The impact of Digitalized Communication on the effectiveness of Local Administrative Authorities - Findings from Central European Countries in the COVID-19 Crisis.

This paper analyses the impact of the use of digital communication tools in administrative procedures on the effectiveness of local administrative authorities during the COVID-19 pandemic. It considers COVID-19-driven changes in the legal competence of the institutional unit and administrative authorities' orientation to good governance as mediators of this relationship. By applying partial least squares structural equation modelling (PLS-SEM) to survey data (N = 610) from five central European countries, we show that the accelerated use of digitalized communication tools driven by the COVID-19 situation has a positive effect on the effectiveness of local administrative authorities. Our data also indicate that the new laws, instructions and good governance driven by the COVID-19 situation - based on mostly convergent administrative traditions and European trends - partially mediate the relationship between the use of digital communication tools and administrative effectiveness. These findings do not significantly differ between participating countries and bureaucratic traditions. Consequently, the COVID-19 crisis proved to be a joint facilitator of responsive public governance that remained compliant with the rule of law, regardless of whether the national administrative systems were traditionally more legalistically or managerially oriented.

Effect of a nursing information system on the quality of information processing in nursing: An evaluation study using the HIS-monitor instrument.

OBJECTIVES: To assess the changes in the quality of information processing in nursing after the introduction of a computer-based nursing information system. METHODS: 94 nurses filled out the HIS-monitor survey, comprising 41 questions and focusing on the quality of the information processing, shortly before and again one year after the introduction of a computer-based nursing information system. A McNemar-Bowker-test was used to assess the changes in quality over time. The HIS-monitor instrument was formally validated by calculating Cronbach Alpha. RESULTS: Despite some technical problems, the quality of the information processing in nursing significantly improved after the introduction of a computer-based nursing information system in many areas. The results show improved support during patient anamnesis and care planning, higher availability and completeness of nursing documentation, better overview on the patient, better readability of nursing documentation, reduction of duplicate documentation, better workflow support with task lists and checklists, and better fulfillment of the legal regulations. The results with regard to time efforts for nursing documentation and the related impact on patient care were mixed, however. Most of the expectations of the nurses that were stated before IT introduction seem to have been realized. CONCLUSIONS: The HIS-monitor was found to be a useful instrument, in turn showing that the quality of the information processing in nursing strongly increased after the introduction of a nursing information system.

Implementation of a secure and interoperable generic e-Health infrastructure for shared electronic health records based on IHE integration profiles.

INTRODUCTION: The ubiquitous availability of medical or care data for authorized clinicians and nurses is expected to increase quality while reducing costs in the health care sector. The standardized, distributed provision of medical or care data is capable to support the vision of patient centered shared electronic health records (SEHRs). A main contribution to cross-institutional data exchange is provided by Integrating the Healthcare Enterprise (IHE). However, holistic implementations of IHE based eHealth infrastructures for SEHRs are currently rare and security and privacy regulations are not fully covered by existing IHE Integration Profiles. This work aims to point out our experiences and lessons learned from five years of development and the implementation of IHE compliant products. METHODS: Cross-Enterprise Document Sharing (XDS) describes the base components for exchanging medical or care data. A unique patient Identification is described by the Patient Identifier Cross-referencing (PIX) and the Patient Demographics Query (PDQ) Integration Profile. All interactions are logged in an "Audit Record Repository" deployed once per Affinity Domain and defined in the Audit Trail and Node Authentication (ATNA) Integration Profile. RESULTS: Based on the IHE Integration Profile XDS and other Integration Profiles high-level components for eHealth infrastructures and applications, supporting a holistic, secure concept and, based on these concepts, software products for a technical cooperative care infrastructure, has been developed. The products are practically evaluated in a project for setting up an IHE XDS Affinity Domain in the Austrian district of Tyrol and a number of lessons have been learned.

HIS-Monitor: an approach to assess the quality of information processing in hospitals.

OBJECTIVES: Hospital information systems (HIS) are a substantial quality and cost factor for hospitals. Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed HIS-Monitor, comprising about 107 questions, focusing on how a hospital information system does efficiently support clinical and administrative tasks. METHODS: The structure of HIS-Monitor consists of a matrix, crossing HIS quality criteria on one axis with a list of process steps within patient care on the other axis. HIS-Monitor was developed based on several pretests and was now tested in a larger feasibility study with 102 participants. RESULTS: HIS-Monitor intends to describe strengths and weaknesses of information processing in a hospital. Results of the feasibility study show that HIS-Monitor was able to highlight certain HIS problems such as insufficiently supported cross-departmental communication, legibility of drug orders and other paper-based documents, and overall time needed for documentation. We discuss feasibility of HIS-Monitor and the reliability and validity of the results. CONCLUSIONS: Further refinement and more formal validation of HIS-Monitor are planned.

HIS-monitor: quality of information processing in hospitals.

Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed the HIS-Monitor questionnaire, focusing on how a hospital information system (HIS) does efficiently support clinical and administrative tasks. HIS-Monitor was applied in a feasibility study with 102 nursing participants. Results point to strengths and weaknesses of information processing in the participating departments. Based on the experiences of the feasibility study, HIS-Monitor is now further being optimized.

Design and development of a monitoring system to assess the quality of hospital information systems: concept and structure.

Hospital information systems (HIS) are a substantial quality and cost factor in health care. Systematic monitoring of HIS quality is an important task for information management; however, this task is often seen to be insufficiently supported by available methods and tools. The aim of this research project is to develop a comprehensive monitoring system to assess the quality of hospital information systems, taking into account both computer-based and paper-based information processing.The structure of the developed monitoring system consists of a matrix, crossing HIS quality criteria on one axis (e.g., accessibility of information, or correctness and completeness of information) with a list of process steps within patient care on the other axis (e.g., patient admission, order entry, or clinical documentation). Relevant fields in this matrix, being defined by one quality criterion and one process step, contain detailed questions, that access the HIS quality with regard to the given criterion in a given process step.Based on the matrix, a questionnaire with around 140 questions has been developed, consisting of specific questions for physicians, nurses and other professional groups. The ongoing international evaluation will verify completeness, reliability, validity, and feasibility of this HIS quality monitoring system. First evaluation steps point to a high acceptance of this approach among IT staff and clinical staff.