The “PALLADiUM” research project was dedicated to the question of how to support multi-professional collaboration on a palliative care ward with the help of digitalisation. As a solution, the interdisciplinary research team, consisting of experts from the fields of medicine, sociology and business informatics, developed a mobile app designed to improve communication and collaboration.
At the end of the bidt-funded project, we spoke to Professor Henner Gimpel, Chair of Digital Management at the University of Hohenheim, Professor Christoph Ostgathe, Chair of Palliative Medicine and Head of the Department of Palliative Medicine at the University Hospital Erlangen and Professor Werner Schneider, Professor of Sociology at the University of Augsburg.
What was the focus of the research project?
Prof. Dr. Werner Schneider: The research project aimed to answer the following fundamental questions: How can digitalisation have a supportive effect in multi-professional working environments? What advantages and benefits can be recognised? What risks or even limitations need to be considered? Our initial consideration was that the field of palliative care, i.e. the care of people at the end of their lives by multi-professional teams, is particularly suitable, because: Unlike industrial manufacturing processes, for example, this is a form of care for people who are in an existential crisis with their loved ones and who are at the centre of the “work process” with their respective needs, requirements and wishes. In this sense, the exemplary view of a palliative care unit with the medical and nursing care provided there through to the psycho-social support of the patients by a highly specialised team seemed to us to be a meaningful field of research for questions relating to digitalisation.
Prof. Christoph Ostgathe: Palliative medicine is a form of medicine that focuses on maintaining and improving the quality of life of people with serious, generally incurable illnesses. It developed in the 1960s in parallel with intensive care medicine, in which a great deal of technical effort is devoted to preserving life. During this time, palliative medicine deliberately developed away from technology and digitalisation, as the focus was on the patient-treatment relationship and less on what was technically possible. Now that technologies have developed further, the consideration was: How can we integrate modern digitalisation approaches into the processes of working on a palliative care ward? What are the prerequisites for success?
The second part is that in medical teams, essential parts of the exchange of information often take place between door and door; the possibilities of digitalisation have so far been little used. The hospital information systems naturally contain all the data, but what happens in conversations between doctors and carers, for example, and the data in the hospital information system has not yet been brought together quickly and meaningfully.
What was your approach?
Prof. Dr. Henner Gimpel: We started by analysing where the problems in collaboration lay. Many things went fantastically well, but not everywhere. When the team members talk to each other in passing, this is good in the short term, but a lot of information is lost because the documentation in the patient file does not reflect the whole picture. We looked at these challenges in detail: At what points are there problems in the transfer of information, where is there a lack of certainty of action and what are the consequences?
Ostgathe: The approach of the project was that we have these different perspectives and professional groups in the field: doctors, carers, social workers, pastoral workers, physiotherapists, psychologists. And of course everyone looks at the patient from their own professional perspective. How can we collect their information, bring it together and make it directly available to the patient in such a way that together we can act in the best interests of the patient with a better quality of life, with a better feeling?
Gimpel: It is impossible to imagine many other areas of life and work without digital technology. It has been used relatively little in palliative care to date because many programmes are not really suitable for this. Hospital information systems are essentially designed for documentation and billing, but not for collaboration. Other programmes such as Microsoft Teams are designed for collaboration, but do not fit into the context of a hospital and a palliative care unit.
The question was therefore: How do we create a digital system for this context that supports collaboration between employees, taking into account important framework conditions such as data protection and confidentiality? We also did not want to thwart the deliberate focus on the holistic situation of people at the end of their lives. In other words, we didn’t want to hand patients a smartphone so that they could enter how they were feeling. Nor did we want the staff on the palliative care ward to always be standing in front of patients with their smartphones and not increase the sometimes excessive burden of ever more documentation.
Digitalisation should take place in the background and help people.
Prof. Dr. Henner Gimpel To the profile
Schneider: For us, the distinction between information and knowledge is closely linked to this. Our aim was not simply to feed this technical system with a wide variety of retrievable information, but to process it in such a way that it becomes transparent for the team members in terms of its genesis and context, as this is the only way to create action-relevant knowledge: Knowledge that provides a sound basis for interpretation (What is the case?) and for options for action (What is to be done?) and goes beyond a pure information and documentation system.
You then developed a mobile app as a solution. What functions does it have and how has it changed the work of the multi-professional teams?
Gimpel: We implemented a mobile app that supports the team in communication and collaboration, specifically tailored to palliative care needs. To do this, we spoke a lot with the team, accompanied them in their day-to-day work, observed them and considered what functions and support they needed. We moulded this into a software prototype, showed it to the team again and again in intermediate stages, discussed it and finally evaluated how the app specifically changes collaboration.
