Discovering the importance of health informatics education competencies in healthcare practice. A focus group interview.

BACKGROUND: As healthcare and especially health technology evolve rapidly, new challenges require healthcare professionals to take on new roles. Consequently, the demand for health informatics competencies is increasing, and achieving these competencies using frameworks, such as Technology Informatics Guiding Reform (TIGER), is crucial for future healthcare. AIM: The study examines essential health informatics and educational competencies and health informatics challenges based on TIGER Core Competency Areas. Rather than examine each country independently, the focus is on uncovering commonalities and shared experiences across diverse contexts. METHODS: Six focus group interviews were conducted with twenty-one respondents from three different countries (Germany (n = 7), Portugal (n = 6), and Finland (n = 8)). These interviews took place online in respondents' native languages. All interviews were transcribed and then summarized by each country. Braun and Clarke's thematic analysis framework was applied, which included familiarization with the data, generating initial subcategories, identifying, and refining themes, and conducting a final analysis to uncover patterns within the data. RESULTS: Agreed upon by all three countries, competencies in project management, communication, application in direct patient care, digital literacy, ethics in health IT, education, and information and knowledge management were identified as challenges in healthcare. Competencies such as communication, information and communication technology, project management, and education were identified as crucial for inclusion in educational programs, emphasizing their critical role in healthcare education. CONCLUSIONS: Despite working with digital tools daily, there is an urgent need to include health informatics competencies in the education of healthcare professionals. Competencies related to application in direct patient care, IT-background knowledge, IT-supported and IT-related management are critical in educational and professional settings are seen as challenging but critical in healthcare.

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.

On the Effective Dissemination and Use of Learning Objectives Catalogs for Health Information Curricula Development.

Catalogs of competency-based learning objectives (CLO) were introduced and promoted as a prerequisite for high-quality, systematic curriculum development. While this is common in medicine, the consistent use of CLO is not yet well established in epidemiology, biometry, medical informatics, biomedical informatics, and nursing informatics especially in Germany. This paper aims to identify underlying obstacles and give recommendations in order to promote the dissemination of CLO for curricular development in health data and information sciences. To determine these obstacles and recommendations a public online expert workshop was organized. This paper summarizes the findings.

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.

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.

Clinical Information Systems - Seen through the Ethics Lens.

OBJECTIVE: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. METHODS: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. RESULTS: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders' attitudes, but not to evaluate specific implementations. CONCLUSION: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

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.

Competencies for nursing in a digital world. Methodology, results, and use of the DACH-recommendations for nursing informatics core competency areas in Austria, Germany, and Switzerland.

While Nursing Informatics competencies seem essential for the daily work of nurses, they are not formally integrated into nursing education in Austria, Germany and Switzerland, nor are there any national educational recommendations. The aim of this paper is to show how such recommendations can be developed, what competency areas are most relevant in the three countries and how the recommendations can be implemented in practice. To this end, a triple iterative procedure was proposed and applied starting with national health informatics recommendations for other professionals, matching and enriching these findings with topics from the international literature and finally validating them in an expert survey with 87 experts and in focus group sessions. Out of the 24 compiled competency areas, the relevance ratings of the following four recommended areas achieved values above 90%: nursing documentation (including terminologies), principles of nursing informatics, data protection and security, and quality assurance and quality management. As there were no significant differences between the three countries, these findings laid the foundation of the DACH Recommendations of Nursing Informatics as joint German (D), Austrian (A), and Swiss (CH) recommendations in Nursing Informatics. The methodology proposed has been utilized internationally, which demonstrates the added value of this study also outside the confines of Austria, Germany, Switzerland.

Technology Informatics Guiding Education Reform - TIGER.

BACKGROUND: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework. OBJECTIVES: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings. METHODS: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics. RESULTS: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains "data, information, knowledge", "information exchange and information sharing", "ethical and legal issues", "systems life cycle management", "management" and "biostatistics and medical technology", all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas. CONCLUSIONS: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.

Towards an International Framework for Recommendations of Core Competencies in Nursing and Inter-Professional Informatics: The TIGER Competency Synthesis Project.

