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Fuchs KF, Kerwagen F, Kunz AS, Schulze A, Ullrich M, Ertl M, Gilbert F. [Optimizing radiological diagnostic management via mobile devices in trauma surgery]. Unfallchirurgie (Heidelb) 2024; 127:374-380. [PMID: 38300253 PMCID: PMC11058621 DOI: 10.1007/s00113-024-01410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Time is a scarce resource for physicians. One medical task is the request for radiological diagnostics. This process is characterized by high administrative complexity and sometimes considerable time consumption. Measures that lead to an administrative relief in favor of patient care have so far been lacking. AIM OF THE STUDY Process optimization of the request for radiological diagnostics. As a proof of concept the request for radiological diagnostics was conducted using a mobile, smartphone and tablet-based application with dedicated voice recognition software in the Department of Trauma Surgery at the University Hospital of Würzburg (UKW). MATERIAL AND METHODS In a prospective study, time differences and efficiency of the mobile app-based method (ukw.mobile based Application = UMBA) compared to the PC-based method (PC-based application = PCBA) for requesting radiological services were analyzed. The time from the indications to the completed request and the time required to create the request on the device were documented and assessed. Due to the non-normal distribution of the data, a Mann-Whitney U test was performed. RESULTS The time from the indications to the completed request was significantly (p < 0.05) reduced using UMBA compared to PCBA (PCBA: mean ± standard difference [SD] 19.57 ± 33.24 min, median 3.00 min, interquartile range [IQR] 1.00-30.00 min vs. UMBA: 9.33 ± 13.94 min, median 1.00 min, IQR 0.00-20.00 min). The time to complete the request on the device was also significantly reduced using UMBA (PCBA: mean ± SD 63.77 ± 37.98 s, median 51.96 s, IQR 41.68-68.93 s vs. UMBA: 25.21 ± 11.18 s, median 20.00 s, IQR 17.27-29.00 s). CONCLUSION The mobile, voice-assisted request process leads to a considerable time reduction in daily clinical routine and illustrates the potential of user-oriented, targeted digitalization in healthcare. In future, the process will be supported by artificial intelligence.
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Affiliation(s)
- Konrad F Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland.
| | - Fabian Kerwagen
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Andreas S Kunz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Andrés Schulze
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Melanie Ullrich
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maximilian Ertl
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Fabian Gilbert
- Digitalisierungszentrum Präzisions- und Telemedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland
- LMU Klinikum Großhadern, Muskuloskelettales Universitätszentrum München, München, Deutschland
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Pfeuffer N, Beyer A, Penndorf P, Leiz M, Radicke F, Hoffmann W, van den Berg N. Evaluation of a Health Information Exchange System for Geriatric Health Care in Rural Areas: Development and Technical Acceptance Study. JMIR Hum Factors 2022; 9:e34568. [PMID: 36107474 PMCID: PMC9523522 DOI: 10.2196/34568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients. Objective This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation. Methods The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach. Results A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. Conclusions Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients’ free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.
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Affiliation(s)
- Nils Pfeuffer
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Angelika Beyer
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Peter Penndorf
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Maren Leiz
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Franziska Radicke
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Uslu A, Stausberg J. Value of the Electronic Medical Record for Hospital Care: Update From the Literature. J Med Internet Res 2021; 23:e26323. [PMID: 34941544 PMCID: PMC8738989 DOI: 10.2196/26323] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/27/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negative effects on the outcome of health care systems. Objective The aim of this review is to summarize empirical studies about the value of electronic medical records (EMRs) for hospital care published between 2010 and spring 2019. Methods The authors adopted their method from a series of literature reviews. The literature search was performed on MEDLINE with “Medical Record System, Computerized” as the essential keyword. The selection process comprised 2 phases looking for a consent of both authors. Starting with 1345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies’ quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications’ conclusions concerning the medical record’s impact on quality and efficiency of health care. Results The majority of the studies stemmed from the United States (19/23, 83%). Mostly, the studies used publicly available data (“secondary data studies”; 17/23, 74%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78%), 16 the effect on the efficiency of health care (70%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56%); 14/18 studies showed an increase of health care quality (78%); the remaining 4 studies missed explicit information about the proposed positive effect. Conclusions This review revealed a clear evidence about the value of EMRs. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records to guide their implementation and operation.
