With the increasing implementation and use of health information technology (IT) in complex environments, new opportunities as well as new risks have emerged. While electronic access to patient information has become less cumbersome due to the adoption of electronic health record (EHR) systems, unintended consequences of using health IT have been reported1. Exploiting the opportunities and avoiding the risks is not simply a matter of hardware and software but strongly includes the individual professionals involved. All types of healthcare professionals (e.g., nurses and physicians), engineers and systems developers, as well as health informatics (HI) specialists – who are bridging the gap between healthcare providers and technical specialists – are involved. Furthermore, board members, executives and other high-level decision makers are also involved and belong to the group of key stakeholders and decision makers who contribute to the success or failure of a system. All these groups require competencies to use, manage or leverage health IT in their particular role.
New informatics challenges also arise when different disciplines and professions form a team to care for a patient. There can be a lack of communication and coordination between different groups, which can negatively affect the care delivered 2. Much of this inter-professional effort also requires the collaborative use of eHealth and the cooperative development of new electronic systems and applications to ensure high-quality patient care.
Although the HI knowledge base is global, education is local and particularly benefits from case studies that reflect local realities as blueprints. Due to the global nature of eHealth knowledge, there are great opportunities for synergy in cross-country learning. While HI recommendations on competencies and education – particularly international recommendations – serve as highly valuable guides for designing curricula and courses, they cannot show how the content should be situated in a specific and local context due to their generic nature. For this purpose, the case study is a more suitable format.
Case studies usually describe a complex phenomenon from multiple perspectives within a unit or environment where the study takes place. Case studies tell the story of this unit with regard to key questions about this phenomenon and illustrate it so that it becomes clearer, more tangible and more understandable 3,4,5. Case studies also lend themselves as stimulation for discussions and are ideal material from which to learn.
The TIGER (Technology Informatics Guiding Education Reform) Initiative has been addressing educational issues for more than a decade worldwide 6,7. During this time, TIGER has brought many instrumental stakeholders together, with a focus on nursing in the early days and with a wide scope integrating all health professional groups today. The results of TIGER activities have been published as various recommendations on HI education 8. In the last three years, the TIGER International Competencies Synthesis Project (ICSP) compiled learning priorities and core competencies from a global perspective. Most recently, the TIGER ICSP has been presented at global scientific conferences and thus combines global expert views about core competency areas with local case studies 9. It is important to note that findings from the ICSP were leveraged to serve as a foundation upon which the EU*US eHealth Work Project was built.
This body of work also integrates approaches and findings from other project deliverables, particularly from the Survey of Current States of Needs and Gap Analysis. Thus, our main questions were:
- Are the core competency areas identified and investigated in D2.1, the survey of current needs, reflected in the curricula and approaches that are described in selected case studies?
- What in-depth information do these case studies provide concerning the gaps in eHealth education as described in D2.3, the gap analysis?
- Do the case studies support, enhance or underscore the Best Practice recommendations postulated by the EU*US eHealth Work Project Consortium?
In order to answer the three questions stated previously, we needed to develop a methodology that would allow different stakeholders to describe their cases in comparable manners. To this end, we designed a case study template that was structured according to sections and provided guidance on which topics belonged to each section.
In total, 22 groups of case study authors were recruited and 22 case studies were completed. Out of the 22 case studies, there are 15 from Europe, representing 10 European states. There are three from the UK (England, Scotland); two from Norway; and two from Finland – of which one is a multi-national study focused on the central Baltic Region (Estonia, Finland, Latvia). Northern (Denmark, Finland, Norway, Sweden); western (UK); southern (Portugal); central (Austria, Germany, Slovenia); and eastern (Estonia, Latvia) parts of Europe are also represented. In addition to the case studies from Europe, contributions from Asia (China, India, Israel, Saudi Arabia); North America (Canada, US); and Africa (Nigeria) were included.
All authors who volunteered their time to develop case studies are affiliated with major leading institutions in their field and hold a high reputation in their country as experts in the field.
Case studies represent the micro (university), meso (hospital/health system) and macro (country) levels. They are inclusive of courses for different professions and inter-professional courses, different academic levels and training/continuing education, and various approaches of technology-supported learning.
Two micro-level case studies describe IT tools and approaches for learning medical and nursing topics that contribute to building experience with technology. One is a clinical decision support system (CDSS) for nurses that is often used for informal learning, training and continuing on-the-job education in hospitals with installations in Denmark, Germany and Norway. The other is a Massive Open Online Course (MOOC) for an inter-professional audience to acquire competencies to use the necessary eHealth tools and perform high-quality collaborative care.
The meso level is represented by case studies that describe the integration of informatics education and training in healthcare organisations. For example, a case study from the US describes progress on work to integrate a nursing informatics team into the culture of a large health system. A similar macro-level study from Portugal describes informatics aspects integrated in nursing graduate programs, as well as continuing education programs across the country, including the development of national-level competencies.
Many case studies, in particular those from academia, describe the curriculum in full detail and/or show the underlying principles and pedagogic rationale. There are macro-level case studies that look at education from the perspective of an entire country and refer to developed or adapted recommendations or to research and development (R&D) projects in which the educational activities are embedded. For example, a case study from India focuses on building a standardized and competency-based eHealth curriculum and training for various allied health professionals to address an expected acute skill gap of 12.7 million in the healthcare sector by 2022.
1 Karsh, B.-T., Weinger, M. B., Abbott, P. A., & Wears, R. L. (2010). Health information technology: fallacies and sober realities. Journal of the American Medical Informatics Association, 17(6), 617-623. doi: 10.1136/jamia.2010.005637.
2Renfro, C. P., Ferreri, S., Barber, T. G., & Foley, S. (2018). Development of a Communication Strategy to Increase Interprofessional Collaboration in the Outpatient Setting. Pharmacy (Basel), 6(1). doi: 10.3390/pharmacy6010004.
3Baxter P, Jack S. Qualitative Case Study Methodology: StudyDesign and Implementation for Novice Researchers. The Qualitative Report 2008; 13(4). Available from: http://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1573&context=tqr.
4 Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011 Jun 27;11:100. doi: 10.1186/1471-2288-11-100.
5Tellis W. Application of a Case Study Methodology. The Qualitative Report 1997; 3(3). Available from: http://nsuworks.nova.edu/cgi/viewcontent.cgi?article=2015 &context=tqr.
6 J. Sensmeier, C. Anderson, T. Shaw, International Evolution of TIGER Informatics Competencies. Stud Health Technol Inform. 2017;232:69-76.
7 M.J. Ball, J.V. Douglas, P Hinton Walker, et.al., Nursing Informatics: Where Technology and Caring Meet. 4th Edition. Springer, London, 2011.
8 B. Gugerty, C.W. Delaney, TIGER Informatics Competencies Collaborative (TICC). Final Report. 2009. http://tigercompetencies.pbworks.com/f/TICC_Final.pdf.
9U.H. Hübner, M.J. Ball, H.F. Marin, et al. Towards Implementing a Global Competency-Based Nursing and Clinical Informatics Curriculum: Applying the TIGER Initiative. Stud Health Technol Inf 225 (2016), 762-4.