Lessons Learned from an Interprofessional European Summer School in Health Informatics

The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students' evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.

Assessing readiness for childhood obesity prevention in German municipalities: application of the community readiness model

The World Health Organization has identified childhood obesity as one of the most serious public health problems of the 21st century. Understanding a municipality's readiness to address it is crucial to achieve successful interventions. However, the preparedness of German municipalities to address childhood obesity has not yet been investigated. This study is the first in Germany to apply the community readiness model (CRM) in this context. The purpose was to determine readiness of five municipalities for childhood obesity prevention and to identify factors that influence their readiness. Therefore, 27 semi-structured key informant interviews were conducted. First, the interviews were analysed following the CRM protocol to categorize the municipalities into a readiness level between one and nine. In a second step, a content analysis was carried out for an in-depth interpretation of the readiness scores. The municipalities achieved an average readiness of 3.84, corresponding to the 'Vague Awareness' stage. A lack of prioritization and leadership support, insufficient low-threshold efforts, a lack of knowledge and problem awareness as well as a lack of structures and resources were identified as factors that can determine municipal readiness to prevent childhood obesity. This study not only extends the application of the CRM to childhood obesity in German municipalities but also offers practical implications for professionals in assessing readiness.

Trust in Digitalization and AI: Findings from a Qualitative Study on Healthcare Professionals in Germany

The acceptance and use of digital technologies depend on the trustworthiness attributed to them. Experts were interviewed about how they assign trust to digital technologies or AI (N=12). The data were analyzed applying the focused qualitative content analysis. All of the experts have experience with digital technologies, but only seven with AI. The majority of experts generally trust digital technologies, but only five experts expressed a general trust in AI. Similar reasons contributing to trust building were given for digital technologies and AI. The results show the complexity of the trust building process and the construct of trust itself. The development of explainable AI and professional training are prerequisites to support a critical and safe use of these technologies.

The Representation of Trust in Artificial Intelligence Healthcare Research

Artificial intelligence (AI) tends to emerge as a relevant component of medical care, previously reserved for medical experts. A key factor for the utilization of AI is the user's trust in the AI itself, respectively the AIt's decision process, but AI-models are lacking information about this process, the so-called Black Box, potentially affecting usert's trust in AI. This analysis' objective is the description of trust-related research regarding AI-models and the relevance of trust in comparison to other AI-related research topics in healthcare. For this purpose, a bibliometric analysis relying on 12985 article abstracts was conducted to derive a co-occurrence network which can be used to show former and current scientific endeavors in the field of healthcare based AI research and to provide insight into underrepresented research fields. Our results indicate that perceptual factors such as "trust" are still underrepresented in the scientific literature compared to other research fields.

Disparities in COVID-19 related health literacy, knowledge, and the assessment of the measures taken in Germany: a cross-sectional study

Aim

Health literacy is necessary to access, understand, assess, and apply information on COVID-19. Studies have shown that health literacy is unequally distributed across social groups. This study aimed to analyze the differences in COVID-19-related health literacy (hereinafter referred to as "COV-19-HL"), knowledge about COVID-19, and the assessment of the measures taken regarding the sociodemographic characteristics as well as the influence of COV-19-HL on knowledge and assessments.

Subject and methods

The study used the data obtained from the cross-sectional online survey "Digital divide in relation to health literacy during the COVID-19 pandemic." The data covers 1570 participants aged ≥18 years in Germany between April 29, 2020 and May 8, 2020. To analyze the differences by way of sociodemographic variables, t-tests and analyses of variance were carried out. Multivariate logistic regression models were used to determine the effect of COV-19-HL on knowledge and the assessment of measures.

Results

The overall COV-19-HL was high with an average value of 37.4 (with 50 representing the highest COV-19-HL). COV-19-HL and knowledge about COVID-19 were slightly lower in men, migrants, people with low subjective social status, and with low education. Government requirements and recommendations were rated as more effective by women, older people, and individuals with a chronic illness. The chance of better knowledge about COVID-19 and rating measures as effective increased with higher COV-19-HL.

