Examining Mental Workload Relating to Digital Health Technologies in Health Care: Systematic Review.

BACKGROUND: The workload in health care is increasing and hence, mental health issues are on the rise among health care professionals (HCPs). The digitization of patient care could be related to the increase in stress levels. It remains unclear whether the health information system or systems and digital health technologies (DHTs) being used in health care relieve the professionals or whether they represent a further burden. The mental construct that best describes this burden of technologies is mental workload (MWL). The measurement methods of MWL are particularly relevant in this sensitive setting. OBJECTIVE: This review aimed to address 2 different but related objectives: identifying the factors that contribute to the MWL of HCPs when using DHT and examining and exploring the applied assessments for the measurement of MWL with a special focus on eye tracking. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement, we conducted a systematic review and processed a literature search in the following databases: MEDLINE (PubMed), Web of Science, Academic Search Premier and CINAHL (EBSCO), and PsycINFO. Studies were eligible if they assessed the MWL of HCPs related to DHT. The review was conducted as per the following steps: literature search, article selection, data extraction, quality assessment (using the Standard Quality Assessment Criteria for Evaluation Primary Research Papers From a Variety of Fields [QualSyst]), data analysis, and data synthesis (narrative and tabular). The process was performed by 2 reviewers (in cases of disagreement, a third reviewer was involved). RESULTS: The literature search process resulted in 25 studies that fit the inclusion criteria and examined the MWL of health care workers resulting from the use of DHT in health care settings. Most studies had sample sizes of 10-50 participants, were conducted in the laboratory, and had quasi-experimental or cross-sectional designs. The main results can be grouped into two categories: assessment methods and factors related to DHT that contribute to MWL. Most studies applied subjective methods for the assessment of MWL. Eye tracking did not play a major role in the selected studies. The factors contributing to a higher MWL were clustered into organizational and systemic factors. CONCLUSIONS: Our review of 25 papers shows a diverse assessment approach toward the MWL of HCPs related to DHT as well as 2 groups of relevant contributing factors to MWL. Our results are limited in terms of interpretability and causality due to methodological weaknesses of the included studies and may be limited by some shortcomings in the search process. Future research should concentrate on adequate assessments of the MWL of HCPs dependent on the setting, the evaluation of quality criteria, and further assessment of the contributing factors to MWL. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271.

Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches.

Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.

[Awareness and Use of Digital Health Services in Germany: A Cross-sectional Study Representative of the Population]. / Bekanntheit und Nutzung von digitalen Gesundheitsangeboten in Deutschland: eine bevölkerungsrepräsentative Querschnittsuntersuchung.

OBJECTIVES: In light of the current efforts of health policy to implement eHealth, the question arises which sections of the population already use online self-help in order to tailor them to users' needs. The present study aims to determine the differences in the use of health information and psychological online counseling based on socio-demographic variables, health status and previous illnesses. METHODS: The basis for the cross-sectional data analyses using logistic regression analysis was the innovation sample of the German socio-economic panel. Data were collected from September 2016 to February 2017, with 4802 participants aged between 17-95 years. RESULTS: Fifty-five percent of the sample searched for health information on the Internet, while 1.1% had experience with online counseling. Logistic regression analyses showed that online search for information was significantly determined by age (Odds Ratio (OR)=0.96; 95-%-CI=0.96-0.97), gender (OR=1.20; 95-%-CI=1.05-1.36), awareness of Internet therapy (OR=2.57; 95-%-CI=2.20-3.00), experience with psychotherapy (OR=1.40; 95-%-CI=1.16-1.69) and the diagnosis of asthma (OR=1.14; 95-%-CI=1.01-1.29) or stroke (OR=0.66; 95-%-CI=0.52-0.84). Regarding the use of online counseling, awareness of Internet therapy and experience with face-to-face psychotherapy proved to be significant determinants. CONCLUSION: For the first time, a reliable picture has become available of the determinants of the awareness of internet therapy and online self-help utilization among the German public that should enable target-group-specific strategies to improve the care situation.

The need for harmonized structured documentation and chances of secondary use - results of a systematic analysis with automated form comparison for prostate and breast cancer.