Ostgathe: At the moment, when I want to find out how a patient is feeling in the morning, I open her patient file and see a list with 250 pieces of information: I have 16 symptoms there and there’s a number in there for each shift. So I can’t see at a glance how the patient is feeling at the moment. And that’s the app’s approach: it visualises better which problem areas are increasing, e.g. through word clouds: I can see immediately that, for example, the pain has increased and other problems have decreased. I can visualise this immediately within eight seconds.
Schneider: So instead of just presenting a wealth of individual pieces of information in tabular form, they are presented in different formats. This creates a holistic picture that can be discussed immediately as a team. The aforementioned simple distinction between information and knowledge is by no means trivial in the working practice of multi-professional teams. In such teams, each profession has its own perspective on which information is important and how relevant it is for which options for action. This means that each professional perspective links the available information with certain meanings, which – in everyday working practice – must be negotiated as transparently as possible, communicated with each other and ultimately brought together in order to reach a decision regarding the further treatment process. The functional benefit of such an app lies precisely in the fact that it supports this process.
Gimpel: On the one hand, the app is an interface to the hospital information system. On the other hand, it adds additional functionalities, e.g. I can send a notification to someone else for an entry that I am currently making in the patient file. That way, they don’t come across it by chance when reading the entire patient file, but are notified directly. It is conceivable that manufacturers will integrate something like this into the hospital information system in the long term or offer it additionally. For modern, patient-centred collaboration, we need more IT functionalities than the hospital information systems currently provide.
What were the challenges that arose during the course of the project?
Ostgathe : One challenge was the human factor. We worked with two palliative care teams as an example. In these teams, there were those with an affinity for technology who were happy, thought along with us and saw potential benefits. At the same time, there was a group of about the same size who said, why do we need this? Another concern was that documentation time would increase instead of decrease.
Gimpel: Another challenge was the user experience. We wanted to create an interface and interaction that was as simple and clear as possible and that everyone could use. That took a few iterations. We were also very concerned with the issue of data protection: To make the system as authentic as possible, we wanted to work with real data in it, also to be able to use realistic patient cases for the evaluation. In the end, we managed to extract data from the University Hospital’s hospital information system under strict conditions and hand it over to us as an external project partner. For continuous operation, the app would have to be connected live to the hospital information system via programming and data interfaces. This is feasible in principle, but was not our focus in the research project.
Ostgathe: The anonymisation of patient data was very time-consuming. But it was also very important. Within the University Hospital Erlangen, employees naturally have clear rules and confidentiality obligations. But we also wanted to look at the data together with our colleagues from Augsburg, integrate it into the app and analyse it in evaluations. We then managed to do this by anonymising the data. This had a positive influence on the development and evaluation of the demonstrator.
Have employees’ attitudes changed over the course of the project?
Ostgathe: The project was very well received by our team because it was also self-reflective. It wasn’t just about developing an app, but also about thinking about how we communicate. And communication is an essential part of collaboration.
Gimpel: We were able to reduce the initial scepticism regarding the amount of documentation required to a certain extent when the team realised that we are extremely focused on what helps day-to-day work and that we are not interested in digitalisation for digitalisation’s sake, but that we have said that this is about people and good care.
Did you also use artificial intelligence?
Gimpel: It is important for the staff on the palliative care ward to get a picture of how the patients are doing. There are various ways of doing this: on the one hand, by assessing the patient’s current condition using quantified standard scales. On the other hand, we can use artificial intelligence, specifically large language models and software agents, to analyse and aggregate information from the free texts. Conversely, these free texts can be processed in the same large language models in order to obtain a profession-specific preparation of the patient file in order to save working time, but at the same time increase the transfer of information and the knowledge gained by reading this preparation.
Ostgathe: This even goes beyond unstructured data and symptoms. A hospital information system is a treasure trove. It contains everything – the X-ray images, the laboratory, the therapies, the interventions. It also contains the family structure. And we now know through modelling that we can, for example, read out from this data with AI with a high degree of accuracy whether someone has a need for palliative care without anyone saying that the patient has a need. Something like a traffic light would be desirable: green – the patient doesn’t need anything, orange – yes, could be, and red – it would be good if the palliative care team were involved. It would be wonderful if we could utilise systems like this and collect this treasure and then process it in a profession-specific way. Otherwise, this is all lost information.
What happens next? Are there already plans or follow-up projects?
Ostgathe: The pull which the project has developed has set a great deal in motion.