Conclusion

The findings of this study show that COV-19-HL and knowledge about the virus are unequally distributed in Germany. Health communication should strengthen pandemic-related health literacy that is tailored to specific target groups.

The usage of DiGA, stratified by sociodemographic/socioeconomic characteristics

Background

The German government undertakes efforts to implement DiGA into the statutory health insurance to improve its quality. DiGA are physician-prescribed applications for patients with certain diagnosed diseases, whose costs are covered by the statutory health insurers. DiGA have the potential to improve healthcare, but it is also possible, that the usage of these applications perpetuates existing health inequalities, summarized by the term Digital Divide; meaning that socially deprived populations are less able to benefit from digital technologies. The aim of this analysis is to determine whether differences exist in DiGA use by sociodemographic/socioeconomic characteristics.

Methods

The results based upon the analysis of an online survey involving 1,200 people (18-74 years) living in Germany between March 10 and March 18, 2022. The sample composition reflects the current distribution of age, gender, and place of residence in the federal states (uncrossed). The questionnaire focused, among other aspects, on the use of DiGA. A binary logistic regression was used for the analysis.

Results

Compared to the lowest subjective social status (SSS), probands with a medium (OR 2.865) or a high SSS (OR 4.085) are more likely to use DiGA. Compared to the reference group (60 years and older), the 18-29-year- (OR 2.044) and the 30-39-year-olds (OR 1.952) tend to have a higher likelihood of using DiGA. The likelihood of the use decreases among probands with medium (OR 0.632) and high educational degree (OR 0.580) compared to the reference group (low education).

Conclusions

In accordance with the results of existing studies, social differences could be identified regarding known determinants of health inequalities, like age and SSS. In this analysis, the highest degree of education does not appear as a predictor for an increased likelihood of use. Thus, further analyses are needed to address the influence of education, especially to develop a broader understanding of the DiGA use.

Key messages

• It appears that DiGA are not equally accessible or used across different population groups, and thus indicating an already existing or emerging Digital Divide regarding the use of DiGA.

• Contrary to the broad assumption that higher expressions of health determinants are related to a higher likelihood of using DiGA, a higher degree of education decreases the likelihood of using DiGA.

Online information seeking and attitudes towards COVID-19 vaccination in Germany

Background

A large proportion of the European population seeks information about the COVID-19 vaccination on the internet. The population seems to split into those with positive stance on the vaccination and those with negative stance, but there are still individuals who do not have a final position yet. By now, there is a lack of understanding about the online information seeking behavior in these three groups. The current analysis sheds light on differences in internet usage and requested qualities of online information regarding the COVID-19 vaccination.

Methods

An online survey with N = 1,000 people (18-74 years) living in Germany was conducted between November 26 and December 8, 2021. The questionnaire included closed questions about frequency, information channels, formats and reasons of online information seeking, as well as one open question about requested qualities of online content. We conducted bivariate analysis for differences in information seeking behavior and content analysis for the requests.

Results

Information seeking behavior differed significantly by attitude towards the vaccination regarding frequency, almost all types of formats, three of ten listed information channels, and three of six reasons for online information seeking. Undecided participants and those who support COVID-19 vaccination used the internet more often than participants who are against the vaccination. Individuals supporting vaccination preferred reading text contributions (e.g. online articles). Informative videos were more often consumed by those who are undecided or against vaccination. Those who have not decided yet preferred online resources providing full information about side-effects and showing reliable facts by credible sources.

Conclusions

Our findings support an online vaccination communication that is tailored to target groups with different attitudes towards the vaccination. Overall, online campaigns should focus on transparent, reliable and complete information.

Key messages

• Online information seeking behavior regarding COVID-19 vaccination varies between individuals with different attitudes towards the vaccination.

• Online information about the COVID-19 vaccination should focus on transparency and reliable information.

