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Introduction: Care transition records (German: Überleitungsbogen – ULB) are crucial for ensuring continuity of care when patients transition between healthcare institutions. A standardized, digital exchange of care data would be beneficial; however, the current transmission process in Germany remains fragmented, with paper-based workflows leading to delays, data loss, and inefficiencies [1], [2].

The German National Association of Statutory Health Insurers (Kassenärztliche Bundesvereinigung, KBV) is legally mandated to specify standardized data exchange formats for medical and care information, known as the medical information object (medizinisches Informationsobjekt, MIO) and care information objects (pflegerisches Informationsobjekt, PIO). The first PIO to be specified was the PIO-ULB; however, the adoption remains limited. The authors created and tested a reference implementation of this new standard in form of a web-based application to gain insights into its suitability, applicability, and potential challenges, and to support the adoption of this new format.

Methods: For the design and development, an agile process was combined with the principles of user-centered design (UCD) [3]. The resulting web application (PIO-ULB Editor) supports about two-thirds of the full PIO-ULB standard and enables the creation, modification, and export of CIO-CTRs. Five German institutions – comprising one university hospital and four long-term care facilities – tested the prototype. Eight professionals (registered nurses) executed five scenario-based tasks: (1) create a CTR, (2) export the XML file, (3) transmit it via the Telematics-Infrastructure KIM service or encrypted e-mail, (4) import the received file, and (5) integrate the data into the local electronic record. Task-completion time, success rate, error logs, and think-aloud comments were captured. User experience was measured using the short User Experience Questionnaire (UEQ-S) [4], and overall usability was assessed with the System Usability Scale (SUS) [5].

Results: N=16 observation sessions were analysed. Sites that completed the entire workflow (tasks 1-5) (n = 3) required a mean of 23.6 ± 12.6 minutes; the hospital was the fastest (15.8 ± 1.9 minutes), whereas long-term-care facilities averaged 27.5 ± 14.0 minutes. The UEQ-S pragmatic quality scored 1.78, the overall user experience 0.95, which exceeds the +0.8 positive threshold. SUS scores ranged from 35 to 77.5 (median = 71); higher values were observed in sites with prior experience using the standard. Participants appreciated auto-completion and the overall design of the PIO-ULB Editor.

Discussion: With the creation of the PIO-ULB Editor, it was possible to test the usability and feasibility of the PIO-ULB standard, but only with a limited number of participants. It is the first publicly available reference implementation, offering a basis for discussion and further improvement. Care professionals' feedback indicated that the Editor is useful; however, even after reducing the amount of information, the content is still overwhelming. This underscores the need for graduate training and suggests that a revision of the standard may be necessary.

The manual data transfer, after exporting the PIO-ULB, remains a bottleneck. Additionally, voluntary adoption is slowed by the absence of regulatory deadlines. The artefacts and insights reported (see https://www.pio-editor.de) can support the nationwide adoption of the standard by primary manufacturers of hospitals and care facilities.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.

References

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