Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Vallendar, Germany.
Department of Medical Management, Faculty of Health Sciences, Medical School Hamburg, Hamburg, Germany.
J Med Internet Res. 2022 Nov 10;24(11):e40124. doi: 10.2196/40124.
The adoption of health information technology (HIT) by health care providers is commonly believed to improve the quality of care. Policy makers in the United States and Germany follow this logic and deploy nationwide HIT adoption programs to fund hospital investments in digital technologies. However, scientific evidence for the beneficial effects of HIT on care quality at a national level remains mostly US based, is focused on electronic health records (EHRs), and rarely accounts for the quality of digitization from a hospital user perspective.
This study aimed to examine the effects of digitization on clinical outcomes and patient experience in German hospitals. Hence, this study adds to the small stream of literature in this field outside the United States. It goes beyond assessing the effects of mere HIT adoption and also considers user-perceived HIT value. In addition, the impact of a variety of technologies beyond EHRs was examined.
Multiple linear regression models were estimated using emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. The adoption and user-perceived value of HIT represented key independent variables, and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted, observed-to-expected outcome ratios for patients who had stroke, myocardial infarction, or hip replacement. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 subdomains of HIT and EHRs was derived from the German 2020 Healthcare IT Report.
Statistical analysis was based on an overall sample of 383 German hospitals. The analyzed data set suggested no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction. However, a higher user-perceived value or quality of the installed tools did improve outcomes. Emergency care outcomes benefited from user-friendly overall digitization (β=-.032; P=.04), which was especially driven by the user-friendliness of admission HIT (β=-.023; P=.07). Elective care outcomes were positively impacted by user-friendly EHR installations (β=-.138; P=.008). Similarly, the results suggested user-friendly, overall digitization to have a moderate positive effect on patient satisfaction (β=-.009; P=.01).
The results of this study suggest that hospital digitization is not an end in itself. Policy makers and hospitals are well advised to not only focus on the mere adoption of digital technologies but also continuously work toward digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that the assumed benefits of single technologies are not realized across all care domains.
医疗保健提供者采用健康信息技术（HIT）通常被认为可以提高护理质量。美国和德国的政策制定者遵循这一逻辑，推行全国性的 HIT 采用计划，为医院投资数字技术提供资金。然而，关于 HIT 对国家层面护理质量的有益影响的科学证据主要基于美国，侧重于电子健康记录（EHR），并且很少从医院用户的角度考虑数字化的质量。
本研究旨在研究德国医院数字化对临床结果和患者体验的影响。因此，本研究补充了美国以外该领域的少量文献。它不仅评估了单纯采用 HIT 的效果，还考虑了用户感知到的 HIT 价值。此外，还研究了超越 EHR 之外的各种技术的影响。
使用急诊护理结果、择期护理结果和患者满意度作为因变量，使用多元线性回归模型进行估计。HIT 的采用和用户感知价值是关键的自变量，病例量、医院规模、所有制和教学地位被纳入控制变量。通过对中风、心肌梗死或髋关节置换患者的风险调整后观察到的预期结果比来捕获护理结果。德国患者体验问卷白皮书提供了患者满意度的信息。通过德国 2020 年医疗保健 IT 报告，获得了 10 个子领域的 HIT 和 EHR 采用和用户感知价值的信息。
统计分析基于 383 家德国医院的总体样本。分析的数据表明，HIT 或 EHR 采用对临床结果或患者满意度没有显著影响。然而，更高的用户感知价值或已安装工具的质量确实可以改善结果。急诊护理结果受益于整体易于使用的数字化（β=-.032；P=.04），这主要是由于入院 HIT 的易用性（β=-.023；P=.07）。择期护理结果受到用户友好的 EHR 安装的积极影响（β=-.138；P=.008）。同样，结果表明整体易于使用的数字化对患者满意度有适度的积极影响（β=-.009；P=.01）。
本研究结果表明，医院数字化本身并不是目的。政策制定者和医院最好不仅要关注数字技术的单纯采用，还要不断努力实现被每天依赖它的医生和护士视为有价值的数字化。此外，医院数字化战略应考虑到单个技术的假定益处并未在所有护理领域实现。