Childhood obesity prevention in schools and municipalities – the digital planning tool WEPI

Background

The development of theory-based prevention efforts is complex and often not feasible in the daily work of project planners. Planning tools such as the Intervention Mapping Approach (IMA), which is a gold standard for project planning, cannot be used in practice without preconditions. How can prevention planning be evidence-based but also practical? Against this background, the research project WEPI was developed, funded by the Federal Ministry of Health, Germany. WEPI is a digital planning tool based on the IMA, that guides municipalities and schools in planning childhood obesity prevention efforts.

Methods

From April 2019 to October 2020, the planning tool was developed. In October 2020 and February 2021, WEPI was tested for the first time by selected municipalities (n = 4) in Bavaria and schools (n = 4) in Lower Saxony. Based on this, the modified planning tool was tested for a second time throughout Germany (05-11/2021). Handling and acceptance were evaluated in a questionnaire survey.

Results

The first test showed that content and technical aspects needed to be optimised in order to bring scientific demands and practical feasibility together. Six municipalities and eight educational institutions participated in the second test phase. The respondents (n = 14) indicated that WEPI facilitates structured project planning (86%) and supports collaboration with colleagues (64%). 93% would use the planning tool again. WEPI offers evidence-based methods for practical implementation as well as a download area, including a template for a project application or a project summary. This service was also evaluated as very helpful (64%).

Conclusions

Through step-by-step guidance, WEPI facilitates evidence-based project planning and ensures planning quality. Effort and benefit are in good proportion. Further optimisations are needed to improve the user-friendliness.

Key messages

• WEPI provides a comprehensive roadmap, helping practitioners to approach a structured project planning.

• Practitioners’ participation promotes acceptance and provides a user-friendly development.

Application of the Community Readiness Model for childhood obesity prevention: a scoping review

The Community Readiness Model (CRM) provides an approach to determine community readiness (CR), which is the degree of a community's preparedness to address a health issue. This scoping review aims to characterize internationally existing applications of the CRM for childhood obesity prevention. Therefore, a systematic literature research was conducted in PubMed, Cochrane Library, LIVIVO and Google Scholar. Of 285 identified records, 17 studies met the eligibility criteria and were included in the scoping review. The CRM has already been applied to childhood obesity prevention in the USA (n = 10), Australia (n = 4), UK (n = 1), Iran (n = 1) and South Africa (n = 1). Mainly geographically defined communities (n = 12) like counties and cities were analysed but also schools (n = 4) and churches (n = 1). The scoping review revealed various methodological changes to the standard protocol of which some are particularly relevant for the application to childhood obesity prevention. The identified studies reported readiness scores in the low to mid-range of the nine-point readiness scale. To increase CR, strategies were proposed that addressed raising awareness and knowledge of childhood obesity, but also supporting connectivity in and between settings. This scoping review provides researchers and health promoters with an overview of international CR measurements and setting-specific strategies to increase CR. It highlights the potential of targeted interventions to increase readiness and shows tentative support for the assumption of a possible link between CR level and changes in obesity prevalence.

The eHealth4all@eu Pipeline of Course Development: TIGER Recommendations in Action

This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.

An Image Based Object Recognition System for Wound Detection and Classification of Diabetic Foot and Venous Leg Ulcers

Venous leg ulcers and diabetic foot ulcers are the most common chronic wounds. Their prevalence has been increasing significantly over the last years, consuming scarce care resources. This study aimed to explore the performance of detection and classification algorithms for these types of wounds in images. To this end, algorithms of the YoloV5 family of pre-trained models were applied to 885 images containing at least one of the two wound types. The YoloV5m6 model provided the highest precision (0.942) and a high recall value (0.837). Its mAP_0.5:0.95 was 0.642. While the latter value is comparable to the ones reported in the literature, precision and recall were considerably higher. In conclusion, our results on good wound detection and classification may reveal a path towards (semi-) automated entry of wound information in patient records. To strengthen the trust of clinicians, we are currently incorporating a dashboard where clinicians can check the validity of the predictions against their expertise.