INTRODUCTION: Medical documentation is a time-consuming task and there is a growing number of documentation requirements. In order to improve documentation, harmonization and standardization based on existing forms and medical concepts are needed. Systematic analysis of forms can contribute to standardization building upon new methods for automated comparison of forms. Objectives of this research are quantification and comparison of data elements for breast and prostate cancer to discover similarities, differences and reuse potential between documentation sets. In addition, common data elements for each entity should be identified by automated comparison of forms. MATERIALS AND METHODS: A collection of 57 forms regarding prostate and breast cancer from quality management, registries, clinical documentation of two university hospitals (Erlangen, Münster), research datasets, certification requirements and trial documentation were transformed into the Operational Data Model (ODM). These ODM-files were semantically enriched with concept codes and analyzed with the compareODM algorithm. Comparison results were aggregated and lists of common concepts were generated. Grid images, dendrograms and spider charts were used for illustration. RESULTS: Overall, 1008 data elements for prostate cancer and 1232 data elements for breast cancer were analyzed. Average routine documentation consists of 390 data elements per disease entity and site. Comparisons of forms identified up to 20 comparable data elements in cancer conference forms from both hospitals. Urology forms contain up to 53 comparable data elements with quality management and up to 21 with registry forms. Urology documentation of both hospitals contains up to 34 comparable items with international common data elements. Clinical documentation sets share up to 24 comparable data elements with trial documentation. Within clinical documentation administrative items are most common comparable items. Selected common medical concepts are contained in up to 16 forms. DISCUSSION: The amount of documentation for cancer patients is enormous. There is an urgent need for standardized structured single source documentation. Semantic annotation is time-consuming, but enables automated comparison between different form types, hospital sites and even languages. This approach can help to identify common data elements in medical documentation. Standardization of forms and building up forms on the basis of coding systems is desirable. Several comparable data elements within the analyzed forms demonstrate the harmonization potential, which would enable better data reuse. CONCLUSION: Identifying common data elements in medical forms from different settings with systematic and automated form comparison is feasible.

Characterization of image transfer patterns in a regional trauma network.

Trauma Networks are currently founded in Germany to improve patient care of severely injured persons. To assure appropriate patient treatment in a short time, the transfer of radiological image data between the connected hospitals over the internet is an important method. This paper characterizes radiological image transfer patterns in a regional trauma network and analyzes various compression options. Within the "TraumaNetwork NorthWest" in Germany, the web-based platform "MedSix" was developed. MedSix is able to transfer DICOM-data quickly and easily between connected hospitals and can be directly connected to the local PACS. Audit data of the routine system between the 01.01.2012 and the 31.12.2012 were analyzed to identify typical characteristics of radiological image exchanges. Five different compression methods were compared by a simulation. MedSix has been used by 12 hospitals. 87 % of the transfers were uploaded within 15 min. Lossless compression is able to save about 50 % bandwidth. 82 % of the transfers have a data volume of less than 200 MB. Temporary accounts for non-regular users were used regularly. Most transfers were done from small to maximum care hospitals. It is feasible to substitute physical image exchange in a trauma network with electronic exchange of radiological images between the connected hospitals. Even large datasets are transferred within an acceptable time frame. Most transfers occur from small to large hospitals. The possibility of temporary accounts seems to be a key feature for the user acceptance.

Electronic Documentation of Intraoperative Observation of Cystoscopic Procedures Using the cMDX Information System.

PURPOSE: Accurate documentation of lesions during transurethral resection of bladder tumors (TURBT) is essential for precise diagnosis, treatment planning, and follow-up care. However, optimizing schematic documentation techniques for bladder lesions has received limited attention. MATERIALS AND METHODS: This prospective observational study used a cMDX-based documentation system that facilitates graphical representation, a lesion-specific questionnaire, and heatmap analysis with a posterization effect. We designed a graphical scheme for bladder covering bladder landmarks to visualize anatomic features and to document the lesion location. The lesion-specific questionnaire was integrated for comprehensive lesion characterization. Finally, spatial analyses were applied to investigate the anatomic distribution patterns of bladder lesions. RESULTS: A total of 97 TURBT cases conducted between 2021 and 2023 were included, identifying 176 lesions. The lesions were distributed in different bladder areas with varying frequencies. The distribution pattern, sorted by frequency, was observed in the following areas: posterior, trigone, lateral right and anterior, and lateral left and dome. Suspicious levels were assigned to the lesions, mostly categorized either as indeterminate or moderate. Lesion size analysis revealed that most lesions fell between 5 and 29 mm. CONCLUSION: The study highlights the potential of schematic documentation techniques for informed decision making, quality assessment, primary research, and secondary data utilization of intraoperative data in the context of TURBT. Integrating cMDX and heatmap analysis provides valuable insights into lesion distribution and characteristics.

