Mixed Reality Head-Mounted Displays in Healthcare - A Design Science Perspective on Requirements, Applications, and Economic Impact in Chronic Wound Management and Dentistry

Mixed Reality Head-Mounted Displays in Healthcare A Design Science Perspective on Requirements, Applications, and Economic Impact in Chronic Wound Management and Dentistry Inauguraldissertation zur Erlangung des akademischen Grades eines Doktors der Wirtschaftswissenschaften des Fachbereichs Wirtschaftswissenschaften der Universität Osnabrück vorgelegt von Sarah-Sabrina Kortekamp, M.Sc. Osnabrück, Oktober 2025 Dekan Prof. Dr. Robert Gillenkirch Referenten Prof. Dr. Frank Teuteberg Prof. Dr. Ingmar Ickerott Datum der Disputation: 28.10.2025 Preface This dissertation was written as part of the project Dorfgemeinschaft 2.0 funded by the Federal Ministry of Education and Research. The work was initiated while I was working as a research assistant at Osnabrück University of Applied Sciences, Faculty of Management, Culture and Technology. I greatly appreciate all those who have accompanied, supported, and encouraged me throughout my journey to this dissertation. In particular, I would like to thank Professor Frank Teuteberg for his dedicated supervision of the dissertation, his support in finding the topic and the methodological orientation of the contributions, and for his helpful and constructive feedback throughout the entire process of writing the dissertation—including on very short notice before deadlines, which was always greatly appreciated. Special thanks go to Professor Ingmar Ickerott for his decisive role in initiating the doctorate and his project-related support throughout the doctoral period. My sincere thanks go to my family and friends, who accompanied me along the way. I am especially grateful to my mum for her continuous support in all phases of the doctorate and for always being available as my discussion partner on various topics related to my work. I would also like to thank her for her sustained interest in my progress, even if her enthusiasm for inquiring about it occasionally exceeded my own. I am deeply thankful to my husband for his constant support. His motivating perseverance contributed significantly to the completion of this dissertation. Georgsmarienhütte, Juni 2025 Sarah-Sabrina Kortekamp Notes on the Structure of the Document This dissertation is divided into two parts: an introductory overview and the research contributions. Section 1 of the introductory overview presents the current state of the art regarding the adoption of new technologies in the healthcare system. Section 2 outlines the motivation for this dissertation, which forms the basis for the objective and the research questions (RQs) presented in Section 3. Section 4 describes the research design used to address the research questions. It also summarises the selected contributions and outlines the methodology applied. Section 5 summarises the key findings of the contributions to highlight opportunities and barriers for adopting mixed reality head-mounted displays in a healthcare context. In addition, it presents a framework for developing such systems. The discussion in Section 6 provides implications for research and practice, identifies future research opportunities, and addresses limitations. The second part complements the introductory overview by presenting a summary of the selected research contributions, including key bibliographic information and abstracts. Contents 1 Introductory Overview 9 1.1 StateoftheArt................................. 9 1.2 Motivation ................................... 10 1.3 Objective & Research Questions . . . . . . . . . . . . . . . . . . . . . . . 11 1.4 ResearchDesign ................................ 12 1.4.1 Summary of the Research Contributions . . . . . . . . . . . . . . . 12 1.4.2 Spectrum of Methods . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.5 Summary of Contributions and Essential Findings . . . . . . . . . . . . . 19 1.5.1 Applications of Mixed Reality Head-Mounted Displays in Healthcare 19 1.5.2 Transformative Opportunities in Healthcare . . . . . . . . . . . . . 21 1.5.3 Barriers to Effective Implementation . . . . . . . . . . . . . . . . . 23 1.5.4 Structured System & Interaction Framework for Developing Mixed Reality Head-Mounted Displays . . . . . . . . . . . . . . . . . . . . 25 1.5.5 Cost-Efficiency and Economic Impact of Mixed Reality Head-Mounted DisplaysinHealthcare......................... 29 1.6 Discussion.................................... 30 1.6.1 Implications for Research . . . . . . . . . . . . . . . . . . . . . . . 31 1.6.2 Implications for Practice . . . . . . . . . . . . . . . . . . . . . . . . 32 1.6.3 Limitations ............................... 34 1.7 Conclusion ................................... 35 2 Research Contributions 42 2.1 Contribution 1: IT-supported Hospital Discharge Management—Findings of a Multi-Method Research Design . . . . . . . . . . . . . . . . . . . . . . 43 2.2 Contribution 2: The Future of Digital Work—Use Cases for Augmented RealityGlasses ................................. 58 2.3 Contribution 3: Design Recommendations for Augmented Reality Applications—A Case Study in Healthcare . . . . . . . . . . . . . . . . . . . . . 65 2.4 Contribution 4: Technology-Supported Dental Home Visits by Non-Medical Personnel to Reduce Infection Risk . . . . . . . . . . . . . . . . . . . . . . 68 2.5 Contribution 5: Cost-Benefit Analysis for Using Mixed Reality in Dentistry—Keeping the Dentist in the Picture . . . . . . . . . . . . . . . . . . 80 List of Figures 1.1 Augmented reality, assisted reality, mixed reality and virtual reality according to Dwivedi et al. (2021) . . . . . . . . . . . . . . . . . . . . . . . . 10 1.2 Categorisation of the individual contributions according to the design science approach (Hevner et al., 2004) . . . . . . . . . . . . . . . . . . . . . . 15 1.3 Frequency of ISIC divisions associated with mixed reality head-mounted display application scenarios (Kortekamp, Werning, et al., 2019) . . . . . 19 1.4 Frequency of identified use cases for mixed reality head-mounted displays (Kortekamp, Werning, et al., 2019) . . . . . . . . . . . . . . . . . . . . . . 20 1.5 Layers of the Structured System & Interaction Framework (own illustration) 26 List of Tables 1.1 Interconnection of research questions and findings . . . . . . . . . . . . . . 12 1.2 Overview of contributions included in this dissertation . . . . . . . . . . . 14 1.3 Overview of methods used in this dissertation . . . . . . . . . . . . . . . . 17 List of Abbreviations 3D Three-Dimensional AR Augmented Reality BPMN Business Process Model and Notation CBA Cost-Benefit Analysis DSR Design Science Research ECIS European Conference on Information Systems FHIR Fast Healthcare Interoperability Resources HDM Hospital Discharge Management HMD Head-Mounted Display ISIC International Standard Industrial Classification IT Information Technology LNI Lecture Notes in Informatics MR Mixed Reality RQ Research Question VoFI Visualisation of Financial Implications VR Virtual Reality WI Wirtschaftsinformation (EN: Business Informatics) WKWI Wissenschaftliche Kommission Wirtschaftsinformatik im Verband der Hochschullehrer für Betriebswirtschaft e.V. 1 Introductory Overview 1.1 State of the Art Modern healthcare systems face increasing challenges, partly due to outdated structures and political negligence. Porter and Guth (2012) report a shortage of skilled workers, gaps in healthcare provision, especially in rural regions, increasing costs, and fluctuating care quality. Inconsistent technology standards and proprietary interfaces lead to media discontinuities. Intersectoral data sharing, in particular, still relies on paper-based data transfer, thereby increasing the likelihood of errors and information loss, and further exacerbating the already high workload of healthcare professionals (Mille & Stier, 2014; Wong & Hogan, 2016). Currently, several efforts aim to address these challenges, particularly through the use of technology. In Germany, several laws were established that empower the use of modern technologies to bring healthcare to people, including the use of telemedicine (Bundesministerium für Gesundheit, 2019), and apps that support patients (Bundesministerium für Gesundheit, 2020b), people in need of long-term care, or caregiving relatives (Bundesministerium für Gesundheit, 2023). To improve data transfer and availability, the electronic health record (Bundesministerium für Gesundheit, 2020a)—a patientmanaged online repository for health-related data—was introduced. By supporting the international Fast Healthcare Interoperability Resources (FHIR) standard (HL7 International, 2024), authorised healthcare professionals and the patients themselves can place and synchronise relevant health documents in this central space. Despite these efforts, the previously mentioned technologies are only slowly gaining momentum (Schmitt, 2024). The parameters influencing technology adoption are manifold, as is the degree of technologisation within the healthcare system. While some medical interventions are supported by ultra-modern technological achievements, such as the da Vinci Surgical System (Grade et al., 2019), other processes remain paper-based or rely on outdated technologies, such as fax systems, for the communication of patient data (Kortekamp, Süßmuth, et al., 2019). Dental practices often have a comparatively high degree of digitisation (Mühlemann et al., 2019). Technology is employed in various areas, including patient management, imaging, and the fabrication of ceramic restorations. One important factor influencing technology adoption is the perceived advantage, such as financial benefits or improved treatment quality (Bhambhani et al., 2013). In this dissertation, mixed reality (MR) is defined according to Dwivedi et al. (2021). To reflect the growing number of possible combinations between physical and virtual 1.4 Research Design Introductory Overview to previously specified problems within the healthcare system by providing guidelines, requirements, and usage scenarios for tailored software that can support healthcare professionals. The overall objective is to research how technology, particularly MR HMDs, can help address modern problems of healthcare professionals. The objectives of individual contributions vary depending on the focus, including the development of design guidelines for MR HMD software (Kortekamp et al., 2020) or a cost-benefit analysis for MR HMDs in dental practices (Kortekamp et al., 2024). Each contribution presents different artefacts that contribute to the overall goal of the work, which is to identify factors influencing the adoption and use of MR HMDs in the healthcare sector. To address the topic of design and development, systematic research methods like literature search, expert interviews and group discussions were used to develop specific usage scenarios and design principles (Kortekamp et al., 