Continuing Education of Nurses in Patient Handovers: Development and Evaluation of a Digitally Enabled Problem-Based Learning Course

Communication deficits belong to the most frequent errors in patient handovers calling upon specialized training approaches to be implemented. This study aims to harness problem-based learning (PBL) methods in handover education and evaluated the learning process. A digitally enabled PBL course was developed and implemented at Klinikum Osnabrück from which eight nurses participated in the course. They agreed on the stimulating effect of the setting regarding self-directed learning and on the potential to translate the new knowledge and skills into the daily clinical practice. In conclusion, the findings are promising that a digitally enabled PBL course is a suitable learning format for handover education.

Subjectively perceived healthcare provision during the first wave of the COVID-19 pandemic

Background

An OECD benchmark (2020) shows that Germany has, in effect, an above-average healthcare infrastructure to face COVID-19. Nevertheless, at the beginning of the pandemic, there were restrictions and uncertainties in the use of health-related services. The following analysis examines the subjective perception of respondents with their healthcare provision whether there were sociodemographic differences.

Methods

Data from an online cross-sectional survey conducted between 29 April and 8 May 2020 were used (N = 1,570; 18-74 years). Bivariate test methods were used for analysis, stratified by age group, subjective social status (SSS) and chronic illness. The subjective perception was assessed via subjects' subjectively perceived worries, fears and difficulties of not receiving an adequate healthcare provision during the COVID-19 pandemic. Thus, an index was constructed with a range of values from 3 to 12 (Cronbach's α = 0.886). A higher index implies a poorer perception of the healthcare provision.

Results

Compared to the groups 50-59-year-olds and 60 years and older the 18-29-year-olds (MRank 431.1) had a significantly (p < 0.05) poorer perception of their healthcare provision during COVID-19. In addition, probands with low SSS were found to have a significantly (p < 0.05) worse perception (MRank 423.0) than subjects with medium SSS (MRank 374.1). Chronically ill subjects suffered significantly poorer perception (MRank 406.1; p < 0.05) compared to healthy subjects (MRank 366.0).

Conclusions

Vulnerable groups with poorer perceptions of their health care provision during COVID-19 can be identified. More investigation is needed to identify subjective or COVID-19 related predictors that cause this subjective perception.

Reference

OECD (2020). Beyond Containment: Health systems responses to COVID-19 in the OECD.

Available: https://read.oecd-ilibrary.org/view/?ref=119_119689-ud5comtf84&title=Beyond_Containment:Health_systems_responses_to_COVID-19_in_the_OECD (Accessed: 14.04.2021)

Key messages

It was found that respondents perceived their subjective healthcare provision during COVID-19 differently, according to sociodemographic stratification.

Especially younger, chronically ill, and socioeconomically deprived respondents experienced a poorer perception of their healthcare provision during the first wave of the COVID-19 pandemic.

Web-based planning tool for obesity prevention in childhood and youth – first trial period

Background

The systematic and theory-based development of interventions is complex and requires time and personnel resources. WEPI is a web-based planning tool for municipalities and schools, that follows the evidence-based intervention mapping approach (IMA) but also supports the planning process of obesity prevention user oriented. The project is supported by the Federal Ministry of Health, Germany.

Methods

Data of a systematic literature review (SLR), expert interviews and focus group discussions served as the foundation for the first version of WEPI. Two further SLR were conducted in the databases Pubmed, LIVIVO and Cochrane on evidence-based determinants of obesity development and on proven obesity intervention methods, to meet the requirements of the IMA. In October 2020 the second version of WEPI was tested with selected municipalities and schools. The prototype as a third version was tested by three municipalities and two schools in February 2021. Feedback was collected through questionnaires and interviews.

Results

In a total of 806 hits of the first SLR, determinants for the development of obesity were identified in 8 guidelines and 37 reviews. They were adopted in form of 15 problem areas which support the WEPI user to conduct an evidence-based problem analysis. Result of the second SLR are 25 obesity prevention interventions which were developed using the IMA. Based on this, 192 evaluated methods were identified and integrated as good practice examples into WEPI. In the first trial the expert feedback revealed aspects of content and user-friendliness as well as technical aspects that should be optimized. The feedback of the municipalities and schools underlines, that scientific findings need to be translated into practical logic.