Informatics competencies of the health care workforce must meet the requirements of inter-professional process and outcome oriented provision of care. In order to help nursing education transform accordingly, the TIGER Initiative deployed an international survey, with participation from 21 countries, to evaluate and prioritise a broad list of core competencies for nurses in five domains: 1) nursing management, 2) information technology (IT) management in nursing, 3) interprofessional coordination of care, 4) quality management, and 5) clinical nursing. Informatics core competencies were found highly important for all domains. In addition, this project compiled eight national cases studies from Austria, Finland, Germany, Ireland, New Zealand, the Philippines, Portugal, and Switzerland that reflected the country specific perspective. These findings will lead us to an international framework of informatics recommendations.

An Iterative Methodology for Developing National Recommendations for Nursing Informatics Curricula.

The increasing importance of IT in nursing requires educational measures to support its meaningful application. However, many countries do not yet have national recommendations for nursing informatics competencies. We thus developed an iterative triple methodology to yield validated and country specific recommendations for informatics core competencies in nursing. We identified relevant competencies from national sources (step 1), matched and enriched these with input from the international literature (step 2) and fed the resulting 24 core competencies into a survey (120 invited experts from which 87 responded) and two focus group sessions with a total of 48 experts (steps 3a/3b). The subsequent focus group sessions confirmed and expanded the findings. As a result, we were able to define role specific informatics core competencies for three countries.

Evaluating a Proof-of-Concept Approach of the German Health Telematics Infrastructure in the Context of Discharge Management.

Although national eHealth strategies have existed now for more than a decade in many countries, they have been implemented with varying success. In Germany, the eHealth strategy so far has resulted in a roll out of electronic health cards for all citizens in the statutory health insurance, but in no clinically meaningful IT-applications. The aim of this study was to test the technical and organisation feasibility, usability, and utility of an eDischarge application embedded into a laboratory Health Telematics Infrastructure (TI). The tests embraced the exchange of eDischarge summaries based on the multiprofessional HL7 eNursing Summary standard between a municipal hospital and a nursing home. All in all, 36 transmissions of electronic discharge documents took place. They demonstrated the technical-organisation feasibility and resulted in moderate usability ratings. A comparison between eDischarge and paper-based summaries hinted at higher ratings of utility and information completeness for eDischarges. Despite problems with handling the electronic health card, the proof-of-concept for the first clinically meaningful IT-application in the German Health TI could be regarded as successful.

Transferring learning to practice with e-learning--experiences in continuing education in the field of ambient assisted living.

The article describes an analysis of the use of e-learning to improve the learning transfer to practice in continuing education. Therefore an e-learning offer has been developed as a part between two attendance periods of a training course in the field of Ambient Assisted Living (AAL). All participants of the course were free to use the e-learning offer. After the end of the e-learning part we compared the e-learning users to the other participants. Using an online questionnaire we explored if there are differences in the activities in the field AAL after the training course. The results show that e-learning is beneficial especially for communication processes. Due to the fact that the possibility to talk about the learning content is an essential factor for the learning transfer, e-learning can improve the learning success.

Communication competence, social support, and depression among college students: a model of facebook and face-to-face support network influence.

This study examined the influence of the social networking site Facebook and face-to-face support networks on depression among (N = 361) college students. The authors used the Relational Health Communication Competence Model as a framework for examining the influence of communication competence on social support network satisfaction and depression. Moreover, they examined the influence of interpersonal and social integrative motives as exogenous variables. On the basis of previous work, the authors propose and test a theoretical model using structural equation modeling. The results indicated empirical support for the model, with interpersonal motives predicting increased face-to-face and computer-mediated competence, increased social support satisfaction with face-to-face and Facebook support, and lower depression scores. The implications of the findings for theory, key limitations, and directions for future research are discussed.

Characteristics of German hospitals adopting health IT systems - results from an empirical study.

Hospital characteristics that facilitate IT adoption have been described by the literature extensively, however with controversial results. The aim of this study therefore is to draw a set of the most important variables from previous studies and include them in a combined analysis for testing their contribution as single factors and their interactions. Total number of IT systems installed and number of clinical IT systems in the hospital were used as criterion variables. Data from a national survey of German hospitals served as basis. Based on a stepwise multiple regression analysis four variables were identified to significantly explain the degree of IT adoption (60% explained variance): 1) hospital size, 2) IT department, 3) reference customer and 4) ownership (private vs. public). Our results replicate previous findings with regard to hospital size and ownership. In addition our study emphasizes the importance of a reliable internal structure for IT projects (existence of an IT department) and the culture of testing and installing most recent IT products (being a reference customer). None of the interactions between factors was significant.