Motivation: Digital decision support can individually promote health-relevant behavior if evidence-based factual knowledge is provided in the decision-making process. Preventive medicine approaches use appropriate patient education methods to promote long-term behavior change in at-risk populations [1]. However, opportunities to increase adherence should not be limited to patients. The Hospital Report 2014 reports that preventable adverse events occur in approximately 2-4% of German hospital cases, of which around 20,000 cases are fatal [2]. Advocates of evidence-based medicine are therefore discussing how medical decisions can be validated with the help of digitally available guidelines [3]. Possible approaches are presented and compared using two examples.

Adherence among healthcare professionals: Kaiserslautern University of Applied Sciences and the Westpfalzklinikum Kaiserslautern are cooperating in the development of digital support methods in the management of patients with multi-resistant pathogens. As part of the "OD-Pfalz" project funded by the federal-state funding initiative "Innovative University", a knowledge-based system for linking medical and nursing knowledge with the applicable hygiene guidelines of the RKI Commission for Hospital Hygiene and Infection Prevention KRINKO was prototypically implemented [4]. The adherence of staff to the guideline-compliant implementation of hygiene requirements in germ management is facilitated by automatically created reminder and to-do lists, which helps to reduce unstructured free text entries and double entries. Methods for data integration, filtering and personalization were developed for distributed, cross-sector and cross-system applications in order to provide case-specific and evidence-based support for both inpatient and outpatient staff along the entire supply chain. Case-specific personas and scenarios are used to simulate processes in germ management and to prepare an evaluation with the help of pilot studies.

Adherence in patients: The BMBF-funded consortium project DiDiER investigated approaches to "digitalization in nutritional advice." [5] In the case of food intolerances/allergies, handwritten symptom food diaries are used for diagnosis, which are very time-consuming to create and evaluate and often contain errors. In telemedical settings, the quality of the data records obtained at home is directly dependent on patient adherence. Together with the German Allergy and Asthma Association (DAAB e.V.), methods have been developed to use patient-side diary apps to create precise data sets that enable computer-aided evaluation [6]. Food product databases are searched using morphological analysis methods and text mining algorithms to make it easier to identify possible allergy triggers [7]. An evaluation study showed that close digital contact between dietitians and patients can contribute to increased adherence in the consultation process.

Conclusion. Digitalization must not be an end in itself. The establishment of digital methods to promote adherence in the healthcare sector requires target group-oriented analyses of the processes and concerns of all stakeholders involved. In order to establish digital procedures to increase adherence on the staff side, changes in responsibilities and workloads should be designed in such a way that a fundamental attitude of refusal is prevented. When collecting data from patients, it cannot be assumed that medical laypersons will always be able to generate therapeutically useful data sets. Assessing the usability and, where applicable, the clinical effectiveness of digital systems is an indispensable part of such a change process [8]. In the case of individual diagnostic or therapeutic consequences for patients, the requirements of the Medical Devices Act and the MDR (Medical Device Regulation) must be taken into account.

Literature list

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2 Klauber, J, Geraedts, M, Fridrich J, & Wasem J. (2014) Krankenhausreport 2014, Berlin, Stuttgart, Germany, Schattauer-Verlag

3 Haas, P. (2015) Knowledge management in medicine, Forum 2016 31:28-32, Berlin Heidelberg, Springer-Verlag DOI 10.1007/s12312-015-0012-6

4. www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Kommission/Tabelle_gesamt.html

5 Elfert, P, Eichelberg, M, Tröger, J, Britz, J, Alexandersson, J, Bieber, D, Bauer, J, Teichmann, S, Kuhn, L, Thielen, M, Sauer, J, Münzberg, A, Woizischke, J, Diekmann, R, Rösch, N & Hein, A. (2017) DiDiER - digitized services in dietary counselling for people with increased health risks related to malnutrition and food allergies, Computers and Communications (ISCC), Heraklion, Greece, pp. 100-104.doi: 10.1109/ISCC.2017.8024512

6 Rösch, N, Münzberg, A, Sauer, J, Arens-Volland, A, Lämmel, S, Teichmann, S, Eichelberg, M& Hein, A. (2019) Digitally supported diagnostics in food allergy by analyzing app-based diaries, European Academy of Allergy & Clinical Immunology (EAACI) Congress Lisbon

7 Münzberg, A, Sauer, J, Lämmel, S, Teichmann, S, Hein, A & Rösch, N. (2019) Optimization and merging of food product data and food composition databases for medical use, European Academy of Allergy & Clinical Immunology (EAACI) Congress Lisbon

8 Matricardi, PM, Dramburg, S, Alvarez-Perea A et.al. (2020) The role of mobile health technologies in allergy care: An EAACI position paper, Allergy. EAACI and John Wiley and Sons A/S. 2020; 75:259-272.