Conclusions

WEPI provides a comprehensive roadmap to the planning process, guiding the user step by step. Acceptance and usability of the planning tool will be evaluated with municipalities and schools from April to November 2021.

Key messages

WEPI enables user oriented, structured and evidence-based planning of prevention interventions. Requirements resulting from practice were considered in the development of the planning tool.

Community Readiness – are municipalities prepared to prevent obesity in childhood and youth?

Background

Essential for the success of prevention efforts is the readiness to address a health problem (community readiness). Aim of this study is to analyze the stage of community readiness for the prevention of childhood obesity in municipalities using the Community Readiness Model (CRM). Based on this, strategies will be developed to improve community readiness for the prevention of obesity in childhood and youth.

Methods

A systematic literature review (SLR) was conducted in the databases PubMed, LIVIVO, Cochrane and Google Scholar to identify studies that used the CRM for the prevention of childhood obesity. In order to assess community readiness, the CRM, a structured interview guide and scoring system, was used. Following the CRM protocol, guided interviews were conducted with key informants that were identified in a modified stakeholder analysis. The transcribed interviews were analyzed by two scientists following the CRM scoring system.

Results

The SLR revealed 270 hits. In 28 international studies the CRM has been applied to childhood obesity prevention, predominantly in the Anglo-American language area. In Germany, no studies could be identified using the CRM for the prevention of childhood obesity. Key informant interviews (n = 28) were conducted in five Bavarian municipalities from January to April 2021. The key informant sample comprised administration departments, health and educational facilities.

Conclusions

The CRM enables a multidimensional analysis of a municipality's material and immaterial infrastructure. In workshops with the participating municipalities the results of the community readiness assessment will be reflected. The aim is to develop an action plan with strategies to increase the stage of readiness and support prevention efforts in order to address childhood obesity.

Key messages

The CRM provides a theoretical basis to understand and improve community readiness. It enables the analysis of assets and weaknesses that can influence obesity prevention in municipalities.

Patient connectivity with healthcare professionals and health insurer using digital health technologies during the COVID-19 pandemic: a German cross-sectional study

Background

Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic.

Methods

The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app.

Results

The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034).

Conclusions

Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.

Perception of a Tracing App During the Covid-19 Pandemic in Germany

Access to digital technologies depends on the availability of technical infrastructure, but this access is unequally distributed among social groups and newly summarized under the term digital divide. The aim is to analyze the perception of a tracing app to contain Covid-19 in Germany. The results showed that participants with the highest level of formal education rate the app as beneficial and were the most likely to use the app.

Digital Skills and Skills to Deal with COVID-19 Information: Sociodemographic Differences in a Cross-Sectional Study

In the current COVID-19 pandemic, the importance of digital media as a source of information for health-related behavior is impressively demonstrated. Until now there has been a lack of national research on the influence of socioeconomic differences in digital literacy and in the use of COVID-19 information. This study aims to analyze the influence of educational status and subjective social status on digital literacy and on the ability in using COVID-19 information. Data from a cross-sectional online survey were used. The results indicate social differences in digital literacy and in the ability to critically evaluate COVID-19 information.

The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data

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 IQ_HIT 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 IQ_HIT 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 IQ_HIT 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.

Planning tool for the development of interventions to prevent overweight in childhood and youth

Background

Studies have shown that interventions to prevent excess weight gain in children and teenagers are often planned unsystematically and not evidence-based. Planning high-quality interventions to prevent childhood obesity is a complex process requiring time and personnel, both limited resources in health promotion. The aim of this project is to develop an evidence-based, user-oriented planning tool to support and optimize the planning process of interventions to prevent excess weight gain in children and teenagers.