Interoperability in clinical research: from metadata registries to semantically annotated CDISC ODM.

Planning case report forms for data capture in clinical trials is a labor-insensitive and not formalized process. These CRFs are often neither standardized nor using defined data elements. Metadata registries as the NCI caDSR provide the capability to create forms based on common data elements. However, an exchange of these forms into clinical trial management systems through a standardized format like CDISC ODM is currently not offered. Thus, our objectives were to develop a mapping model between NCI forms and ODM. We analyzed 3012 NCI forms and included common data elements regarding their frequency and uniqueness. In this paper, we have created a mapping model between both formats and identified limitations in the conversion process: Semantic codes requested from the caDSR registry did not allow a proper mapping to ODM items and information like the number of module repetitions got lost. Summarized, it can be stated that our mapping model is feasible. However, mapping of semantic concepts in ODM needs to be specified more precisely.

Semantic enrichment of medical forms - semi-automated coding of ODM-elements via web services.

Semantic interoperability is an unsolved problem which occurs while working with medical forms from different information systems or institutions. Standards like ODM or CDA assure structural homogenization but in order to compare elements from different data models it is necessary to use semantic concepts and codes on an item level of those structures. We developed and implemented a web-based tool which enables a domain expert to perform semi-automated coding of ODM-files. For each item it is possible to inquire web services which result in unique concept codes without leaving the context of the document. Although it was not feasible to perform a totally automated coding we have implemented a dialog based method to perform an efficient coding of all data elements in the context of the whole document. The proportion of codable items was comparable to results from previous studies.

Designing and implementing a biobanking IT framework for multiple research scenarios.

This paper presents a biobanking IT framework, comprising a set of integrated biobanking information technology components. It provides adaptable and scalable IT support for varying biobanking scenarios, workflows and projects, while avoiding redundancy in data and technology. Feasibility of this approach is illustrated by implementations for four different biobanking projects at Erlangen University Hospital and with cooperating partners in Münster and Lübeck.

How Does Mental Workload Influence the Adoption of Clinical Information Systems: An Exploratory Study.

Mental workload and technology acceptance are relevant factors that relate to use behavior and performance. Studies show a potential moderating effect of mental workload on predictors of technology acceptance. Aim of this study was the investigation of predictors of technology acceptance (UTAUT) related to clinical information systems and their relation to mental workload. This quasi-experimental study with 48 participants used the following measures: NASA TLX and UTAUT questionnaire. Participants had to perform three tasks on a clinical information system as well as four task-levels of the n-back task with increasing difficulty. Analyses show a high level of technology acceptance (M=3.82, SD=.76) and confirm performance expectancy as the most relevant predictor of behavioral intention (ß=.48, p<.001). A linear regression showed that a high level of mental workload has an influence on performance expectancy (F1,46=8.438, p<.05). The study shows an influence of mental workload on acceptance, the strength and role of which (e.g. moderation) needs to be further investigated, especially in the context of other determinants.

[Perception and mindfulness-based occupational therapy in people with mental disorders-A retrospective observational study on the SELWA-treatment]. / Wahrnehmungs- und achtsamkeitsbasierte Ergotherapie bei Menschen mit psychischen Störungen ­ Eine retrospektive Beobachtungsstudie zur Anwendung der SELWA-Behandlung.

During occupational therapeutic treatment of clients with mental disorders, perception and mindfulness-based techniques are used. However, little is known regarding relevant outcomes. Aim of the present study is to describe the results of a perception and mindfulness-based occupational therapeutic intervention (self-control techniques using perception-based methods (SELWA®) by S. Thielen) regarding the outcomes occupational performance and satisfaction in self-care, productivity and leisure, as well as concentration. The data of 28 clients (22 â™€, 6 â™‚; mean age = 42.8 (±SD 14.7) years) with mental disorders, that were collected before and after prescribed occupational therapeutic treatment, were analyzed. The outcomes were quantified using the Canadian Occupational Performance Measure (COPM) and the revision test, respectively. Significance of changes after the intervention was tested using the Wilcoxon-Signed Rank Test (p < 0.05). Effect sizes Cohen's dz and r were determined to evaluate the meaningfulness of changes. The occupational performance as well as the satisfaction in the COPM improved significantly after the therapeutic intervention (p < 0.001; dz = 2.37, r = 0.77 and dz = 2.24, r = 0.75). Moreover, the clients improved significantly in the revision test after the therapeutic intervention (p < 0.001; dz = 0.65, r = 0.31). Clients with mental disorders seem to benefit meaningfully from the SELWA®-treatment by S. Thielen regarding occupational performance and satisfaction in self-care, productivity and leisure. Furthermore, a moderate improvement of concentration seems to occur after the therapeutic intervention.

Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey.

BACKGROUND: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. OBJECTIVE: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients' preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). METHODS: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. RESULTS: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. CONCLUSIONS: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

Artificial Intelligence-Based Prognostic Model for Urologic Cancers: A SEER-Based Study.

BACKGROUND: Prognostication is essential to determine the risk profile of patients with urologic cancers. METHODS: We utilized the SEER national cancer registry database with approximately 2 million patients diagnosed with urologic cancers (penile, testicular, prostate, bladder, ureter, and kidney). The cohort was randomly divided into the development set (90%) and the out-held test set (10%). Modeling algorithms and clinically relevant parameters were utilized for cancer-specific mortality prognosis. The model fitness for the survival estimation was assessed using the differences between the predicted and observed Kaplan-Meier estimates on the out-held test set. The overall concordance index (c-index) score estimated the discriminative accuracy of the survival model on the test set. A simulation study assessed the estimated minimum follow-up duration and time points with the risk stability. RESULTS: We achieved a well-calibrated prognostic model with an overall c-index score of 0.800 (95% CI: 0.795-0.805) on the representative out-held test set. The simulation study revealed that the suggestions for the follow-up duration covered the minimum duration and differed by the tumor dissemination stages and affected organs. Time points with a high likelihood for risk stability were identifiable. CONCLUSIONS: A personalized temporal survival estimation is feasible using artificial intelligence and has potential application in clinical settings, including surveillance management.

Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains.

BACKGROUND: Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format. METHODS: Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions. RESULTS: More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed. CONCLUSION: Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.

HIS-based Kaplan-Meier plots--a single source approach for documenting and reusing routine survival information.

BACKGROUND: Survival or outcome information is important for clinical routine as well as for clinical research and should be collected completely, timely and precisely. This information is relevant for multiple usages including quality control, clinical trials, observational studies and epidemiological registries. However, the local hospital information system (HIS) does not support this documentation and therefore this data has to generated by paper based or spreadsheet methods which can result in redundantly documented data. Therefore we investigated, whether integrating the follow-up documentation of different departments in the HIS and reusing it for survival analysis can enable the physician to obtain survival curves in a timely manner and to avoid redundant documentation. METHODS: We analysed the current follow-up process of oncological patients in two departments (urology, haematology) with respect to different documentation forms. We developed a concept for comprehensive survival documentation based on a generic data model and implemented a follow-up form within the HIS of the University Hospital Muenster which is suitable for a secondary use of these data. We designed a query to extract the relevant data from the HIS and implemented Kaplan-Meier plots based on these data. To re-use this data sufficient data quality is needed. We measured completeness of forms with respect to all tumour cases in the clinic and completeness of documented items per form as incomplete information can bias results of the survival analysis. RESULTS: Based on the form analysis we discovered differences and concordances between both departments. We identified 52 attributes from which 13 were common (e.g. procedures and diagnosis dates) and were used for the generic data model. The electronic follow-up form was integrated in the clinical workflow. Survival data was also retrospectively entered in order to perform survival and quality analyses on a comprehensive data set. Physicians are now able to generate timely Kaplan-Meier plots on current data. We analysed 1029 follow-up forms of 965 patients with survival information between 1992 and 2010. Completeness of forms was 60.2%, completeness of items ranges between 94.3% and 98.5%. Median overall survival time was 16.4 years; median event-free survival time was 7.7 years. CONCLUSION: It is feasible to integrate survival information into routine HIS documentation such that Kaplan-Meier plots can be generated directly and in a timely manner.

CIS-based registration of quality of life in a single source approach.