Gimpel: The app has demonstrated what is feasible and useful and has helped us to publicise it. However, it is only a research prototype and is no longer in use. That’s a shame, of course. However, we have already been in contact with manufacturers of hospital information systems and other companies. We are delighted when someone takes up our ideas and findings, develops such IT systems professionally and puts them into use. In the end, staff and patients will be better off. That is the goal.
Ostgathe: We are also of the opinion that it is scalable. This is not only important for palliative care, it could also be scaled for emergency medicine, the intensive care unit or other areas where the focus is naturally different. I am convinced of that.
Schneider: From a sociological perspective, the use of the functional demonstrator and the evaluation at the end was an interesting and important point, because it allowed us to see to some extent how the professional players actually deal with such an app in their professional practice. It has been shown that it is actually helpful for a multi-professional team to have a technical tool that goes beyond the purely informative service function.
Ostgathe : A lot has changed for us on the palliative care ward in Erlangen as a result of the project. Through self-reflection on our communication structures within the team and the exchange of information, we are now using the existing systems much more for our professional dialogue as long as we don’t yet have the app. We were lucky that we also changed our hospital information system at the same time. We were able to adapt it more closely to what we learnt in PALLADiUM. Now we use the data together and consider together what is important at any given time: what is the goal, what is the symptom burden, what is the burden on the patient? Now we use the system as a communication tool as far as possible.
From the perspective of the practitioners involved – to summarise the feedback from the evaluation – collaboration, communication and interaction in this team was supported by the app in two ways: Firstly, through the way in which it relates information to each other, and secondly, because it makes it easier and clearer to generate and share actionable knowledge within the team.
Prof. Dr. Werner Schneider To the profile
Gimpel: The exchange within the scientific community was also important to us. With the articles that we have already published or that are currently under review, we have brought colleagues from various disciplines to this interface topic. In business informatics, where I come from, nobody traditionally thinks about palliative care. Thanks to our publications and the conferences we go to, more people are now doing so. Conversely, we have also organised events in the palliative care community and brought people together and got them excited about digitalisation. I hope that we have been able to create momentum in the scientific community so that even more people jump on board with this topic and we make further progress.
Ostgathe : We have held events with PALLADiUM at international congresses, for example in a workshop at the EAPC World Congress on Palliative Care in Barcelona in 2024 – with the result that there will be a special issue on digitalisation and AI in palliative care in the main specialist journal. In October 2024, I was also able to take part in an event organised by the EU Commission on the “EU Cancer Mission”. There, I had the opportunity to present PALLADiUM and other projects in the field of technology under the heading “Innovations in Palliative Care”.
How important was interdisciplinarity for your project?
Gimpel: I believe that the interdisciplinary collaboration we had here was absolutely right. We needed medicine as a discipline, but also the whole team in Erlangen with all the other professions. Otherwise we would have had no chance of understanding what is really necessary in this context. We needed sociology to gain a good understanding of how people interact with each other. It is deeply sociological how these communication and collaboration processes work and the research methods used by sociologists were essential for understanding the work processes, the challenges and also for reflecting on possible solutions. It wouldn’t have worked without us from business informatics because we have theories and an eye for what modern IT systems should look like, because we were able to design them and develop and implement them as prototypes. This interaction was therefore extremely important. But as always in interdisciplinary collaboration, it is also challenging because we look at the same topic from different theories and methodologies.
The interdisciplinarity is super exciting because you first have to learn to understand the language of others. I found that extremely enriching. From my perspective, that’s what makes research the most fun. That’s when it gets really exciting and new things emerge.
Prof. Dr. med. Christoph Ostgathe To the profile
What was the significance of the bidt and the funding?
Ostgathe: Ideas alone are not enough, you also need financial support. What has certainly helped the project – and the bidt is exemplary in this respect – is the fact that you are always tied back. It is not just funded and then there is an interim and a final report – in the sprint reviews you keep reporting and also hear what the other projects are doing. This has also resulted in cooperation or exchange at various points, which of course also enriches your own project – and perhaps leads to new applications in the future. The social dimensions of the topics seem to be important to the bidt. For us as “Palliative”, this project was a real catalyst.
Gimpel: It also takes a lot of time to work together, especially in the interdisciplinary field, to really get to grips with the content and to be able to create added value. And we were able to make this much time for collaboration possible with the funds provided by the bidt.
What role did networking and collaboration play, particularly between the Bavarian universities?
Gimpel : It was simply enriching: I got to know some colleagues at other Bavarian universities. And that is also very important for networking among researchers beyond the project results.
Ostgathe: I am sure that we will continue to draw on this pool of contacts made at bidt in the future.
Thank you very much for the interview!
The interview was conducted by Vivien Lingelbach
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