Care Transition Records and Their Transmission Process in Germany: Detailed Analysis and a Proposal for a Digital Solution (Preprint)

Abstract

In Germany, healthcare digitalization is critical for enhancing patient care and system efficiency, yet it faces challenges in innovation, regulatory compliance, data security, and equitable access. German legislation, influenced by EU regulations, mandates strict data handling, impacting the adoption of digital solutions. Internationally, a number of countries have developed digital healthcare projects, but Germany lags behind, partly due to its stringent data protection laws. Additionally, medical and nursing facilities are under considerable pressure because patient numbers are increasing and nursing staff is scarce. Digitalizing administrative care processes could help to save time that could be used for individual care and improve the overall satisfaction of care staff. One example is the digitalization of Care Transition Records (CTRs) and their transmission process. Currently, there are many problems associated with this process: the time-consuming nature of creating CTRs, lack of standard formats, legal regulations, and data protection concerns.

This paper analyses the Care Transition Record (CTR) and CTR transmission process in Germany as part of transition management and suggests improvements towards a seamless digital solution.

Several methods were used to assess the satisfaction of nursing staff in the context of patient data transfer in care facilities in Germany. These include the creation of an online questionnaire, conducting field observations and contextual inquiries, BPMN modeling, semantic and frequency analysis of existing CTRs, and a user story mapping.

An online questionnaire involving German nursing professionals (n=33) revealed significant delays in patient care due to manual, patient-transferred Care Transition Records (CTRs), with 70% of respondents advocating for digital transmission to improve efficiency. Observations (n=11) confirmed the high administrative burden, averaging 34 minutes per CTR within a hospital and 47 minutes in care facilities. A semantic analysis of CTRs (n=4) proved the need for standardization and attempted to manually map existing CTRs to the new CTR standard (CTR-MIO). This showed the overall complexity of the new standard. A frequency analysis showed which information in the CTRs is the most important. Based on the key findings, a new digital approach, encompassing a "CTR translator" and "CTR-MIO viewer/editor", was conceptualized to streamline the transfer process, offering solutions for both standardized and non-standardized CTRs.

The findings of this paper conclude that a future solution should simplify the overall CTR transmission process by minimizing manual transfers into in-house systems, standardizing the CTR, and providing a secure digital transfer. Doing so could positively impact the overall care process and patient experience. With our solutions, we attempt to support care staff in their daily activities and processes until nationwide state regulations are implemented successfully, but it is uncertain how long this will take.