2020, 2021). Furthermore, a complex cost-benefit framework was developed to evaluate the financial value of MR HMDs in dental practices (Kortekamp et al., 2024). For demonstration and evaluation purposes, theoretical demonstrations and implementation concepts illustrated the artefacts’ functionality. For example, the design principles for MR HMD applications were presented based on a concept for an application that could support chronic wound management professionals. The cost-benefit framework was evaluated during expert interviews, based on an exemplary use-case scenario. These theoretical approaches helped to assess the usability and economic viability of the developed artefacts. The final step, communication, was accomplished by presenting the research findings at various international conferences, including the European Conference on Information Systems, and publishing them in journals to make them available for the scientific community and practitioners. The overall methodological approach follows a mixed-methods design (Venkatesh et al., 2013), combining qualitative and quantitative elements to provide a comprehensive understanding of the research problem. Given the novelty of the topic of MR HMDs, particularly in the healthcare sector, qualitative methods were the predominant approach. On the one hand, the lack of data became apparent during the literature searches, which, despite using broad search terms, yielded only a limited number of relevant results. Additionally, when attempting to collect practice data, only a few professionals with experience in using MR HMDs in a medical context could be found, making it impossible to conduct quantitative surveys. However, quantitative methods were applied where appropriate, for example, in the cost-benefit analysis. Table 1.3, together with the following paragraphs, provides an overview of the methods used. Interviews are a qualitative research method that helps to gain deeper insights into the interviewees’ subjective opinions, experiences, and perspectives. One of their benefits is that they allow for the exploration of specific questions while still allowing for responses to unforeseen aspects. Interviews are suitable for understanding complex processes that depend on the interviewees’ individual experiences (Gläser & Laudel, 2010). In this dis16 1.4 Research Design Introductory Overview Research Method Contribution Reference 12345 Qualitative Methods Interviews Gläser and Laudel, 2010 Group Discussion Flick, 2009 Shadowing McDonald, 2005 Literature Review Vom Brocke et al., 2015; Webster and Watson, 2002 Qualitative Content Analysis Mayring, 2014 Quantitative Methods Cost-Benefit Analysis Grob, 1989; Heister, 1962; Sassone and Schaffer, 1978 Monte-Carlo Simulation Savvides, 1994 Table 1.3: Overview of methods used in this dissertation sertation, interviews were employed to gain a deep understanding of the daily challenges faced by healthcare professionals (Kortekamp, Süßmuth, et al., 2019) and to validate the findings used to calculate the VoFI tables (Kortekamp et al., 2024). Group discussions are a qualitative research method especially suited to gather collective opinions, attitudes and perceptions on a predefined topic. According to Flick (2009), the participants’ interactions during group discussions allow researchers to discover new perspectives and illuminate the topic in-depth. The character of the discussions promotes open exchange, allowing researchers to analyse not only individual opinions but also group dynamic processes and collective views. The method is especially suited for including different interest groups. This dissertation employed group discussions to develop a concept for an MR-based user interface (Kortekamp et al., 2020) and to identify potential use cases and challenges for using MR HMDs in dental practices (Kortekamp et al., 2021). Shadowing is a qualitative research method where the researcher observes a person in their natural work environment. The goal is to follow the person’s activities and interactions to gain a deeper understanding of their tasks, processes and challenges. Shadowing is especially useful for analysing work and decision processes in a real-world context, as it allows the researcher to observe not only the person’s actions but also the situational context and interactions with other actors (McDonald, 2005). In contrast to interviews or questionnaires, shadowing provides direct and detailed insights into prac17 1.4 Research Design Introductory Overview tice, eliminating the need for retrospective or subjective reports from participants. In this dissertation, shadowing was used to gain an understanding of the daily challenges and processes faced by discharge management employees. This method uncovered valuable insights such as critical processes and media disruptions in interand intrasectoral information flows (Kortekamp, Süßmuth, et al., 2019). Literature review is a systematic method that helps to identify, analyse and aggregate existing knowledge within a specified research topic. Using a structured approach, literature reviews can help to identify research gaps and put research into context. Systematically selecting and analysing scientific publications from relevant databases ensures holistic and resilient findings (Vom Brocke et al., 2015; Webster & Watson, 2002). In this work, literature reviews were employed to provide an overview of the current state of the art regarding the use of MR HMDs in healthcare environments. For example, a literature search of over 650 publications from relevant databases, such as EBSCOhost, provided insights into the current use of MR HMDs across different trades and use cases, and allowed for the derivation of guidelines for decision-makers and tasks for researchers (Kortekamp, Werning, et al., 2019). Qualitative content analysis is a structured method for systematically deriving categories from large amounts of data, such as interview transcripts or literature. Mayring (2014) distinguishes between an inductive and deductive approach depending on whether the categories are developed based on the material (inductive) or based on existing theory (deductive). The goal is to extract relevant data and structure it in a clear and comprehensible manner, allowing well-founded insights to be derived. In this dissertation, qualitative content analysis is used to analyse data from expert interviews and literature search. For instance, to gain a holistic picture of the users’ needs, the requirements analysis for MR HMD software used in dental applications employs interview transcripts and relevant literature to deduce key requirements and summarise them into superordinate categories. Cost-benefit analysis is a quantitative method that systematically assesses a project’s economic advantages and disadvantages. Cost-benefit analysis (CBA) is suitable for evaluating monetary and non-monetary costs to provide a well-founded basis for investment decisions (Grob, 1989). Heister (1962) developed the method further to make it suitable for complex projects with multiple variables and uncertainties. The method offers a detailed structure for identifying, evaluating and prioritising costs and benefits throughout an investment’s life cycle. This dissertation employs a CBA to evaluate the economic viability of using MR HMDs in dental practices. To validate the findings, VoFI tables and Monte-Carlo simulations were used to analyse possible risks regarding future investments (Kortekamp et al., 2024). 18 1.5 Summary of Contributions and Essential Findings Introductory Overview 1.5 Summary of Contributions and Essential Findings In the following section, the findings from the various contributions are thematically grouped to address the three overarching research questions (see Section 1.3). How MR HMDs can be applied in the business sector, particularly in healthcare (RQ1) is answered in Sections 1.5.1 and 1.5.2. The results of Sections 1.5.3 and 1.5.4 contribute to requirements and design principles that should be considered for the use of MR HMDs (RQ2), with Section 1.5.3 highlighting possible barriers and Section 1.5.4 presenting derived recommendations and principles. Section 1.5.5 provides insights into the costefficiency of MR HMDs (RQ3). Section 1.4 offers a detailed overview of the research methods employed; therefore, this section will focus on the findings. 1.5.1 Applications of Mixed Reality Head-Mounted Displays in Healthcare To better understand the technological and economic context of the presented application scenarios for MR HMDs in healthcare, the International Standard Industrial Classification of All Economic Activities (ISIC) (United Nations. Statistical Division, 2008) is used as a framework. ISIC defines 21 sections, further divided into 78 divisions. Kortekamp, Werning, et al. (2019) identified nine sections and 26 divisions associated with MR HMD application scenarios. Figure 1.3 presents an overview of the relevant divisions and the frequency with which the trade divisions are named in the literature. Among these, the category Human health and social work activities stands out, with a frequency of over 25%, marking it as the most frequently cited area. Figure 1.3: Frequency of ISIC divisions associated with mixed reality head-mounted display application scenarios (Kortekamp, Werning, et al., 2019) 19 1.5 Summary of Contributions and Essential Findings Introductory Overview Figure 1.4: Frequency of identified use cases for mixed reality head-mounted displays (Kortekamp, Werning, et al., 2019) Within these trade divisions, Kortekamp, Werning, et al. (2019) identified seven application scenarios as shown in Figure 1.4. In the context of healthcare applications, three primary scenarios are particularly relevant: data access & visualisation,training & education, and collaboration & communication. Accordingly, this section will focus on those scenarios. Within the Data Access and Visualisation application scenario, MR HMDs are employed across various medical use cases, including chronic wound management, dental home visits by non-medical staff, and the visualisation of procedural steps in dental preparation, planning, and surgery. In the context of chronic wound management, MR HMDs can be used effectively during wound assessment (Kortekamp et al., 2020). A key advantage is their hands-free usage, so that documentation and treatment can be performed simultaneously without the need for re-sterilisation in between. This facilitates more detailed and precise documentation, which is crucial for treatment success (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege, 2015). Patients benefit from faster wound healing, while cost-bearers benefit from reduced treatment costs. Especially when combined with smart features, such as context-sensitive suggestions for appropriate wound materials, costs can be significantly reduced, as currently only 30% to 40% of chronic wound care materials are being used effectively (Mader, 