Methods

To identify existing tools for planning interventions, a systematic literature review (SLR) was first conducted in the databases PubMed, LIVIVO and Cochrane. In addition, seven interviews were carried out with practitioners in schools and communities to determine difficulties encountered during the planning process. This data served as the foundation for the design of an initial draft of the planning tool, which was subsequently tested in focus group discussions (FGD) with potential users.

Results

The SLR identified a total of 23 planning tools. Of these, four comprehensive and evidence-based ones were chosen to compare planning steps and context requirements. The interviews revealed that practitioners require support with problem and needs analysis, target setting and the development of theory-based strategies. The first planning step of the tool was tested in FGD and modified in response to group feedback. An optimized version of the tool can be presented. Future work will focus on converting the tool into a web-based application and pretesting it in schools and communities.

Conclusions

The planning tool will support the systematic development of evidence-based prevention interventions. It provides a comprehensive roadmap to the planning process, guiding the user step by step. The conversion into a web-based application will simplify and support these planning steps. This project is supported by the Federal Ministry of Health, Germany.

Key messages

The tool enables time-saving, structured and quality-assured planning of prevention interventions. Requirements resulting from practice were considered in the development of the planning tool.

The relevance of cultural diversity on safety culture: a CIRS data analysis to identify problem areas and competency requirements of professionals in healthcare institutions

Aim: The society and consequently also the health system have become increasingly culturally diverse which applies to both - patients and professionals. Studies indicate an influence of the ethnicity on the care context. With regard to this, considerably more knowledge is available regarding diversity among patients than among professionals, for example considering the effect of cultural diversity in teams. The impact of cultural diversity on patient safety has barely been investigated which means that potential effects as well as required measures and competencies cannot currently be specified. As part of the project "Gestaltungskompetenz als Innovator für hochzuverlässige Organisationen im Gesundheitssystem" (abbreviation: GIO, "Gestaltungskompetenz as an Innovator for High Reliability Organisations in the Healthcare System") these questions are investigated in the context of a case study. Therefore, a CIRS data analysis was carried out to identify specific problem areas to derive competencies for the safe handling of cultural diversity between employees. On this basis and adjusted to the target group, an interactive learning management system will be developed for the advanced training of professionals. Method: For the topic of cultural diversity, an analysis of the patient safety cases reported in CIRSmedical (Critical Incident Reporting System) was carried out followed by a qualitative summarising content analysis. The systematic search in CIRS was based on previously defined search terms as well as inclusion and exclusion criteria. Results: 45 cases were included in the analysis. The results can be classed into two categories: "(Unsuccessful) communication" and "Unsuccessful adaptation to patient needs". Cultural diversity was not usually named as a primary or explicit cause but usually a combination of several factors was given as the reason for the occurrence of an undesirable event. Conclusion: The analysis of CIRS data identified concrete challenges resulting from the intercultural composition of teams and in the care context. The approaches for improvement should include both, organisational and personnel measures. In case of the latter, it is essential that competency requirements are identified resulting in suited offers for the competence development in the course of initial and professional development training for medical and nursing staff in ethnically diverse teams.

How to Access Personal Health Records? Measuring the Intention to Use and the Perceived Usefulness of Two Different Technologies: A Randomised Controlled Study

Personal health records (PHR) are instruments to compile, store and present health and wellness related data digitally with proven effects on self-management of diseases. The aim of this study was to investigate whether there were differences in the intention to use (ITU) and perceived usefulness (PU) of two technologies allowing users to access the PHR, i.e. a kiosk system and a smart phone based app (access as usual). The study also aimed at modelling ITU and PU with multiple linear regressions. A total of 46 subject participated in the study who were randomly assigned to one of the two experimental groups (nkiosk = 22; napp = 24). The task for both groups was to digitise their "Medikationsplan" (medical record) and upload it to the PHR. There was no significant difference in ITU and PU between the two technologies. ITU could only be significantly explained by PU (R2 = .55, p < 0.001), while PU was determined by perceived ease of use and psychological factors (R2 = .64, p < 0.001). Severity of disease did not play any significant role. The German "Terminservice- und Versorgungsgesetz" underpins the importance and timeliness of this study. The assumption that both - the publicly accessible kiosk and the app - are equally acceptable for people of different gender, age and technology background demonstrates the opportunity to master a potential digital divide among the population and allows users to get access to their PHR in multiple ways.