BACKGROUND: Documenting quality of life (QoL) in routine medical care and using it both for treatment and for clinical research is not common, although such information is absolutely valuable for physicians and patients alike. We therefore aimed at developing an efficient method to integrate quality of life information into the clinical information system (CIS) and thus make it available for clinical care and secondary use. METHODS: We piloted our method in three different medical departments, using five different QoL questionnaires. In this setting we used structured interviews and onsite observations to perform workflow and form analyses. The forms and pertinent data reports were implemented using the integrated tools of the local CIS. A web-based application for mobile devices was developed based on XML schemata to facilitate data import into the CIS. Data exports of the CIS were analysed with statistical software to perform an analysis of data quality. RESULTS: The quality of life questionnaires are now regularly documented by patients and physicians. The resulting data is available in the Electronic Health Record (EHR) and can be used for treatment purposes and communication as well as research functionalities. The completion of questionnaires by the patients themselves using a mobile device (iPad) and the import of the respective data into the CIS forms were successfully tested in a pilot installation. The quality of data is rendered high by the use of automatic score calculations as well as the automatic creation of forms for follow-up documentation. The QoL data was exported to research databases for use in scientific analysis. CONCLUSION: The CIS-based QoL is technically feasible, clinically accepted and provides an excellent quality of data for medical treatment and clinical research. Our approach with a commercial CIS and the web-based application is transferable to other sites.

Populating the i2b2 database with heterogeneous EMR data: a semantic network approach.

In an ongoing effort to share heterogeneous electronic medical record (EMR) data in an i2b2 instance between the University Hospitals Münster and Erlangen for joint cancer research projects, an ontology based system for the mapping of EMR data to a set of common data elements has been developed. The system translates the mappings into local SQL scripts, which are then used to extract, transform and load the facts data from each EMR into the i2b2 database. By using Semantic Web standards, it is the authors' goal to reuse the laboriously compiled "mapping knowledge" in future projects, such as a comprehensive cancer ontology or even a hospital-wide clinical ontology.

The single source architecture x4T to connect medical documentation and clinical research.

Clinical trials often require large and redundant documentation efforts, because information systems in patient care and research are separated. In two clinical trials we have assessed the number of study items available in the clinical information system for re-use in clinical research. We have analysed common standards such as HL7, IHE RFD and CDISC ODM, regulatory constraints and the documentation process. Based on this analysis we have designed and implemented an architecture for an integrated clinical trial documentation workflow. Key aspects are the re-use of existing medical routine data and the integration into current documentation workflows.

Which Factors of Digitisation Bias the Work-Related Stress of Healthcare Employees? A Systematic Review.

BACKGROUND: Digitisation affects our working environment. It demands new cognitive and digital skills of healthcare employees. Technostress and burnout are more likely to occur due to the additional workload. AIM: Objective is the identification of determinants affecting work related technostress. METHODOLOGY: We carried out a systematic review according to the PRISMA statement. For the identification of the digital factors, we applied an inductive content analysis based on Mayring's theory. RESULTS: Included studies showed the following factors to be relevant for coping with technostress: autonomy, competence, understanding of roles, time pressure, attitude, security and ergonomics. The emerging factors serve the regulation of stress in the healthcare system and contribute to better healthcare and higher occupational safety.

Examining the Mental Workload Associated With Digital Health Technologies in Health Care: Protocol for a Systematic Review Focusing on Assessment Methods.

BACKGROUND: The workload in health care is high; physicians and nurses report high stress levels due to a demanding environment where they often have to perform multiple tasks simultaneously. As a result, mental health issues among health care professionals (HCPs) are on the rise and the prevalence of errors in their daily tasks could increase. Processes of demographic change are partly responsible for even higher stress levels among HCPs. The digitization of patient care is intended to counteract these processes. However, it remains unclear whether these health information systems (HIS) and digital health technologies (DHT) support the HCPs and relieve stress, or if they represent a further burden. The mental construct that describes this burden of technologies is mental workload (MWL). Work in the clinic can be viewed as working in safety-critical environments. Particularly in this sensitive setting, the measurement methods of MWL are relevant, mainly due to their strongly differing levels of intrusiveness and sensitivity. The method of eye tracking could be a useful way to measure MWL directly in the field. OBJECTIVE: The systematic review aims to address the following questions: (1) In which manner do DHT contribute to the overall MWL of HCPs? (2) Can we observe a direct or indirect effect of DHT on MWL? (3) Which aspects or factors of DHT contribute to an increase in MWL? (4) Which methods/assessments are applied to measure MWL related to HIS/DHT? (5) What role does eye tracking/pupillometry play in the context of measuring MWL? (6) Which outcomes are being assessed via eye tracking? METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, we will conduct a systematic review. Based on the research questions, we define keywords that we then combine in search terms. The review follows the following steps: literature search, article selection, data extraction, risk of bias assessment, data analysis, and data synthesis. RESULTS: We expect results as well as a finalization of the review in the summer of 2021. CONCLUSIONS: This review will evaluate the impact of DHT on the MWL of HCPs. In addition, assessment methods of MWL in the context of digital technologies will be systematically analyzed. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29126.