2016). MR HMDs could also relieve dentists by enabling allied dental personnel to perform various dental tasks. Kortekamp et al. (2021) report five possible use cases that could be performed during home visits by allied dental personnel based on their training and expertise if equipped with an MR HMD. The use cases range from video documentation of the oral cavity performed by medical or nursing staff to dental prophylaxis performed 20 1.5 Summary of Contributions and Essential Findings Introductory Overview by a dental hygienist. The MR HMD can support the dental personnel by providing information about the patient, guiding them through procedures and documenting the treatment outcome. If necessary, the dentist or other experts can be consulted via a video call, allowing them to observe the patient’s situation directly through the MR HMD’s camera feed. Another use case in the Data Access and Visualisation application scenario involves the utilisation of MR HMDs during preparation, planning and surgery. Using the patient’s 3D data, anatomical structures can be viewed and analysed in 3D during preoperative planning (Kortekamp et al., 2024). During surgery, the 3D imaging data can be overlaid onto the patient and enhanced with additional information, such as the correct drill positioning and critical anatomic structures (Song et al., 2018). In implantology, the preoperatively planned placement can be compared with the current implant position in real-time (Pellegrino et al., 2019; Yotpibulwong et al., 2022). The training and education application scenario entails use cases applicable to all stages of dental education, from student to specialist training. Using the 3D visualisation capabilities of MR HMDs for studying dental anatomy by providing supplementary 3D visual material activates higher-order cognitive skills and, thus, can enhance the learning experience significantly (Espejo-Trung et al., 2015). Additionally, using MR HMDs can help simulate complex procedures. Specialised simulators combine MR HMDs with monitors and haptic devices to simulate a wide range of dental problems without consuming natural materials, allowing students to get accustomed to the correct posture and develop necessary fine motor skills (Li et al., 2022). Collaboration and communication is another application scenario for MR HMDs. The collaborative features enable interdisciplinary cooperation by providing the tools for experts from different specialities to view the same 3D data and jointly consult on the optimal surgical procedure (Bartella et al., 2021). Additionally, the use of this technology can enhance student-instructor interactions in clinical training environments. For example, instructors can provide immediate guidance while observing procedures from the student’s perspective during practical training sessions, which leads to more effective supervision (Mårell-Olsson & Jahnke, 2019). 1.5.2 Transformative Opportunities in Healthcare The above-mentioned usage scenarios and capabilities of MR HMDs have the potential to provide several benefits when using them in healthcare settings. Optimised operational workflows. Using an MR HMD can improve operational efficiency and effectiveness (Kortekamp, Süßmuth, et al., 2019; Kortekamp et al., 2024) by helping streamline workflows, reducing treatment time and the need for supportive staff (Kortekamp et al., 2024). Telecommunication and documentation features could improve overall time management in dental practices by allowing allied dental personnel to take over defined tasks, thereby reducing the doctor’s workload (Kortekamp et al., 2021). 21 1.5 Summary of Contributions and Essential Findings Introductory Overview Medical process enhancement. MR HMDs can help during different stages of medical workflows. Starting with pre-operational planning, the 3D visualisation of patient data can lead to a better spatial understanding of anatomical structures, and thus to more precise procedures (Bartella et al., 2021). Using the telecommunication feature in this context can also improve interdisciplinary cooperation, helping in complex cases where different medical disciplines need to collaborate for successful surgery (Bartella et al., 2021). During surgery, project information such as context-based data, visual cues and 3D anatomical structures can be projected directly onto the patient or into the surgeon’s view, helping with navigation and keeping their focus on the patient (Armstrong et al., 2016; Song et al., 2018). However, MR HMDs can also be helpful in other healthcare settings, such as patient care, by providing real-time data and instructions to the wearer (Kortekamp et al., 2020). For example, relevant patient information and guidelines can be directly displayed within the wearer’s field of view, eliminating the need to shift attention between documentation on paper or another screen, thereby keeping the focus on the patient (Klinker et al., 2020). This can also be used for step-by-step instructions and to support less experienced staff while performing complex or new tasks (Kortekamp et al., 2021). Efficient data handling in sterile environments. A significant advantage is the handsfree usage of MR HMDs (Klinker et al., 2020; Kortekamp, Werning, et al., 2019; Kortekamp et al., 2020, 2021; Mewes et al., 2017). Especially in sterile environments, as this feature enables the wearer to access, visualise and edit data without the risk of contamination during medical treatments (Kortekamp, Werning, et al., 2019; Kortekamp et al., 2020, 2021). For example, in the case of chronic wound care treatment, this can lead to improved outcomes for patients and healthcare providers alike, as continuous and detailed documentation is an important factor for the wound healing progress when treating chronic wounds (Kortekamp et al., 2020; Panfil et al., 2015). Enhanced data availability is also beneficial for other areas in healthcare, as data disruption remains an essential topic, especially when considering data disruption in combination with intersectoral patient transfers (Kortekamp, Süßmuth, et al., 2019). Real-time collaboration. MR HMDs technology provides video calls and virtual meetings, enabling diverse applications for cooperation and collaboration. During those meetings, the patient’s 3D data can be viewed by all participants so that it can be used for intersectoral tumour boards or preoperative planning sessions of complex cases (Kortekamp et al., 2024; Tepper et al., 2017). When encountering issues during medical treatment, MR HMDs can also facilitate cooperation with distant experts who can be consulted via a video call. The advantage is that the expert can view the situation from the wearer’s perspective, thereby gaining a better understanding of the situation and the patient’s condition (Kortekamp et al., 2020, 2021). Apart from potentially better patient outcomes, this also has advantages in terms of reduced travel costs and time (Kortekamp et al., 2024). 22 1.5 Summary of Contributions and Essential Findings Introductory Overview Medical education and training. Practical experience plays an important role in medical education and training. MR HMDs can enhance on-the-job training by providing context-sensitive information or remote support from experts (Kortekamp, Werning, et al., 2019). The improved spatial understanding and simulation capabilities of specialised training gear can enhance students’ practical skills without requiring physical resources, such as real teeth, for studying tooth morphology (Mahrous et al., 2021; Mladenovic, 2020). Using the 3D presentation capabilities, students can improve their knowledge of anatomic structures (Espejo-Trung et al., 2015), learn complex procedures and—when combined with specialised gear like the Unidental Mixed Reality Simulator—acquire the necessary fine motor skills and correct posture needed for their work as a dentist (Li et al., 2022). Customised visual augmentation. Another use case, apart from medical care, is the use of MR HMDs by visually impaired individuals. Since MR HMDs are see-through and enhance reality with visual information, they can be used to assist the wearer in their daily lives and also help them with navigation (Sandnes & Eika, 2017). It is also possible to highlight important objects or improve the environment’s visual contrasts to accommodate their wearer’s needs (Ehrlich et al., 2017). 1.5.3 Barriers to Effective Implementation The following subsection presents potential obstacles and challenges, including technological limitations, acceptance from medical professionals and questions regarding data security. Integration and interoperability challenges. The integration of new information technology (IT) systems into existing healthcare IT ecosystems is often challenging, as many manufacturers of healthcare IT solutions stick to their proprietary standards. Providing the necessary interfaces may require high expenditures for either development or licensing costs. However, to use MR HMDs effectively, data exchange and compatibility are crucial (Kortekamp, Werning, et al., 2019). Even more complex is the topic of intersectoral communication (Kortekamp, Süßmuth, et al., 2019), i.e., sharing data between inpatient and outpatient facilities, as this involves not only technical specifications but also procedural hurdles, especially adherence to privacy laws (Kortekamp, Süßmuth, et al., 2019). Administrative and operational overheads. Apart from technical and regulatory difficulties, introducing a new IT system such as an MR HMD will also come with significant administrative overheads during the implementation phase (Kortekamp, Süßmuth, et al., 2019; Kortekamp et al., 2024). Before it can be used efficiently, processes might need reworking, and the staff needs adequate training. During the familiarisation and training phase, the workload and costs might be higher than before, until the new processes work smoothly and the benefits take effect (Kortekamp et al., 2024). Especially in the medical 23 1.5 Summary of Contributions and Essential Findings Introductory Overview field, this can be a hurdle, as the workload is already high and the negative aspects of the implementation phase are more tangible than the long-term benefits (Kortekamp et al., 2024). Regulatory and data security challenges. The use of new technology is often confronted with different legal questions. Especially on mobile devices, concerns regarding the security of vulnerable patient data arise (Carenzo et al., 2015; Kanevsky et al., 2019; Sparwasser et al., 2018). Therefore, rigorous security measures need to be implemented, including those that comply with applicable regulatory requirements (Kortekamp et al., 2024). However, these measures in combination with robust security protocols can increase the technical and financial burdens (Kortekamp, Süßmuth, et al., 2019), contributing further to the discouraging effect. In combination with requirements from existing data privacy