Detailed Analysis and Road Map Proposal for Care Transition Records and Their Transmission Process: Mixed Methods Study
Authors: Mess Elisabeth Veronica , Regner Matthias , Balic Sabahudin , Kleybolte Lukas , Daufratshofer Lisa , Mahler Andreas , Tilmes Sabrina , Werlitz Viktor , Reuter Claudia , Teynor Alexandra 
Published: November 2024

Background
The digitalization of health care in Germany holds great potential to improve patient care, resource management, and efficiency. However, strict data protection regulations, fragmented infrastructures, and resistance to change hinder progress. These challenges leave care institutions reliant on outdated paper-based workflows, particularly for patient data transmission, despite the pressing need for efficient tools to support health care professionals amid a nursing shortage and rising demand for care.

Objective
This paper aims to analyze Germany’s care transition record (CTR) and CTR transmission process as part of transition management and suggests improvements toward a seamless digital solution.

Methods
To understand the current challenges of manual CTR transfers, we used a mixed methods approach, which included a web-based questionnaire with nursing professionals, field observations, business process model and notation modeling, semantic and frequency analysis of CTR entries, and user story mapping.

Results
A web-based questionnaire involving German nursing professionals (N=59) revealed considerable delays in patient care due to manual, patient-transferred CTRs. Of the 33 usable responses (n=33), 70% (n=23) of the respondents advocating for digital transmission to improve efficiency. Observations (N=11) in care facilities (n=5, 45%) and a hospital (n=6, 55%) confirmed the high administrative burden, averaging 34.67 (SD 10.78) minutes per CTR within a hospital and 44.6 (SD 20.5) minutes in care facilities. A semantic analysis of various CTRs (N=4) highlighted their differences and complexity, stressing the need for standardization. Analyzing a new CTR standard (care information object CTR) and manually mapping an existing CTR to it showed that the procedure was ambiguous, and some associations remained unclear. A frequency analysis of CTR entities revealed which were most used. In addition, discussions with care staff pointed out candidates for the most relevant entities. On the basis of the key findings, a stepwise transition approach toward a road map proposal for a standardized, secure transfer of CTRs was conceptualized. This road map in the form of a user story map, encompassing a “CTR transformer” (mapping of traditional CTRs to a new standard) and “care information object CTR viewer/editor” (in short, CIO-CTR viewer and editor; a new standard for viewing, editing, and exporting), shows a possibility to bridge the transition time until all institutions fully support the new standard.

Conclusions
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. This 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, though the timeline for this remains uncertain.