title: Understanding latent structures of clinical information logistics: A bottom-up approach for model building and validating the workflow composite score.
abstract: Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score.
  
  
  
  Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice.
  
  
  
  We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were "flow of data and information", "mobility", "clinical decision support and patient safety", "electronic patient record" and "integration and distribution". The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach.
  
  
  
  Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness.
authors.affiliation: Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany. Electronic address: m.esdar@hs-osnabrueck.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Esdar
authors.affiliation: Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany. Electronic address: u.huebner@hs-osnabrueck.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Hübner
authors.affiliation: Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany. Electronic address: j.liebe@hs-osnabrueck.de.
authors.forename: Jan-David
authors.initials: JD
authors.lastname: Liebe
authors.affiliation: Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany. Electronic address: j.huesers@hs-osnabrueck.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Hüsers
authors.affiliation: Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany. Electronic address: johannes.thye@hs-osnabrueck.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Thye
mesh_terms: D057286:Electronic Health Records; D005163:Factor Analysis, Statistical; D008490:Medical Informatics / Q000458:organization & administration*; D008962:Models, Theoretical; D061214:Patient Safety; D057188:Workflow
keywords: clinical information logistics; clinical workflows; composite score; factor analysis; health information technology; model building