regulations, such as the GDPR (European Parliament and Council, 2016), realising efficient and accessible information, especially across institutional boundaries, is often challenged by patient data protection requirements (Kortekamp, Süßmuth, et al., 2019). Technical limitations. Technology is advancing rapidly, but for the current models, some technical limitations for healthcare use cases were reported. Current models have performance limitations regarding their limited storage capacity and processing power (Galati et al., 2020; Talaat et al., 2019). The mobile processor capabilities constrain the efficient use of complex applications (Galati et al., 2020; Sparwasser et al., 2018). Additionally, the battery life was found to be unsatisfactory, limiting continuous usage during prolonged procedures (Galati et al., 2020; Martin et al., 2020; Sparwasser et al., 2018). In addition, many mobile MR HMD applications rely heavily on network connections, so that network stability and bandwidth issues can significantly disrupt usage (Martin et al., 2020). The above limitations can be partly circumvented by using MR HMDs that are not stand-alone but are powered by a desktop computer. However, here, the required cable connections and the mobility loss were deemed impractical (Moosburner et al., 2019; Sparwasser et al., 2018). User experience and interaction. Using MR HMDs in a professional context also means that the system is used daily for more extended periods. This makes comfort an important factor (Krichenbauer et al., 2014). While the first Microsoft HoloLens had a front-heavy design that negatively impacted the user posture during prolonged use (Galati et al., 2020), the newer model shifted central components like the computing unit and battery to the back of the headset, resulting in a more balanced composition and an enhanced wearing comfort even during longer usage periods (Pose-Díez-de-la-Lastra et al., 2022). As one of the most critical capabilities, the visualisation of 3D data and objects contributes essentially to the overall user experience. MR HMDs often suffer from a limited 24 1.5 Summary of Contributions and Essential Findings Introductory Overview visual field that is smaller than the natural human field of view. This can lead to orientation issues, especially if virtual data or information lies outside the HMDs’ visual field (Moosburner et al., 2019; Pellegrino et al., 2019). Although helpful for certain tasks, the virtual overlays can also have a negative impact during surgery, as the response to unforeseen events might be slower (Kanevsky et al., 2019). Due to the versatile usage possibilities, the content design for MR HMDs faces some challenges. The devices are used in heterogeneous usage conditions with different lighting and real-life situations (Kortekamp et al., 2020). This means that information must be displayed in a manner that text and visual content remain clear and legible across environments (Emmerich et al., 2017). This also leads to a mix of virtual and real environments (Klose et al., 2019) so that possible dangers might be overseen (de Belen & Bednarz, 2019; Klose et al., 2019). As a result of the aforementioned challenges, the usability of such devices is simultaneously critical and challenging. Addressing issues such as comfort and user interface design is crucial for broader acceptance in healthcare settings (Berkemeier et al., 2017). Issues named include the calibration process for optical settings being cumbersome, especially in shared-use scenarios (Moosburner et al., 2019), and frustrating errors in voice and gesture recognition (Galati et al., 2020; Moosburner et al., 2019). The latter is especially problematic for use cases in healthcare and potentially sterile environments. User acceptance also depends on successfully integrating the system into the existing workflows of medical professionals. While system design plays an important role, organisational measures are also necessary, for example, considering the experience and usage context, adapting existing workflows or creating incentives (Ghosh et al., 2017). Adoption and integration barriers. Various concerns, including efficiency and the costs associated with implementation and training, contribute to poor adoption of MR HMDs (Kortekamp et al., 2024; Zobel et al., 2016). Another point is that the effective use of MR HMDs demands a high level of digitisation, such as the availability of 3D patient data and adequate network infrastructure. To ensure these prerequisites, additional investments in supporting technologies, such as intra-oral scanners, might be necessary (Kortekamp et al., 2024). Further, current software solutions for MR HMDs are often not certified for medical use or don’t match the quality of traditional 2D tools, potentially limiting their effectiveness (Kortekamp et al., 2024). 1.5.4 Structured System & Interaction Framework for Developing Mixed Reality Head-Mounted Displays The following section will summarise the requirements from different contributions and unite them in a structured system and interaction framework, intended to guide the further development and adoption of MR HMDs in medical contexts. Figure 1.5 gives an overview of the six layers that were inductively defined by grouping the individual requirements into meaningful chunks. The layers build on each other, starting with environmental prerequisites (Layer 1) and progressing to more specific requirements, 25 1.6 Discussion Introductory Overview addition, Contribution 4 supplements the knowledge base with principles for the design of MR systems in mobile medical research by presenting issues, meta-requirements and design principles (Kortekamp et al., 2021). In this context, future research should focus on specifying and evaluating the design recommendations and design principles. Possible cultural differences should also be considered. One possibility would be to test the presented application scenarios in practice, with a focus on usability and user acceptance. In addition, it could be analysed to what extent existing design recommendations or identified problems from related areas, such as VR, can also be transferred to MR. Another vital point provides the implementation concept from Contribution 4 (Kortekamp et al., 2021). By linking technological, organisational and medical requirements within the areas of healthcare, informatics and ergonomics, the concept supports the demand for interdisciplinary design processes. These findings contribute to and support the concepts of human-centred design (Bødker & Kyng, 2018). Further research and testing are needed to explore possible applications and the practical suitability of MR for dental home visits. Interdisciplinarity and the individual should be considered as decisive factors. Contribution 5 successfully transfers the VoFI method to the new context of dentistry (Kortekamp et al., 2024). Combined with a cost taxonomy and a benefit framework, it is shown that these methods can be successfully applied to the use case of IT investments in the healthcare sector. Besides, the categorised costs and benefits can be adapted easily to individual scenarios. Moreover, a research gap is identified, particularly with regard to the costs and possible disadvantages of using MR HMDs in the healthcare sector, which underlines the need for corresponding analyses in this area (Kortekamp et al., 2024). Accordingly, potential economic disadvantages and costs should be further researched to enable the development of more reliable cost factors and calculations. Case studies conducted with dental practices can also be helpful in generating real-life data. In this context, further adoption parameters should be identified and possible workflows analysed. Socio-technical aspects also play an important role, which should not be ignored in future research projects. The presented contributions advance the scientific knowledge base of business informatics and health IT by further developing methodological approaches, deriving relevant design guidelines, and integrating economic and technological considerations. Future research should focus on empirically validating the proposed models and further investigating the integration possibilities of new digital technologies into existing health IT infrastructures. 1.6.2 Implications for Practice The present contributions identified several challenges regarding health IT and the use of MR HMD devices. By addressing these challenges, possible solutions and implications for manufacturers and decision-makers could be derived. Contribution 1 identified several media disruptions and inefficient processes that occur specifically when information is shared across different health sectors, potentially lead32 1.6 Discussion Introductory Overview ing to information loss and care problems during inter-organisational transitions. This indicates a need for interoperable IT systems that enable seamless data transfer between inpatient and outpatient facilities. In this setting, IT systems that allow for the sharing and accessing of up-to-date patient data can support intersectoral communication and teamwork, free up time resources, and eliminate possible sources of errors. These advantages can enhance the efficiency and effectiveness of the worker’s tasks. Decisionmakers can use these findings as a basis for their individual requirements analysis before investing in new software that can simplify interdisciplinary communication and reduce manual administrative effort. Software manufacturers may draw on these insights as a basis for developing user-centred systems. Here, regular feedback loops can help to continuously adapt the IT system to current requirements (Kortekamp, Süßmuth, et al., 2019). The trade classification and use case categorisation from Contribution 2 provides developers and decision-makers with an overview of the trades and areas in which MR HMDs are already being used successfully (Kortekamp, Werning, et al., 2019). Decision-makers and developers may find this information helpful before introducing new MR HMDs into trades or use cases. It allows them to focus first on easily accessible trades and use cases, where MR HMDs are already in use. These scenarios allow them to utilise the available real-life data as a basis for thorough evaluation and decision-making. Also associated with a relatively low risk are trade and use cases that are similar to those where MR HMDs are already in use. The knowledge from related use cases can be transferred to the new use case (Kortekamp, Werning, et al., 2019). Overall, Contribution 2 offers recommendations for developing new use cases, particularly in industries where MR HMDs are less established, such as agriculture or water management. Decision-makers can benefit from the synergies and increased market acceptance that the transfer of use cases to new industries brings (Kortekamp, Werning, et al., 2019). Another challenge is supporting medical staff in various activities