Differential effects of electronic patient record systems for wound care on hospital-acquired pressure injuries: Findings from a secondary analysis of German hospital data.

INTRODUCTION: Despite the improvements made in recent decades, the OECD regards hospital-acquired pressure injuries (HAPI) as high priority areas for actions to ensure patient safety. This study was aimed at investigating the degree of utilization of two types of electronic patient record systems for wound care on lowering HAPI rates. Furthermore, the effect of user satisfaction with the systems and perceived alignment with clinical processes should be studied. MATERIAL AND METHODS: A regression analysis of post-stratified data from German hospitals obtained from the Hospital Quality Reports (observed/expected HAPI ratio) and the IT Report Healthcare was performed. The sample comprised 319 hospitals reporting on digital wound record systems and 199 hospitals on digital nursing record systems for system utilization and the subset of hospitals using a digital system for user satisfaction and process alignment. RESULTS: The study revealed a significant effect of hospital ownership for both types of systems and a significant interaction of ownership and system utilization for digital wound record systems: Only the for-profit hospitals benefited from a higher degree of system utilization with a lower HAPI ratio. In contrast, non-profit hospitals yielded a reversed pattern, with increasing HAPI rates matching an increased system utilization. User satisfaction (significant) and the perceived alignment of the clinical process (trend) of the digital nursing record system were related with lower HAPI ratios. DISCUSSION: These findings point to a differential effect of system utilization on HAPI ratios depending on hospital ownership, and they demonstrate that those users who are satisfied with the system can act as catalysts for better care. The explained variance was small but comparable to other studies. Furthermore, it shows that explaining quality care is a complex undertaking. Sheer utilization has no effect while a differential perspective on the facilitators and barriers might help to explain the patient outcomes.

Health IT Adoption in German Hospitals: Could We See Any Changes Between 2017 and 2023?

INTRODUCTION: Increase in health IT adoption is often driven by financial support through the state. In 2020, the German Hospital Future Law passed Parliament with a schedule to see potential effects in 2023. The research question of the present study thus was if there were differences between 2017 and 2023 in selected application areas eligible for funding by the law. METHODS: Availability and percentage of use in clinical units was measured in a panel of 172 hospitals for these areas. A linear mixed model with repeated measures yielded a significant increase in "medication management" and "discharge management". RESULTS AND DISCUSSION: In "medication management", hospitals in a group as compared to single hospitals tripled the percentage of clinical units using IT systems for this purpose. Not-for-profit hospitals doubled their IT systems for "discharge management" when compared to for-profit hospitals. CONCLUSION: Whether these changes can be attributed to the Hospital Future Law is debatable due to severe delays in various fields, particularly in making funding available. There is room for speeding up particularly the administrative funding process and finally demonstrating results that are proportional to the government money invested.

What Determines the Use of Clinical Decision Support Systems in Nursing? Results of a Multiple Regression Analysis.

INTRODUCTION: In nursing, professionals are expected to base their practice on evidence-based knowledge, however the successful implementation of this knowledge into nursing practice is not always assured. Clinical Decision Support Systems (CDSS) are considered to bridge this evidence-practice gap. METHODS: This study examines the extent to which evidence-based nursing (EBN) practices influence the use of CDSS and identifies what additional factors from acceptance theories such as UTAUT play a role. RESULTS AND DISCUSSION: Our findings from three regression models revealed that nursing professionals and nursing students who employ evidence-based practices are not more likely to use an evidence-based CDSS. The relationship between an EBN composite score (model 1) or is individual dimensions (model 2) and CDSS use was not significant. However, a more comprehensive model (model 3), incorporating items from the UTAUT such as Social Influences, Facilitating Conditions, Performance Expectancy, and Effort Expectancy, supplemented by Satisfaction demonstrated a significant variance explained (R2 = 0.279). Performance Expectancy and Satisfaction were found to be significantly associated with CDSS utilization. CONCLUSION: This underscores the importance of user-friendliness and practical utility of a CDSS. Despite potential limitations in generalizability and a limited sample size, the results provide insights into that CDSS first and foremost underly the same mechanisms of use as other health IT systems.

Information in Healthcare - From Data to Knowledge: Improving Data Literacy Competencies.

Digitalization in healthcare and the increasing availability of data demand data literacy competences of nurses and other healthcare professionals including technical, ethical and communication skills. The international Spring School 2023 "Information in Healthcare - From Date to Knowledge" aimed at these competences covering interoperability, data protection and security, data analytics and ethical issues. These topics were embedded in the overall case of data-driven quality improvement for diabetes patients in a region. The curriculum includes an online preparation-phase and a five-days attendance week, incorporating problem-based and group work approaches. According to the studentt's evaluation, the awareness of the importance of the topics was raised and theoretical as well as practical application skills were improved. The Spring School enhanced data literacy competences, critical thinking, problem-solving, interprofessional und intercultural skills among healthcare professionals. Such course offering can contribute to meeting the increasing challenges of digitalization in healthcare.

Dimensions of Evidence-Based Practice in Nursing: Results of a Factor Analysis.

Clinical decision support systems (CDSS) are capable of bridging evidence and practice. However, it is unclear what dimensions determine evidence-based practice under real world conditions. To answer this question, 126 registered nurses and nursing students from the Munich municipal hospital group filled in a systematically developed and validated questionnaire with 26 items. An exploratory factor analysis revealed the three dimensions "Knowledge", "Trust" and "Practice" which explain 56.5% of the total variance. They are corroborated by the literature and match findings about evidence-based practice in medicine. These results not only provide insights into the construct evidence-based practice but also give practical hints how to foster evidence-based daily work in nursing. A supportive clinical environment seems to be paramount to achieve this goal: access to evidence-based resources, team meetings to reflect the experience and the inclusion of the patients' needs.

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.

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.

Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective.

BACKGROUND: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. OBJECTIVES: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. METHODS: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. RESULTS: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). CONCLUSIONS: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.