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Affiliation(s)
- Aykut Uslu
- USLU Medizininformatik, Düsseldorf, Germany
| | - Jürgen Stausberg
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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de Swart ME, Kouwenhoven MCM, Hellingman T, Kuiper BI, Gorter de Vries C, Leembruggen-Vellinga M, Maliepaard NK, Wouda EJ, Moraal B, Noske DP, Postma TJ, Sanchez Aliaga E, Uitdehaag BMJ, Vandertop WP, Zonderhuis BM, Kazemier G, de Witt Hamer PC, Schuur M. A multidisciplinary neuro-oncological triage panel reduces the time to referral and treatment for patients with a brain tumor. Neurooncol Pract 2021; 8:559-568. [PMID: 34589232 PMCID: PMC8475234 DOI: 10.1093/nop/npab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Regional collaboration and appropriate referral management are crucial in neuro-oncological care. Lack of electronic access to medical records across health care organizations impedes interhospital consultation and may lead to incomplete and delayed referrals. To improve referral management, we have established a multidisciplinary neuro-oncological triage panel (NOTP) with digital image exchange and determined the effects on lead times, costs, and time investment. Methods A prospective cohort study was conducted from February 2019 to March 2020. All newly diagnosed patients referred to Brain Tumor Center Amsterdam were analyzed according to referral pathway: (1) standard referral (SR), (2) NOTP. The primary outcome was lead time, defined as time-to-referral, time-to-treatment, and total time (median days [interquartile range]). Secondary outcomes were costs and time investment. Results In total, 225 patients were included, of whom 153 had SR and 72 NOTP referral. Patients discussed in the NOTP were referred more frequently for first neurosurgical consultation (44.7% vs 28.8%) or combined neurological and neurosurgical consultation (12.8% vs 2.5%, P = .002). Time-to-referral was reduced for NOTP referral compared to SR (1 [0.25-4] vs 6 [1.5-10] days, P < .001). Total time decreased from 27 [14-48] days for the standard group to 15 [12-38.25] days for the NOTP group (P = .040). Costs and time investment were comparable for both groups. Conclusion Implementation of digital referral to a multidisciplinary NOTP is feasible and leads to more swift patient-tailored referrals at comparable costs and time investment as SR. This quality improvement initiative has the potential to improve collaboration and coordination of multidisciplinary care in the field of neuro-oncology.
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Affiliation(s)
- Merijn E de Swart
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mathilde C M Kouwenhoven
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tessa Hellingman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Babette I Kuiper
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Niels K Maliepaard
- Department of Neurology, Dijklander Ziekenhuis, Purmerend, the Netherlands
| | - Ernest J Wouda
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David P Noske
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tjeerd J Postma
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Esther Sanchez Aliaga
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - William P Vandertop
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Barbara M Zonderhuis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Philip C de Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Esdar M, Hübner U, Thye J, Babitsch B, Liebe JD. The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data. JMIR Med Inform 2021; 9:e23306. [PMID: 33720029 PMCID: PMC8077601 DOI: 10.2196/23306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/13/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023] Open
Abstract
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 IQHIT 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 IQHIT 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 IQHIT 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.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Johannes Thye
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Birgit Babitsch
- Institute of Health and Education, New Public Health, Osnabrück University, Osnabrueck, Germany
| | - Jan-David Liebe
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany.,Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Ammenwerth E, Duftschmid G, Al-Hamdan Z, Bawadi H, Cheung NT, Cho KH, Goldfarb G, Gülkesen KH, Harel N, Kimura M, Kırca Ö, Kondoh H, Koch S, Lewy H, Mize D, Palojoki S, Park HA, Pearce C, de Quirós FGB, Saranto K, Seidel C, Vimarlund V, Were MC, Westbrook J, Wong CP, Haux R, Lehmann CU. International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study. Methods Inf Med 2020; 59:e46-63. [PMID: 33207386 DOI: 10.1055/s-0040-1715796] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare. OBJECTIVES This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country. METHODS The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators. RESULTS Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden. CONCLUSION Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.
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