within a sterile environment. This includes retrieving patient data, documenting medical activities performed, and providing visual support during operations by displaying anatomical structures. MR HMDs enable hands-free access to this information and functions (Kortekamp et al., 2020, 2021, 2024). Contribution 4 and 5 address issues related to IT adoption within the dental sector. This information can be used as a basis for adoption and development strategies. The defined application scenarios for home visits, the practical implementation concept using the Microsoft HoloLens 2, and the overview of possible applications, with a focus on the dental surgery sector, enable stakeholders to make informed decisions regarding IT adoption (Kortekamp et al., 2021, 2024). Additionally, the results of Contribution 4 offer guidance for dentists. They help decision-makers to categorise which application scenarios exist, which requirements are necessary, which implementation approaches are already available and which problems could potentially arise. For software manufacturers, the results can be helpful by showing possible applications that new MR HMD systems should be able to cover and which 33 1.6 Discussion Introductory Overview individual requirements the respective speciality places on the system (Kortekamp et al., 2021). The development of effectively usable digital health applications is complex due to the combination of various regulatory, functional and non-functional requirements in conjunction with a broad stakeholder base. The different nature of MR HMDs in terms of interaction and content presentation makes the development of intuitive applications in the medical field particularly challenging. Contribution 3 and 4 address this issue, with the former focusing on design recommendations for MR HMD applications (Kortekamp et al., 2020). The latter focuses on the definition of meta-requirements and design principles for MR HMDs themselves (Kortekamp et al., 2021). The results can serve as a basis for software and hardware manufacturers. Interdisciplinary use and the early involvement of potential user groups are also emphasised. Apart from that, the findings can also help interested decision-makers define requirements tailored to the individual situation, thereby simplifying the selection and successful integration of new technologies into existing infrastructure and processes. There are several adoption barriers, especially when it comes to emerging technologies within the healthcare sector. However, one of the key questions is whether the investment is profitable. To address this issue, Contribution 5 provides a cost-taxonomy and benefit framework. Decision-makers can apply these findings to their own use case to better consider the potential impacts of new investments. The exemplary cost-benefit analysis for the use of MR HMDs in a dental practice shows that MR HMDs have the potential to be economically advantageous under certain conditions (Kortekamp et al., 2024). Decision-makers can utilise the Excel tool to adapt the VoFI analysis to their own needs, allowing them to base their decision on facts rather than feelings. Moreover, the findings of Contribution 5 suggest several recommendations for decisionmakers before investing in MR HMDs, including that the MR HMD systems need to be tailored to their individual needs and requirements, and that the system needs to be correctly integrated into existing processes to be used effectively (Kortekamp et al., 2021). The contributions demonstrate that digital technologies can enhance inpatient and outpatient care in various scenarios. However, success depends on a user-centred design of the device and application, an individual assessment of the situation and economic impact, as well as a close integration in existing work processes. 1.6.3 Limitations This dissertation is subject to several limitations. Regarding methodological and empirical aspects, most contributions rely heavily on findings from literature, although stakeholders were included where possible (Kortekamp, Süßmuth, et al., 2019; Kortekamp et al., 2020). Potential users and healthcare professionals should be included in further research and development processes. Besides, the developed artefacts, such as the design guidelines and meta-requirements, were presented through concepts. Although those were based on the findings, a real-life evaluation is still pending (Kortekamp, Werning, et al., 2019; Kortekamp et al., 2021). Additionally, this dissertation focuses 34 Introductory Overview mainly on technical success factors for the use of MR HMDs. Socio-technological and environmental factors, such as patient and staff acceptance, as well as the influence of changing environments during everyday use, should also be taken into account. Another factor is the available technology. MR HMDs and applications are often not fully developed and lack the necessary certifications for use in the medical sector (Kortekamp et al., 2024). The technology and applications are constantly being further developed, demanding a continuous evaluation. Economic and regulatory limitations also play a role due to research gaps, especially regarding potential costs or disadvantages of using MR HMD devices in medical scenarios. Other factors influencing technology adoption besides potential costs and benefits, such as the legal framework, socio-technological aspects and technological maturity, must also be considered (Kortekamp et al., 2024). 1.7 Conclusion This dissertation aims to explore the application of MR HMDs in healthcare settings, with a focus on chronic wound care and dentistry. To answer the defined research questions, the design science approach was used to gather relevant information from scientific literature and relevant stakeholders. RQ1 is answered by identifying use cases for supporting hospital discharge management workers, providing an overview of industry sectors MR HMDs are currently used in, and deriving potential application scenarios for using MR HMDs in dental practices. These findings illustrate how these devices can be applied in the business sector, particularly in healthcare. By defining requirements for a software system that assists hospital discharge management workers, deriving best practices for designing MR HMD interfaces and highlighting issues, meta-requirements and design principles for MR HMDs this dissertation gives insight into answers to the question which requirements and design principles should be considered for the use of MR HMDs in healthcare, and, thus addresses RQ2. 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Augmented Reality am Arbeitsplatz der Zukunft: ein Usability-Framework für Smart Glasses. In INFORMATIK 2016 (pp. 1727–1740). Gesellschaft für Informatik e.V. In addition to the systematic literature search, statutory requirements regarding the discharge management as well as the expert standard discharge management in healthcare [Ex09] were analysed. 3 Analysis and Findings 3.1 Consolidated requirements and use cases Use cases are qualiĄed for a clear presentation of functional requirements. They provide a tool for describing the tasks and goals of the involved actors as well as the desired system behaviour in different situations. The result can be used in order to debate the level of the system development in a group and to present the planning to an interdisciplinary team of stakeholders [Co08]. We used the principles described in [Co08] to gain short and meaningful use cases. We identiĄed a total of 37 requirements based on the semistructured interviews, the shadowing and the systematic literature search. In order to provide a clear and more helpful overview, we grouped the requirements with similar traits and used this as a basis for the development of the use cases. Eleven requirements are valid for all interactions with the software. They were assigned to the three inductively formed categories: documentation and input of patient data,interoperability and security (cf. Table 1). Category Requirements Interoperability Adapts the terminology depending on the userŠs profession c,[Hü15; MS14] Provides a user and rights management c,[Ra16] Is accessible by different users at the same time a,b,c,[Ra16] Enables all authorised staff to access relevant patient data a,c,[Hä17] Integrates seamlessly in all work processes b,c,[Hü15] Supports standardised processes and responsibilities c,[Hä17; HK13; MS14; PK11] Documentation and input of patient data Runs a real-time validity check during data input b,c,[Ra16] Provides help functionality for Ąlling out predeĄned forms and reports b,c,[Ra16] Is able to detect errors during data input c,[MS14; Ra16; WH16] Security SupportstheveriĄcationofsentandreceivedelectronicdocuments b,c,[Ra16] Supports high data security standards a,c,[Ra16] aInterviews; bShadowing; cLiterature Tab. 1: Superordinate requirements The requirements in the category named Interoperability constitute the systemŠs basis. Due to the broad range of different electronic hospital information systems, it is essential that the described system is compatible with the existing one when it comes to terms of data input and retrieval. In this way, all relevant actors can access and edit the patientŠs data. IT-supported Hospital Discharge Management 69 Directly linked to the Ąrst category, is the category Documentation and input of patient data. The system supports the input and modiĄcation of data. Portability ensures that data can be input where it is collected. The prompt input of data diminishes the chance of incomplete and outdated information. To further decrease the chance of faulty data, the IT system should be able to check the entered information for validity and inconsistencies. Also, data can be used to Ąll in, send and export formulas automatically. Manually exchanging data and redundant data sets were a common issue for the interviewees. For example, the process of patient admission to patient discharge at the hospital involved Ąve data transitions from digital to non-digital data and vice versa regarding a patientŠs medication information. The last category Security holds a particular position in the management of health care data. It is not only necessary to deny unauthorised persons access to the data but also to verify the consignor. Table 2 shows the remaining 26 requirements on the left and the derived use cases on the right. Each requirement regarding the discharge management of a patient that involves interaction with the software is represented in one of fourteen use cases. They are numbered consecutively for cross-referencing in the text and Ągure 1. One critical factor in these use cases is that users can directly enter new or missing patient data in the system (1). Due to low capacities at follow-up care facilities, the discharge management worker has to plan a patientŠs hospital discharge as soon as possible. Therefore, the identiĄcation of vulnerable patients is essential (2). On