Towards the TIGER International Framework for Recommendations of Core Competencies in Health Informatics 2.0: Extending the Scope and the Roles

This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.

Improving the Prediction of Emergency Department Crowding: A Time Series Analysis Including Road Traffic Flow

BACKGROUND

Crowding in emergency departments (ED) has a negative impact on quality of care and can be averted by allocating additional resources based on predictive crowding models. However, there is a lack in effective external overall predictors, particularly those representing public activity.

OBJECTIVES

This study, therefore, examines public activity measured by regional road traffic flow as an external predictor of ED crowding in an urban hospital.

METHODS

Seasonal autoregressive cross-validated models (SARIMA) were compared with respect to their forecasting error on ED crowding data.

RESULTS

It could be shown that inclusion of inflowing road traffic into a SARIMA model effectively improved prediction errors.

CONCLUSION

The results provide evidence that circadian patterns of medical emergencies are connected to human activity levels in the region and could be captured by public monitoring of traffic flow. In order to corroborate this model, data from further years and additional regions need to be considered. It would also be interesting to study public activity by additional variables.

Hospital CEOs Need Health IT Knowledge and Trust in CIOs: Insights from a Qualitative Study

BACKGROUND

IT is getting an increasing importance in hospitals. In this context, major IT decisions are often made by CEOs who are not necessarily IT experts.

OBJECTIVES

Therefore, this study aimed at a) exploring different types of IT decision makers at CEO level, b) identifying hypotheses if trust exists between these different types of CEOs and their CIOs and c) building hypotheses on potential consequences regarding risk taking and innovation.

METHODS

To this end, 14 qualitative interviews with German hospital CEOs were conducted to explore the research questions.

RESULTS

The study revealed three major types: IT savvy CEOs, IT enthusiastic CEOs and IT indifferent CEOs. Depending on these types, their relationship with the CIO varied in terms of trust and common language. In case of IT indifferent CEOs, a potential vicious circle of lack of IT knowledge, missing trust, low willingness to take risks and low innovation power could be identified.

CONCLUSION

In order to break of this circle, CEOs seem to need more IT knowledge and/or greater trust in their CIO.

What Are Inter-Professional eHealth Competencies?

As health IT supports processes along the entire patient trajectory and involves different types of professional groups, eHealth is inter-professional by nature. The aim of this study, therefore, is to investigate which competencies are at the intersection of the individual groups of health professionals. 718 international experts provided relevance ratings of eHealth competencies for different professional roles in an online survey. Communication and leadership proved to be important competencies across all professions, not only for executives. None or very little differences between professions were found between physicians and nurses, between IT experts at different levels and between IT experts and executives. However, there were a number of competencies rated differently when contrasting direct patient care specialists with executives. These findings should encourage organisations issuing educational recommendations to specify areas of shared competencies more extensively.

Understanding the Characteristics of Frequent Users of Emergency Departments: What Role Do Medical Conditions Play?

Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources.

Determinants of Clinical Information Logistics: Tracing Socio-Organisational Factors and Country Differences from the Perspective of Clinical Directors

The establishment of successful clinical information logistics (CIL) within the care processes is one of the main objectives of strategic health IT management in hospitals. While technical realisations in terms of useful, usable and interoperable IT solutions are essential precursors of CIL, there is limited empirical research on what socio-organisational factors underlie an innovation-friendly culture and how they can affect successful information provision. We applied factor analysis on survey data from 403 clinical directors from Germany, Austria and Switzerland and used the dimensions identified to explain the level of CIL with ordered logistic regression analysis. The intensity of collaboration and exchange with the IT department as well as the degree of executive IT leadership showed to be strongly associated with better CIL while personal views and attitudes of clinical directors were not. Analysing country differences revealed the degree of the exchange with the IT department to be significantly lower in German hospitals. This points at a potential strategic lever for German hospital executives to focus on.

