Evaluation der Digitalisierung der medizinischen Dokumentation in Sammelunterkünften für Geflüchtete in Deutschland: eine qualitative Studie

Background

Many refugees initially receive medical care in the medical outpatient clinics of initial reception centers as part of the statutory health service restrictions in Germany. The care on offer varies greatly depending on the center and the resources available. Reliable information on the health status or health needs of refugees in these contexts remains scarce. Against this backdrop, an electronic medical records (EMR) software (Refugee Care Manager [Ref.Care]) was developed at Heidelberg University Hospital with funding from the Federal Ministry of Health. The development began in 2016, and the software has since been implemented in over 40 reception facilities in three federal states. On the one hand, the software makes it possible to document medical treatments digitally in a standardized form and, on the other hand, to process the treatment data anonymously and based on indicators. Extensive research into the effects of EMRs has already been carried out. Health care provided for refugees in reception centers has rarely been included in this research. This study therefore examines 1) the contributions that EMRs can make to patient care from the perspective of the software users and 2) the potential for improvement with regard to both software and implementation strategy.

Methods

In 2018, semi-structured expert interviews were conducted with 30 service providers from outpatient clinics in reception facilities in Germany. The interview guide focused on the topics of satisfaction, acceptance, and usability of the newly introduced electronic medical records. The interviews were digitally recorded, pseudonymized, transcribed verbatim, and analyzed based on content-structuring content analysis according to Kuckartz. MAXQDA 20 was used to support the analysis.

Results

The introduction of the electronic medical records software was facilitated by personal contact with the practice teams during and after the training courses. The materials provided were rarely used afterwards. In everyday care provision, the possibility to adapt the software to the treatment context was seen as particularly positive. Technical difficulties and missing features, such as lack of interoperability with other software products, sometimes made it difficult to apply Ref.Care. From the respondents’ point of view, the software makes an important contribution to improving the quality of care and increasing efficiency in terms of documentation. The option to further use the data for research purposes was viewed positively as well, and adaptability to specific professional groups and user needs was identified as a potential area of improvement.

Conclusion

The early evaluation of the introduction of the software Ref.Care shows that the advantages and disadvantages of electronic medical records in the setting of care for refugees are very similar to those in routine care, and the problem of the lack of interoperability between different software products is also reflected here. To ensure acceptance and use of digital interventions, a participatory development process and an adapted implementation strategy would be beneficial.