the one hand, this ensures early detection of patients requiring discharge management and on the other hand, no resources are wasted on patients not requiring discharge management. In doing so, an IT-supported systematic assessment should be implemented, and the reporting of eligible patients must be as easy as one click (3). In order to not miss important deadlines (e.g. for cost refunds) or guarantee a seamless transition to the new care or rehab facility, it is the time component that matters. In no case should the IT-system hinder the discharge management worker but instead support and automatise tasks. Therefore, the IT system helps by assigning reported patients to the responding worker and providing helpful overviews regarding patients, tasks and deadlines (4). Additionally, it provides an overview of possible follow-up care facilities and medical aids (8, 9). Further support is given, by providing an easy and fast way to document the whole process as well as exporting formulas for applications and accounting (7, 10). The discharge management worker has direct contact to the patient in order to access the pre-hospital living situation as well as wishes regarding post-hospital health care, e.g. statutory or ambulant care and the favoured care provider (5, 6). Also, the actors are subject to considerable constraints regarding their time management. Receiving and sendingmessageswithout theneedto wait fortheircounterpart saves valuable time. Time is also a factor when it comes to the electronic exchange of patient information and data (11-14). Being able to send data right from the IT system to follow-up care facilities 70 Sarah-Sabrina Kortekamp et al. Use Cases Requirements 1 Input patient data into IT system Supportsinput andstorageofall necessary patientdata a,b,c,[Ra16] 2 Assess critical patients Supports a systematic vulnerability assessment of new patients a 3 Report critical patients Supports a one-click report of critical patients a Inhibits redundant reports of critical patients a,b 4 Plan tasks Assigns reported patients automatically to the speciĄed responsible worker, e.g. based on the patientŠs ward a Gives an overview of reported critical patients incl. sorting functions a,b,c,[Br13; Ra16] Supports full calendar functionality a Shows tasks in a calendar view a Shows an overview of all due tasks b,c,[Ex09; Ra16] Supports reminders and priority settings for scheduled events a,b,c,[Br13; Hä15; HK13; Ra16] Shows the responsible discharge management worker b,c,[Ra16] 5 Obtain informed consent from patient Allows the documentation of the informed consent c,[Hä15; Hä17; KS16; MS14] 6 Assess patients needs and wishes Allows simple input of data acquired during patient interviews on-the-go a,c,[Ex09; Ra16] Must be portable b Allows to search and access structured data and application required for the cost unit a,b,c,[Ra16] 7 Request refund at cost unit Supports the documentation, accounting data and appication required for the cost unit a,b,c,[Ra16] 8 Request medical aids Shows information regarding further treatment possibilities a 9 Look for free capacities of follow-up care facilities Provides an interactive overview of possible follow-up care facilities and home care a,b,c,[MS14; Ra16] Provides an overview function showing free capacities from follow-up care providers a,b 10 Draw up and send statement of account to cost unit Generates documents such as transfer sheets from saved patient data a,b 1114 Communication with follow-up care provider/facility Is linked to all necessary stakeholders such as transportation a Enables the exchange of data and information with all relevant follow-up care givers a,b,c,[Br15; Ex09; Hä12; HK13; Me17; MS14; Os15; Ro13] Is able to exchange electronic documents with all relevant followup care givers a Enables internal and external synchronous communication b Enables asynchronous communication with stationary and ambulant stakeholders b,c,[Ra16] Provides feedback function for all relevant stakeholders a,c,[Ex09] aInterviews; bShadowing; cLiterature Tab. 2: IdentiĄed use cases and responding requirements IT-supported Hospital Discharge Management 71 leads to higher availability of patient data without the potential of losing data and time which may result from a manual transmission. The emphasis lies here on data security standards including the veriĄcation of sent and received documents. Patient data is highly sensitive, and in Germany, informed consent of the patient is necessary for the actors in order to be able to send those data. 3.2 Visualisation of the use cases through a process model The ŞBusiness Process Modeling NotationŤ (bpmn) is suited to document existing processes, introduce new processes and to visualise changes made by digitising existing processes [FR14]. The notation is rather simple with strictly deĄned elements and rules that can be combined to picture complex processes. In this case, the aim is to support an existing process by implementing an IT system. Figure 1 shows the use cases stated above in bpmn. The process shows four lanes, one for each primary actor. The lanes are clustered depending on the superordinated institution. Here, these are the hospital on the one hand and the follow-up care facility on the other. Each lane accommodates the tasks (rectangles) and events (circles) that refer to the responding primary actor. Three different lines link the separate elements. A solid line with a Ąlled arrow deĄnes the sequence of tasks and events, a dashed line with an empty arrow indicates the Ćow of messages, and a dotted line with a curved arrow links artefacts. The artefacts used in this bpmn-process are the data storage and the data object. The Ąrst exists independently from the process. For example, stored data is still available after the process of discharging a patient has ended. The latter represents information that only exists during the runtime of the process Şdischarge managementŤ [FR14], i.e. data is no longer available afterwards. The process of a patientsŠ discharge starts with the admission of the patient to the hospital. When entering the central patient admission, the soon-to-be patient makes contact Ąrst with the nurses. They collect the patientŠs personal information and enter the data into the IT system. Next, they conduct a standardised assessment of the patientsŠ need for discharge management. The result is entered into the IT system. If the patient requires discharge management, the discharge management worker is informed. If not, the process related to discharge management ends. When a patient requires discharge management, the IT system notiĄes the discharge management worker. The next step is the analysis of the required proceedings and tasks. The IT system supports the discharge management worker with an overview of reported patients. It also helps with sorting out daily tasks. The discharge management worker then visits the patient in order to give information about the upcoming procedure and ask for informed consent. An assessment regarding the patientŠs needs and wishes is carried out. The worker directly enters all the acquired information in the IT system, and thus makes it available for following tasks and authorised staff. Especially when regarding patients in 72 Sarah-Sabrina Kortekamp et al. Fig. 1: Use case dependencies (bpmn Process) IT-supported Hospital Discharge Management 73 need of discharge management, it is possible that they are not able to make decisions on their own. In this case, the discharge management worker consults the patientŠs custodian. After the necessary steps for a gapless discharge are sorted out, the discharge management worker starts organising the follow-up care. The Ąrst step is to Ąle applications to the responding cost units for the discussed items, such as Ąnancing nursing care or medical aids. If a refund is declined, the worker will discuss other possibilities for adequate follow-up care with the patient or custodian. Two main tasks when organising the follow-up care are ordering needed medical aids and Ąnding a facility that provides stationary or ambulatory care. It depends on the needs and wishes of the patient, what measurements are taken. If the patient needs medical aids, the respective form can be Ąlled out automatically with the available patient information from the IT system. The form can also be adjusted manually and then exported or directly sent to the provider. Since communication with follow-up care providers is necessary, the second task is more difficult. In order to circumvent manually calling a list of care facilities, the IT system shows a list with free capacities to the discharge management worker. The care facilities provide their status information at regular time intervals. The results shown can be sorted or limited to match the needs of the current patient. If a care facility is suitable, the IT system sends a request to the chosen facility. It includes essential patient information such as age, sex and necessary care. The care facility can then evaluate whether they can provide the needed care to the patient. They answer back to the discharge management worker via email. In case of a negative answer, the IT system sends a new request to another suitable care facility, is the answer positive, the ward of the patient is also notiĄed. The nurses at the ward maintain contact with the follow-up care facility and provide more detailed information that helps the care facility to plan for the patientŠs arrival Ů thus ensuring gapless care after discharge. The nurses are also responsible for communicating the time and date of the planned discharge as well as changes to the plan. After the successful transition, the discharge management worker is responsible for drawing up the statement of account and sending it to the cost unit. Since all executed steps are documented in the IT system, the information can be used to Ąll out the predeĄned forms automatically. The Ąnished forms can be exported or sent directly to the cost unit. 4 Discussion and Conclusion In this paper the research question ŞWhat use cases can the IT-system support for a hospital discharge management and what requirements for such a system exist?