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.

Evaluation of a Clinical Decision Support System in the Domain of Chronic Wound Management.

The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.

Implementation and Analysis of Two Knowledge Base Approaches for the Treatment of Chronic Wounds.

The access to data in healthcare is an enabler for the implementation of clinical decision support systems (CDSS) in practice. The usage of CDSS aims to be of efficient assistance to healthcare providers. The aim of the BMBF project "PosiThera", is to support the involved professions in the treatment process of chronic wounds. In this study we implemented the formalized knowledge of chronic wound diagnosis into two different knowledge base approaches, the HL7 Arden Syntax and a Petri net approach. The motivating factor behind our study was to use both approaches for the implementation of the projects knowledge base and to compare the results. We implemented the formalized knowledge successfully in both approaches. The results of our comparison showed similarities and differences of the Arden Syntax and the Petri net approach, which might support the evolution of both approaches in the future.

Requirements for Collaborative Decision Support Systems in Wound Care: No Information Continuity Without Management Continuity.

Health IT systems are employed to support continuity of care via information continuity, while management continuity is often neglected. This study aims at investigating issues of management continuity when developing a collaborative decision support system for chronic wounds. Thirty-three experts from a variety of professions and disciplines discussed problems and possible solutions in four workshops. The following topics emerged from the discussion: existing networks involving payers, responsibilities as well as good discharge management. These topics clearly address management continuity and are also relevant for the scenario of inter-professional wound care across different settings.

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.

Nursing routine data as a basis for association analysis in the domain of nursing knowledge.

This paper describes the data mining method of association analysis within the framework of Knowledge Discovery in Databases (KDD) with the aim to identify standard patterns of nursing care. The approach is application-oriented and used on nursing routine data of the method LEP nursing 2. The increasing use of information technology in hospitals, especially of nursing information systems, requires the storage of large data sets, which hitherto have not always been analyzed adequately. Three association analyses for the days of admission, surgery and discharge, have been performed. The results of almost 1.5 million generated association rules indicate that it is valid to apply association analysis to nursing routine data. All rules are semantically trivial, since they reflect existing knowledge from the domain of nursing. This may be due either to the method LEP Nursing 2, or to the nursing activities themselves. Nonetheless, association analysis may in future become a useful analytical tool on the basis of structured nursing routine data.

IT adoption of clinical information systems in Austrian and German hospitals: results of a comparative survey with a focus on nursing.

BACKGROUND: IT adoption is a process that is influenced by different external and internal factors. This study aimed1. to identify similarities and differences in the prevalence of medical and nursing IT systems in Austrian and German hospitals, and2. to match these findings with characteristics of the two countries, in particular their healthcare system, and with features of the hospitals. METHODS: In 2007, all acute care hospitals in both countries received questionnaires with identical questions. 12.4% in Germany and 34.6% in Austria responded. RESULTS: The surveys revealed a consistent higher usage of nearly all clinical IT systems, especially nursing systems, but also PACS and electronic archiving systems, in Austrian than in German hospitals. These findings correspond with a significantly wider use of standardised nursing terminologies and a higher number of PC workstations on the wards (average 2.1 PCs in Germany, 3.2 PCs in Austria). Despite these differences, Austrian and German hospitals both reported a similar IT budget of 2.6% in Austria and 2.0% in Germany (median). CONCLUSIONS: Despite the many similarities of the Austrian and German healthcare system there are distinct differences which may have led to a wider use of IT systems in Austrian hospitals. In nursing, the specific legal requirement to document nursing diagnoses in Austria may have stimulated the use of standardised terminologies for nursing diagnoses and the implementation of electronic nursing documentation systems. Other factors which correspond with the wider use of clinical IT systems in Austria are: good infrastructure of medical-technical devices, rigorous organisational changes which had led to leaner processes and to a lower length of stay, and finally a more IT friendly climate. As country size is the most pronounced difference between Germany and Austria it could be that smaller countries, such as Austria, are more ready to translate innovation into practice.

ICT supporting nurses and physicians in hospitals: results of a comparative survey in Austria and Germany.

This study aimed to compare the use of clinical information systems, particularly for nursing, in Austria and Germany. In 2007, all acute care hospitals in both countries received questionnaires with identical questions. 12.4% in Germany and 34.6% in Austria responded. The surveys revealed a consistent higher usage of clinical IT in Austrian than in German hospitals. It also included a significant difference in the percentage of electronic nursing records in use. These findings correspond with a significantly higher number of PC workstations on the wards. Despite these differences, Austrian and German hospitals reported a nearly identical IT budget. Factors which might have influenced the wider use of clinical IT are a re-focus on clinical matters after rigorous organisational changes, legal constraints and a general IT-friendly climate in Austria.

Nursing in the information age: status quo and future of ICT use in German hospitals.

Hospital information systems (HIS) should give support to nurses in their clinical and managerial duties. Though there are statistical data on the current use of HIS systems we know only little about the numbers of nursing modules implemented. We therefore conducted a nationwide survey in Germany (n = 2182) on the current state and future plans of HIS modules including nursing applications (response rate of 27.6 %). The findings show that management applications (84 % accounting) are still more frequent than clinical applications, in particular clinical patient record systems (19 %). What applied for HIS modules in general held also true for nursing on a lower level. Whereas 51 % of the hospitals had rostering systems in place only 6 % used care planning software. Priorities and plans for the future reveal no change in the rank order of systems. We argue that in order for clinical documentation and planning systems to catch up they must be immediately rewarding for the clinicians in their daily need for information