Materials and methods

With its integrated HIS ORBIS, Agfa HealthCare is market leader in the German market for hospital information systems [56]. Therefore, this application was chosen.

Development of the evaluation criteria was based on a combination of intensive literature analysis, hidden external observation for inclusion of practical requirements of doctors and nurses from all departments of the big German hospital Klinikum Fürth, derivation from system goals and profound product analysis of the hospital information system ORBIS including strong and weak points whereby great importance was paid to cognitive walkthrough and think aloud. At the same time available addons for the HIS were examined. The creativity method brainstorming was used for collection and structuring of practical requirements. The data collection phase lasted 4 months.

Overall, medical and administrative objectives of the HIS and inpatient facilities were developed together with requirement profiles for stakeholders with main attention on doctors and nurses. Criteria in terms of requirements to be met were derived from these objectives to assess availability, usefulness and efficient integration of needed functionalities in the implementation.

Databases for the wide-ranging literature research were the following: PubMed, Scopus, ScienceDirect, Springer Link, Thieme Connect, Google, Google Scholar and EBSCO.

As a starting point, a media-independent catalogue of requirements for information processing in hospitals [36,57] was analyzed and modified in a differentiated way. Since most of the criteria were too general and did not focus on an efficient design of daily hospital routine including data exchange between departments, comprehensive criteria were formulated based on this structure. The scope of functions, user interface and links to third-party systems were examined in detail based on the implementation. Both theoretically available and actually used functionalities were evaluated, including more than 260 integrated knowledge databases for administrators and end users as well as the manufacturer’s website. Usability criteria were based on preliminary work adapted and expanded to the goal of efficiency [58,59].

Furthermore, the vision of the hospital was analyzed, with references to the organization’s goals process optimization and continuous improvement. Findings of Cooperation for Transparency and Quality in Health Care audit in 2018 were also taken into account. Comparative analyses of the addon showroom and HIS were carried out. Medical colleagues and nursing staff were included in an external observation.

In addition to 612 screenshots, 50 medical histories were evaluated anonymously to comprehensively analyze documents, requirements, functionalities, usability and existing paper documents alongside electronic documentation. In addition, particularly significant sub-areas and requirements for contemporary IT support were identified by brainstorming. Functionalities and features that promote usability, data exchange, access to medical datasets and cooperation between professional groups to avoid multiple documentation were classified as efficiency-enhancing. The global perspective ranged from admission to discharge of patients. These criteria were finally applied to the practical example ORBIS at Klinikum Fürth as a teaching hospital of the University of Erlangen-Nuremberg with 807 beds.