Ť was examined. Thehospitaldischargemanagementisaninterdisciplinarymulti-userprocess.Theimplementation of an IT system can enhance the efficiency and effectivity of the accomplished tasks 74 Sarah-Sabrina Kortekamp et al. and goals. The authors conducted multi-method research in order to analyse requirements for an IT system and derive relevant use cases. Most requirements could be identiĄed solely by analysing the interviews and the shadowing protocol (32 of 37 requirements; 86.5%). Only eleven of the requirements resulted from both methods. The literature analysis, in combination with the analysis of the statute and the expert standard Śdischarge management in healthcareŠ, resulted in 24 out of 37 requirements (64,9%). Thus, by combining the different methods, a more holistic view of the topic could be formed. Especially the Śexpert standard discharge managementŠ in healthcare yielded only a few requirements. The reason might become evident when regarding its aim. The expert standard provides an instrument for securing and developing quality in health care, with a focus on the improvement of the cooperation between inpatient and outpatient care. It does not constitute a set of rules for organisational processes. The study identiĄed mainly functional requirements. Non-functional requirements were neither named during the interviews nor found when analysing the literature. The only exception is the requirement ŚportabilityŠ which originates from the shadowing. Regarding the outcome of the literature search, the lack of non-functional requirements might be due to the nature of the found literature. The publications focus mainly on the inĆuence of new statutes regarding discharge management or on enhancing the processes from the patientsŠ point of view. However, the development or implementation of IT systems is missing. Nevertheless, non-functional requirements such as usability, an intuitive interface, reliability andsupportof learningmust betakenintoaccount, whendevelopingITsystems.Fortunately, most of these requirements are universal and therefore already described in the scientiĄc literature (cf. [Ba11]) as well as in DIN standards (cf. [Er06]). The discharge of a hospital patient is a highly interdisciplinary process. For success, communication and teamwork are key aspects. The process involves not only several wards within one institution but can also require several independent ambulatory health care professionals. Being able to share the data rather than having to (re)collect, (re)input and (re)print them anew in every institution or ward, would have two main advantages. First, it would free more time resources that are very hard in need at the moment (also regarding the ongoing lack of skilled workers). Second, it would assure that up-to-date patient data is available where it is needed and when it is needed. Errors that may happen by manual transition can be diminished. In addition to the practical beneĄts listed above, the development of such IT structures requires interdisciplinary research in order to understand the full range of problems and their solutions. Also, research regarding factors that ensure the participation of health care institutions on the one hand and software development enterprises on the other could be helpful. The lack of software interfaces and the associated interoperability of the systems might be one limiter regarding intersectoral communication. Therefore, we deduced the following implications for future development and research: IT-supported Hospital Discharge Management 75 1. The IT-systems should support intersectoral cooperation and motivate the reduction of hierarchical structures. 2. The sharing of necessary patient data with health care professionals taking part in the patientŠs care should be simpliĄed. 3. Further research should be conducted with an interdisciplinary team. The same refers to the development of software systems. The presented research is subject to some limitations. On the one hand, the interviews and shadowing rely on one hospital with adjoining care support point in a rural area. On the other hand, although the authors interviewed various professionals in the hospital, only one discharge management worker was observed in the course of the shadowing. Even though the discharge management worker occupies the central position regarding the analysed processes, the other actors should be taken into account as well. In future research, additional stakeholders such as physicians and pharmacists should be included. Table 3 provides an overview of the current research agenda. Each step includes a reevaluation of the previous Ąndings. The aim is to provide a holistic approach for IT-supported discharge management, comprised of an intuitive IT system that supports the interdisciplinary processes of the discharge management and guidelines for the transfer to the IT systems of follow up healthcare institutions. Aim Methods Findings 1 Prototyping Development of a prototype based on the requirements Storyboards Click-Prototypes Formative Analysis IT system in prototypic stage that can be usedforrealworldtest 2 Implementation and Validation Evaluation of the prototype Cognitive Walkthrough Usability Study Summative Analysis Summativeevaluation of the developed prototype 3 Transfer Conceptfortransferto other healthcare institutions Cost-beneĄt analysis Quantitative study Guideline for generalisation of IT system to other institutions Tab. 3: Research agenda The implications for practice and research highlight the importance of IT-systems that can support and motivate skilled workers towards a more interdisciplinary and intersectoral approach. 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Leveling up: Are non-gamers and women disadvantaged in a virtual world classroom? Computers in Human Behavior,65, 210–219. https://doi.org/10.1016/J.CHB.2016.07.033 Webster, J., & Watson, R. T. (2002). Analyzing the past to prepare for the future: Writing a literature review. MIS Quarterly,26(2), xiii–xxiii. https://www.jstor.org/stable/ 4132319 Werning, S., Berkemeier, L., Zobel, B., Fitte, C., Ickerott, I., & Thomas, O. (2019). Smart Glasses als Assistenzsystem in der betrieblichen Einarbeitung. HMD Praxis der Wirtschaftsinformatik,56(3), 612–627. https://doi.org/10.1365/s40702-018-00478-2 Wilkerson, J., McGee, R., Reitz, B., Bellido, R., Estabridis, K., Hewer, G., & Erb, R. (2018). Automated collision avoidance developed within a mixed reality system. In J. Chen (Ed.), Advances in human factors in robots and unmanned systems (pp. 323–334). Springer International Publishing. https://doi.org/10.1007/978-3-319-60384-1_31 Wojciechowski, R. (2017). 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Markopoulos (Eds.), Distributed, ambient and pervasive interactions (pp. 416–424). Springer International Publishing. https://doi.org/10.1007/978-3-319-58697-7_31 Zaher, M., Greenwood, D., & Marzouk, M. (2018). Mobile augmented reality applications for construction projects. Construction Innovation,18, CI–02–2017–0013. https://doi.org/ 10.1108/CI-02-2017-0013 Zobel, B., Berkemeier, L., Werning, S., & Thomas, O. (2016). Augmented Reality am Arbeitsplatz der Zukunft: ein Usability-Framework für Smart Glasses. In INFORMATIK 2016 (pp. 1727–1740). Gesellschaft für Informatik e.V. Zobel, B., Berkemeier, L., Werning, S., Vogel, J., Ickerott, I., & Thomas, O. (2018). Towards a modular reference architecture for smart glasses-based systems in the logistics domain smart glasses for logistics services functions. Proceedings of the 9th International Workshop on Enterprise Modelling and Information Systems Architectures (EMISA 2018), 76–80. 2.3 Contribution 3: Design Recommendations for Augmented Reality Applications—A Case Study in Healthcare Contribution 3 Title Gestaltungsempfehlungen für Augemented-Reality-Applikationen – Ein Anwendungsbeispiel im Gesundheitswesen Authors Sarah-Sabrina Kortekamp, Ingmar Ickerott, Frank Teuteberg Year 2020 Medium Conference Outlet 15th International Conference on Wirtschaftsinformatik (WI 2020) Ranking VHB-JOURQUAL 4: B WKWI: A Bibliographic information Kortekamp, S.-S., Ickerott, I., & Teuteberg, F. (2020). Gestaltungsempfehlungen für Augmented-Reality-Applikationen – Ein Anwendungsbeispiel im Gesundheitswesen. In Proceedings of the 15th International Conference on Wirtschaftsinformatik (WI 2020). https://doi.org/ 10.30844/wi_2020_f4-kortekamp Identification DOI: 10.30844/wi_2020_f4-kortekamp Link https://doi.org/10.30844/wi_2020_f4-kortekamp Abstract Der Einsatz von Augmented-Reality-Headsets eröffnet vielfältige Anwendungsmöglichkeiten und könnte auch in der Wundversorgung zur Anwendung kommen. Das Zusammenspiel mit der Nutzungsumgebung sowie die erweiterten Möglichkeiten der Interaktion erhöhen die Komplexität der Parameter, die bei der Gestaltung geeigneter Applikationen beachtet werden müssen. Daher verfolgt dieser Beitrag zwei Ziele. Als erstes werden Gestaltungsempfehlungen für Augmented-Reality-Applikationen für Headsets formuliert. Als zweites werden die zuvor formulierten Gestaltungsempfehlungen anhand eines Konzepts für eine Nutzeroberfläche zur Dokumentation chronischer Wunden demonstriert. Es wurde eine systematische Literaturrecherche durchgeführt. Von den 629 gefundenen Publikationen konnten 15 als relevant identifiziert werden. Die Inhalte der Publikationen wurden mithilfe einer qualitativen Inhaltsanalyse nach Mayring (2015) analysiert. Insgesamt konnten zehn Gestaltungsempfehlungen für AugmentedReality-Applikationen generiert und anhand des Anwendungsfalls, der Dokumentation chronischer Wunden, demonstriert werden. Die präsentierten Gestaltungsempfehlungen können als Basis für die Entwicklung von Augmented-Reality-Applikationen insbesondere mit dem Fokus auf Headsets genutzt werden. References Antoniou, P. E., Dafli, E., Arfaras, G., & Bamidis, P. D. (2017). Versatile mixed reality medical educational spaces; requirement analysis from expert users. Personal and Ubiquitous Computing,21(6), 1015–1024. https://doi.org/10.1007/s00779-017-1074-5 Armfield, D. M., Hill Duin, A., & Pedersen, I. (2018). Experiencing content: Heuristics for humancentered design for augmented reality. 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Retrieved November 18, 2019, from https://github. com/MicrosoftDocs/mixed-reality/blob/master/mixed-reality-docs/typography.md Pittman, C., & LaViola, J. J. (2019). Determining design requirements for AR physics education applications. 2019 IEEE Conference on Virtual Reality and 3D User Interfaces (VR), 1126–1127. https://doi.org/10.1109/VR.2019.8797908 Santos, C., Miranda, B., Araujo, T., Carneiro, N., Marques, A., Mota, M., Morais, J., & Meiguins, B. (2016). Guidelines for graphical user interface design in mobile augmented reality applications. In S. Lackey & R. Shumaker (Eds.), Virtual, Augmented and Mixed Reality (pp. 71–80). Springer International Publishing. Shneiderman, B., Plaisant, C., Cohen, M., Jacobs, S., & Elmqvist, N. (2018). Designing the user interface: Strategies for effective human–computer interaction (6th ed.). Pearson Education. Stocker, A., Spitzer, M., Kaiser, C., Rosenberger, M., & Fellmann, M. (2017). Datenbrillengestützte Checklisten in der Fahrzeugmontage. Informatik-Spektrum,40(3), 255–263. https://doi.org/10.1007/s00287-016-0965-6 Webster, J., & Watson, R. T. (2002). Analyzing the past to prepare for the future: Writing a literature review. MIS Quarterly,26(2), xiii–xxiii. https://www.jstor.org/stable/ 4132319 2.4 Contribution 4: Technology-Supported Dental Home Visits by Non-Medical Personnel to Reduce Infection Risk Contribution 4 Title Technikgestützte zahnmedizinische Hausbesuche durch nicht-ärztliches Fachpersonal zur Minderung des Ansteckungsrisikos Authors Sarah-Sabrina Kortekamp, Ingmar Ickerott, Frank Teuteberg Year 2021 Medium Journal Outlet HMD Praxis der Wirtschaftsinformatik Ranking VHB-JOURQUAL 4: C WKWI: B Bibliographic information Kortekamp, S.