Development of a virtual patient as a chatbot to promote physicians' digital literacy in the context of digital health applications

Contact person: Carolin Gellner

Digitalisation in the healthcare system is supposed to promote the quality of care and the autonomy of patients but is proceeding rather slowly in Germany (Bratan et al., 2022). Reasons for this include scepticism among service providers and deficits in training medical staff in new technologies (ibid.). Digital health applications (german: Digitale Gesundheitsanwendung – short: DiGA), which the medical profession and psychotherapists can prescribe to people with health insurance in Germany since 2019, also meet a certain degree of scepticism among the medical profession (Bundesanzeiger Verlag, 2019; Bitkom, 2020). Current research suggests that most medical professionals do not want to prescribe DiGAs or that there is still uncertainty (Bitkom, 2020; Dahlhausen et al., 2021). Information deficits and technological uncertainties were primarily mentioned as obstacles (Dahlhausen et al., 2021). Accordingly, the need for good education and improvement of digital competencies in the health professions is a basis for dealing with digital applications in everyday medical life and increasing acceptance (Bratan et al., 2022; Kirsten et al., 2022; Dahlhausen et al., 2022). In addition, further research is needed on the factors influencing the prescription of digital health apps (Dahlhausen et al., 2022; Techniker Krankenkasse, 2022). Education on digital health apps and digital literacy promotion could be achieved by integrating suitable teaching content into the medical curriculum. So far, such learning content has hardly been included in medical training (Bratan et al., 2022; Neumann et al., 2021). A technological-methodological approach to this can be virtual patients. These learning technologies provide a multimedia opportunity to practice clinical, problem-solving and decision-making skills in real-world situations (Sahu et al., 2019). Although current research points to the potential of chatbots as a flexible and accessible way to improve medical students' skills, there is little research on implementing such chatbots (Kaur et al., 2021; Frangoudes et al., 2021).

The cumulative dissertation project aims at the prototypical development of a virtual patient as a chatbot to promote physicians' digital literacy on digital health applications in medical education. According to Design-Search-Research (DSR), with a mixed-methods approach, a design- and problem-oriented approach is planned (Hevner et al., 2004; Peffers et al., 2007). The project aims to address three research questions:

Q1: What are the requirements for an artificially-intelligent patient as a chatbot for prescription research and training on digital health applications?

Q1 aims to develop a concept that includes design options for a virtual patient chatbot for research on physicians’ intention to prescribe health apps and to train prescriptions on digital health apps with physicians, and a (first) prototype for the patient chatbot.

Q2: What factors influence physicians' prescribing intention for digital health apps?

F2 aims to develop a model on the influencing factors of physicians' prescribing intention for digital health apps identified in an online experiment with the chatbot.

Q3: What implications for promoting physicians' digital literacy in digital health apps can be derived for medical education?

Q3 aims to develop implications in the form of a (training) concept and the virtual artificially intelligent patient chatbot to promote digital literacy in medical education in the context of digital health applications.


References

Bitkom. (2021). Ärzteumfrage: Werden Sie künftig digitale Gesundheitsanwendungen (DiGA) verordnen bzw. haben Sie dies bereits getan? [Graph]. In Statista. Zugriff am 11. August 2022, von https://de.statista.com/statistik/daten/studie/1201096/umfrage/aerzteumfrage-in-deutschland-zur-verordnung-digitaler-gesundheitsanwendungen/

Bratan, Tanja et al. (2022): E-Health in Deutschland: Entwicklungsperspektiven und internationaler Vergleich, Studien zum deutschen Innovationssystem, No. 12-2022, Expertenkommission Forschung und Innovation (EFI), Berlin; https://www.econstor.eu/bitstream/10419/251366/1/1795368888.pdf

Bundesanzeiger Verlag. (2019). Gesetz für eine bessere Versorgung durch Digitalisierung und Innovation (Digitale-Versorgung-Gesetz - DVG). Bundesgesetzblatt, Teil I Nr. 49 (vom 09.12.2019). http://www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzeiger_BGBl&jumpTo=bgbl119s2562.pdf

Dahlhausen, F., Zinner, M., Bieske, L., Ehlers, J. P., Boehme, P., & Fehring, L. (2021). Physicians’ Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study. JMIR mHealth and uHealth, 9(11), e33012. https://doi.org/10.2196/33012

Dahlhausen, F., Zinner, M., Bieske, L., Ehlers, J. P., Boehme, P., & Fehring, L. (2022). There’s an app for that, but nobody’s using it: Insights on improving patient access and adherence to digital therapeutics in Germany. DIGITAL HEALTH. https://doi.org/10.1177/20552076221104672

Frangoudes, F., Hadjiaros, M., Schiza, E.C., Matsangidou, M., Tsivitanidou, O., Neokleous, K. (2021). An Overview of the Use of Chatbots in Medical and Healthcare Education. In: Zaphiris, P., Ioannou, A. (eds) Learning and Collaboration Technologies: Games and Virtual Environments for Learning. HCII 2021. Lecture Notes in Computer Science(), vol 12785. Springer, Cham. https://doi.org/10.1007/978-3-030-77943-6_11

Hevner, A.R., March, S.T., Park, J., & Ram, S. (2004). Design Science in Information Systems. MISQuarterly, 28(1), 75-105

Kaur, A., Singh, S., Chandan, J. S., Robbins, T., & Patel, V. (2021). Qualitative exploration of digital chatbot use in medical education: A pilot study. DIGITAL HEALTH. https://doi.org/10.1177/20552076211038151

Kirsten, N., Augustin, M. & Strömer, K. Digitale Gesundheitsanwendungen und Datenschutz. Hautarzt 73, 391–397 (2022). https://doi.org/10.1007/s00105-022-04980

Neumann, M., Fehring, L., Kinscher, K., Truebel, H., Dahlhausen, F., Ehlers, J. P., Mondritzki, T., & Boehme, P. (2021). Perspective of German medical faculties on digitization in the healthcare sector and its influence on the curriculum. GMS journal for medical education, 38(7), Doc124. https://doi.org/10.3205/zma001520

Peffers, K., Tuunanen, T., Rothenberger, M.A., & Chatterjee, S. (2007). A Design Science Research Methodology for Information Systems Research. Journal of Management Information Systems,24 (3), 45-77

Sahu, P. K., Chattu, V. K., Rewatkar, A., & Sakhamuri, S. (2019). Best practices to impart clinical skills during preclinical years of medical curriculum. Journal of education and health promotion, 8, 57. https://doi.org/10.4103/jehp.jehp_354_18

Techniker Krankenkasse. (2022). DiGA-Report 2022. https://www.tk.de/resource/blob/2125136/dd3d3dbafcfaef0984dcf8576b1d7713/tk-diga-report-2022-data.pdf

B*IMA | 10.05.2024