The inpatient sector consists of inter- and multidisciplinary service processes [1]. Due to inefficiencies and overlapping processes, redundant activities with extensive documentation are characteristic for the working routine in many hospitals. Media discontinuities between paper and digital data processing extend process times leading to additional expenditure due to multiple recording and manual exchange. Difficulties in organization, cooperation and communication are leading to negative effects such as unnecessary use of resources in diagnostics and therapy. Deficits in information logistics not only have negative impacts on the quality of care [2–5], but also financial ones, such as empty operating rooms. Cooperation of all professional groups is of great importance. They need comprehensive information to perform their tasks. End user satisfaction [6–8] and knowledge logistics [9] are success factors for making data available in time, in the right format, at the right place and for those involved in processes to support decision-making [10–12].
Data processing is a productivity and quality factor in a highly competitive environment [11,13,14]. German hospitals fall far behind in international comparison when it comes to digitalization [15]. The degree of digitalization is very low [16]. There is a high backlog demand [17]. Integrated hospital information systems (HIS) can help to eliminate information gaps and shorten processes. 20 to 40 % of services in the health care system represent data acquisition and communication [18]. Doctors spend several hours a day on documentation [19,20]. 85 % of them rate IT support as mediocre to very poor [21]. Physicians’ perceptions of usefulness of HIS have great impact on the acceptance of such systems [22]. Acceptance strongly depends on the extent to which required functions of end users are covered [23]. Inefficient processes with a lack of structured documentation, transfer, reuse of data and automation lead to delays, loss of time, cost explosion and reduced quality of care [2]. This is aggravated by the fact that manufacturers of medical devices and software often do not ensure technical integration and data exchange without problems despite established standards, such as Health Level 7 (HL7), resulting in parallel isolated solutions with independent data storage preventing efficient collaboration.
Processes are seldom specifically coordinated with each other by information systems. Instead, applications are often only used for electronic documentation for specific tasks or in few departments [24]. Inexpedient processes with gaps between electronic and analogue process steps without completely covering processes, documentation and data exchange are the consequence. The majority of physicians hope to increase efficiency through digitalization. However, the status quo shows a lack of user-friendly software and cross-disciplinary electronic documentation.
It is crucial to make everyday life in hospital as efficient as possible. The challenge is to map a complex coordinated process sequence of successive and parallel services using information technology. This depends to a large extent on cooperation of departments to reduce redundant work and to implement a common information base with multiple automatic reuses of information documented once (single-source-approach). Hospital information systems have developed from departmental systems to comprehensive applications [25] and include many programs from mostly different manufacturers with redundancies due to insufficient functional integration and limited interoperability.
Integrated HIS can overcome interface problems by accelerating access, increasing quality of communication, ensuring timely availability and positive effects on process and result quality [26,27]. This concept benefits from advantages similar to integration of Radiology Information Systems and HIS with Picture Archiving and Communication Systems [28]. Nevertheless, many physicians still find it difficult to obtain complete information [29], despite the progress made in comparison to exclusively paper-based documentation [30,31]. Increasing specialization, complexity, medical progress and rising co-morbidities are increasing importance of systematic information processing for hospitals as a whole. Evaluations of systems are the decisive prerequisite for development and high-quality as well as efficient care [2,32–34].
Systematic participation of employees represents a key factor for successful design of digitalization. Digitalization can thus be accomplished in a needs-based and user-oriented way. However, only 15 % of staff members are typically involved [35]. Available criteria, such as a requirements index [13,36] or benchmarking indicators of HIS [37], have in common that they are often too general and not comprehensive enough to be applied directly to a hospital with this goal of global efficiency improvement or concentrate on architecture and usability [14,38–45]. Another gap is that many criteria are only valid for single institutions, workflows, user groups or choice of software but not further improvement [11,46–55]. For this reasons, comprehensive evaluation criteria for efficient hospital information systems have to be developed and evaluated in practice.
