze data and facilitate the search for a correct diagnosis or suitable intervention. The potential of such systems is often emphasized. However, implementation in clinical practice deserves continuous attention. This article aims to shed light on the needs and challenges arising from the use of AI-DSS from physicians' perspectives.

Methods

The basis for this study is a qualitative content analysis of expert interviews with experienced nephrologists after testing an AI-DSS in a straightforward usage scenario.

Results

The results provide insights on the basics of clinical decision-making, expected challenges when using AI-DSS as well as a reflection on the test run.

Discussion

While we can confirm the somewhat expectable demand for better explainability and control, other insights highlight the need to uphold classical strengths of the medical profession when using AI-DSS as well as the importance of broadening the view of AI-related challenges to the clinical environment, especially during treatment. Our results stress the necessity for adjusting AI-DSS to shared decision-making. We conclude that explainability must be context-specific while fostering meaningful interaction with the systems available.

Diffused responsibility: attributions of responsibility in the use of AI-driven clinical decision support systems

Good decision-making is a complex endeavor, and particularly so in a health context. The possibilities for day-to-day clinical practice opened up by AI-driven clinical decision support systems (AI-CDSS) give rise to fundamental questions around responsibility. In causal, moral and legal terms the application of AI-CDSS is challenging existing attributions of responsibility. In this context, responsibility gaps are often identified as main problem. Mapping out the changing dynamics and levels of attributing responsibility, we argue in this article that the application of AI-CDSS causes diffusions of responsibility with respect to a causal, moral, and legal dimension. Responsibility diffusion describes the situation where multiple options and several agents can be considered for attributing responsibility. Using the example of an AI-driven ‘digital tumor board’, we illustrate how clinical decision-making is changed and diffusions of responsibility take place. Not denying or attempting to bridge responsibility gaps, we argue that dynamics and ambivalences are inherent in responsibility, which is based on normative considerations such as avoiding experiences of disregard and vulnerability of human life, which are inherently accompanied by a moment of uncertainty, and is characterized by revision openness. Against this background and to avoid responsibility gaps, the article concludes with suggestions for managing responsibility diffusions in clinical decision-making with AI-CDSS.