Going Mobile: An Empirical Model for Explaining Successful Information Logistics in Ward Rounds

BACKGROUND

Medical ward rounds are critical focal points of inpatient care that call for uniquely flexible solutions to provide clinical information at the bedside. While this fact is undoubted, adoption rates of mobile IT solutions remain rather low.

OBJECTIVES

Our goal was to investigate if and how mobile IT solutions influence successful information provision at the bedside, i.e. clinical information logistics, as well as to shed light at socio-organizational factors that facilitate adoption rates from a user-centered perspective.

METHODS

Survey data were collected from 373 medical and nursing directors of German, Austrian and Swiss hospitals and analyzed using variance-based Structural Equation Modelling (SEM).

RESULTS

The adoption of mobile IT solutions explains large portions of clinical information logistics and is in itself associated with an organizational culture of innovation and end user participation.

CONCLUSION

Results should encourage decision makers to understand mobility as a core constituent of information logistics and thus to promote close end-user participation as well as to work towards building a culture of innovation.

Experts' Insights into eHealth-Legislation: Comparing Switzerland and Germany

This prospective longitudinal study aims at better understanding eHealth success factors in different European nations, esp. the role of eHealth-legislation in Switzerland and Germany. Qualitative interviews with 39 matched experts from a large variety of institutions in both nations were conducted. The individual statements in the interviews and the overall satisfaction rating indicate a clear trend for a more optimistic attitude towards the law in Switzerland than in Germany. This result is not surprising given the history of a telematics infrastructure in Germany. Cross-country learning topics for German politicians are the inclusion of the inpatient sector and the focus on one major application. In a next step, interview results from Austria will be included and with that the scope of study findings enriched.

IT Decision Making in German Hospitals - Do CEOs Open the Black Box?

Health IT and communication systems are indispensable in German hospitals for clinical as well as administrative process support. However, IT is often regarded as a "black box" for hospital CEOs. Thus, the question arises how can CEOs decide if they do not know what is in the box? In order to answer this question, half-structured interviews with 14 German hospital CEOs were conducted. They revealed three principle decision processes: the supported decision, the joint decision and the corporate level decision. In all cases, the hospital CEO and the CIO interacted to reach the final decision, most strongly in the joint decision mode and least strongly in the corporate decision mode. Only the joint decision mode definitely forced the CEO to open the "black box" of IT. In the era of digitalisation, however, CEOs must develop better competencies to decide over complex matters.

[Criteria catalogue to systematize conceptual approaches in universal prevention of childhood overweight : Methodological approach and first results]

BACKGROUND

Overweight and obesity are serious health risks for children and adolescents. Hence, various prevention projects have been initiated and implemented. Until now, a systematic overview of interventions in different settings has been lacking.

AIM(S)/RESEARCH QUESTION

The aim of the "Prevention of child overweight" project (SkAP-project) is to prepare a systematic overview of the conceptual approaches used in universal prevention of overweight among children and adolescents. First of all, a comprehensive criteria catalogue will be developed based on systematic searches. In the next step the criteria catalogue will be applied to identify and characterize conceptual approaches.

DATA AND METHODS

Criteria to describe conceptual approaches as well as determinants of childhood overweight were determined by systematic searches. The searches included relevant data bases and were further expanded by internet and hand search. Three settings (kindergarten, school and communities) and families are addressed by the systematic searches. Additional non-setting specific searches were conducted.

RESULTS

A comprehensive criteria catalogue was developed, which allows a detailed analysis of conceptual approaches. This catalogue covers further quality criteria as well as determinants of childhood overweight.

DISCUSSION

Currently, the criteria catalogue is being employed. Although the detailed analysis of conceptual approaches can be regarded as advantage of the criteria catalogue, there are also some limitations, such as the lack of necessary information provided in publications. Overall, the application will reveal an overview regarding universal prevention in childhood overweight, which is still lacking, and will support development in this field.