-S., Ickerott, I., & Teuteberg, F. (2021). Technikgestützte zahnmedizinische Hausbesuche durch nicht-ärztliches Fachpersonal zur Minderung des Ansteckungsrisikos. HMD Praxis der Wirtschaftsinformatik,58, 754–764. https://link.springer.com/10.1365/s40702-02100733-z Identification DOI: 10.1365/s40702-021-00733-z Link https://link.springer.com/article/10.1365/s40702-021-00733-z Abstract Ziel des Beitrags ist die Identifikation von Problemen, Meta-Anforderungen und Designprinzipien für den Einsatz von Mixed und Virtual Reality Brillen zur Unterstützung nicht-ärztlichen Fachpersonals bei zahnmedizinischen Hausbesuchen. Im Rahmen von zwei Gruppendiskussionen und einem Experteninterview wurden zunächst mögliche Einsatzszenarien identifiziert. Anschließend wurde eine systematische Literaturrecherche in den Datenbanken CINAHL, Business Source Premier und MEDLINE durchgeführt. In der gefundenen Literatur konnten 14 Probleme bei der Anwendung von Mixed und Virtual Reality Brillen identifiziert werden. Darauf basierend wurden 14 Meta-Anforderungen abgeleitet und in fünf Designprinzipien zusammengefasst. Abschließend wurden die Ergebnisse mit den Spezifikationen der Microsoft HoloLens 2 abgeglichen, um eine Eignung für die Unterstützung der geplanten Hausbesuche festzustellen. Zudem wurde ein Umsetzungskonzept skizziert. Die Ergebnisse dienen als wichtige Empfehlungen für die praxisnahe Umsetzung zukünftiger Konzepte bezüglich der Anwendung von Mixed und Virtual Reality Brillen im (zahn-)medizinischen Kontext. Die Literaturrecherche zeigt eine Forschungslücke im Bereich zahnmedizinischer Hausbesuche auf. Die Ergebnisse dieses Beitrags schaffen daher eine solide Basis für die zukünftige Forschung. SCHWERPUNKT https://doi.org/10.1365/s40702-021-00733-z HMD Technikgestützte zahnmedizinische Hausbesuche durch nicht-ärztliches Fachpersonal zur Minderung des Ansteckungsrisikos Sarah-Sabrina Kortekamp · Ingmar Ickerott · Frank Teuteberg Eingegangen: 15. Januar 2021 / Angenommen: 19. April 2021 © Der/die Autor(en) 2021 Zusammenfassung Ziel des Beitrags ist die Identifikation von Problemen, MetaAnforderungen und Designprinzipien für den Einsatz von Mixed und Virtual Reality Brillen zur Unterstützung nicht-ärztlichen Fachpersonals bei zahnmedizinischen Hausbesuchen. Im Rahmen von zwei Gruppendiskussionen und einem Experteninterview wurden zunächst mögliche Einsatzszenarien identifiziert. Anschließend wurde eine systematische Literaturrecherche in den Datenbanken CINAHL, Business Source Premier und MEDLINE durchgeführt. In der gefundenen Literatur konnten 14 Probleme bei der Anwendung von Mixed und Virtual Reality Brillen identifiziert werden. Darauf basierend wurden 14 Meta-Anforderungen abgeleitet und in fünf Designprinzipien zusammengefasst. Abschließend wurden die Ergebnisse mit den Spezifikationen der Microsoft HoloLens 2 abgeglichen, um eine Eignung für die Unterstützung der geplanten Hausbesuche festzustellen. Zudem wurde ein Umsetzungskonzept skizziert. Die Ergebnisse dienen als wichtige Empfehlungen für die praxisnahe Umsetzung zukünftiger Konzepte bezüglich der Anwendung von Mixed und Virtual Reality Brillen im (zahn-)medizinischen Kontext. Die Literaturrecherche zeigt eine Forschungslücke im Bereich zahnmedizinischer Hausbesuche auf. Die Ergebnisse dieses Beitrags schaffen daher eine solide Basis für die zukünftige Forschung. Schlüsselwörter Designprinzipien · Mixed Reality · Virtual Reality · HeadMounted Devices · Zahnmedizinische Hausbesuche S.-S. Kortekamp () · I. Ickerott Institut für Management und Kultur, Hochschule Osnabrück, Lingen, Niedersachsen, Deutschland E-Mail: s[email protected] S.-S.Kortekamp·F.Teuteberg Fachgebiet für Unternehmensrechnung und Wirtschaftsinformatik, Universität Osnabrück, Osnabrück, Niedersachsen, Deutschland K S.-S. Kortekamp et al. Technology-assisted dental home visits by nondoctoral professionals to reduce the risk of infection Abstract The aim of this paper is to identify problems, meta-requirements and design principles for the use of mixed and virtual reality glasses to support nondoctoral professionals during dental home visits. In the course of two group discussions and one expert interview, possible application scenarios were first identified. Subsequently, a systematic literature search was conducted in the databases CINAHL, Business Source Premier and MEDLINE. The literature revealed 14 problems in the application of mixed or virtual reality glasses. Based on this, 14 meta-requirements were derived and summarised in five design principles. Finally, the results were compared with the specifications of the Microsoft HoloLens 2 to determine suitability. An implementation concept was also outlined. The results serve as important recommendations for the practical implementation of future concepts regarding the application of mixed and virtual reality glasses in a (dental) medical context. The literature review reveals a research gap in the field of dental home visits. Therefore, the results of this paper provide a solid basis for future research. Keywords Design principles · Mixed reality · Virtual reality · Head-mounted devices · Dental home visits 1 Einleitung Aufgrund der Corona-Pandemie wurden in vielen Ländern Maßnahmen getroffen, die eine Ausbreitung von Covid-19 möglichst eindämmen sollen. Bestimmte Personengruppen, wie ältere Menschen mit chronischen Erkrankungen, sind durch ein erhöhtes Infektionsrisiko und möglicherweise schwere Krankheitsverläufe besonders betroffen (Jordan et al. 2020; Zhou et al. 2020). Der Besuch beim Zahnarzt stellt für diese Personengruppen durch den engen Kontakt zu anderen Personen trotz sorgfältiger Hygienemaßnahmen ein erhöhtes Ansteckungsrisiko dar. Ein Auslassen der Kontrolltermine oder das Ignorieren von Beschwerden kann allerdings ebenso gravierende Folgen haben. So können Infektionen im Mundraum durch eine Verschleppung von Keimen beispielsweise eine Aspirationspneumonie auslösen (Baumgartner et al. 2015). Hausbesuche könnten hier eine mögliche Alternative darstellen, die eine zahnmedizinische Versorgung ermöglicht und dabei das Ansteckungsrisiko vulnerabler Personen möglichst minimiert. Die Durchführung von zusätzlichen Hausbesuchen stellt aber auch gleichzeitig eine höhere Belastung des zahnärztlichen Personals dar. Im hausärztlichen Bereich existieren bereits seit Längerem Fortbildungen für nicht-ärztliche Praxisassistenzen. Dies ermöglicht die Delegation von ansonsten ärztlichen Tätigkeiten an nicht-ärztliches medizinisches Personal. Nichtärztliches Fachpersonal kann so verschiedene Maßnahmen im Rahmen von Hausbesuchen selbstständig durchführen (Gisbert Miralles et al. 2020). Dieses Angebot besteht allerdings noch nicht für zahnmedizinische Praxen (BARMER Internetredaktion 2020). K Technikgestützte zahnmedizinische Hausbesuche durch nicht-ärztliches Fachpersonal zur... Auch in der Forschung ist dieses Thema kaum repräsentiert. Eine explorative Literaturrecherche mithilfe von Google Scholar ergab zwar viele Ergebnisse zum Einsatz von Mixed Reality (MR) Brillen zur Ausbildung oder Unterstützung während Operationen im zahnmedizinischen Bereich. Wissenschaftliche Beiträge zu Hausbesuchen durch nicht-ärztliches Fachpersonal im Allgemeinen oder in Verbindung mit MR Brillen konnten nicht gefunden werden. Das Ziel dieser Forschung ist daher die Erprobung von Hausbesuchen durch nicht-ärztliches zahnmedizinisches Personal. Dabei soll beispielhaft die Microsoft HoloLens 2 unterstützend eingesetzt werden. Die Forschungsfragen dieses Beitrags lauten: Welche Behandlungen können im Rahmen eines zahnmedizinischen Hausbesuchs mit nicht-ärztlichem Fachpersonal und unterstützt durch MR Brillen durchgeführt werden? Welche Anforderungenstellt dieses Nutzungsszenario an Hardware und Software? Inwiefern wird die Microsoft HoloLens 2 diesen Anforderungen gerecht? Im nächsten Abschnitt wird das methodische Vorgehen beschrieben, bevor die Ergebnisse im dritten Abschnitt in Form von Einsatzszenarien, Designprinzipien und einem Umsetzungskonzept dargestellt werden. Im letzten Abschnitt werden die Ergebnisse, die Limitationen des Beitrags sowie die praktische und theoretische Signifikanz diskutiert. 2 Methode Im Rahmen des Design Science Ansatzes (Gregor and Hevner 2013) wird ein iteratives Vorgehen anvisiert. Entsprechend werden bestehende Ergebnisse fortlaufend überprüft und im Falle neu gewonnener Erkenntnisse überarbeitet. 2.1 Gruppendiskussion und Experteninterview Zur Beantwortung der ersten Frage wurden zwei interdisziplinäre, formal geleitete Gruppendiskussionen durchgeführt (Flick 2009). Unter den fünf und acht Teilnehmenden befanden sich ein Zahnarzt und Personen aus den Bereichen der Informationsund Kommunikationstechnik, der Wirtschaftsinformatik sowie der Ergonomie. Die erste Gruppendiskussion diente dem Finden möglicher Einsatzszenarien für nicht-ärztliche zahnmedizinische Hausbesuche mit Unterstützung durch die Microsoft HoloLens 2. Die darauffolgende Gruppendiskussion sowie ein halbstrukturiertes Experteninterview mit einem praktizierenden Zahnarzt dienten der Konkretisierung der sondierten Szenarien. 2.2 Systematische Literaturrecherche Um die zweite Frage zu beantworten, wurde eine systematische Literaturrecherche durchgeführt (vom Brocke et al. 2015). Dafür wurden CINAHL und Business Source Premier als relevante Datenbanken für die Wirtschaftsinformatik ausgewählt. K S.-S. Kortekamp et al. Aufgrund des medizinischen Themas wurde MEDLINE in die Recherche eingeschlossen. Eine Fokussierung auf MR in einem zahnmedizinischen Kontext war infolge der geringen relevanten Treffer nicht möglich. Aufgrund der thematischen Verwandtschaft wurde daher auch Literatur inkludiert, die sich mit Virtual Reality (VR) in einem generellen medizinischen Setting beschäftigt. Für die Suche wurden die Begriffe „Augmented Reality“, „Mixed Reality“ und „Virtual Reality“ mit den Begriffen „dental*“, „dentist*“, „medicine“, „care“ und „telehealth“ kombiniert. Die gefundenen Beiträge wurden systematisch auf die Nennung von Problemen bei der Nutzung von Mixed oder Virtual Reality Brillen untersucht. Inklusionskriterien waren die Nutzung einer solchen Brille durch medizinisches Fachpersonal. Ausund Weiterbildungsszenarien wurden aufgrund zu unterschiedlicher Parameter ausgeschlossen. Insgesamt konnten zehn relevante Beiträge identifiziert werden. Zur Beantwortung der dritten Frage wurden die identifizierten Meta-Anforderungen und Designprinzipien mit den Eigenschaften der Microsoft HoloLens 2 verglichen (s. Abschn. 3.3). 3 Ergebnisse 3.1 Einsatzszenarien Es konnten insgesamt fünf Einsatzszenarien für die Anwendung von MR Brillen bestimmt werden, die in Tab. 1, Spalte 1, dargestellt sind. In der zweiten Spalte werden die Mindestanforderungen an die Qualifikation beschrieben und in Spalte 3 das Equipment, das zusätzlich zur MR Brille erforderlich ist. Im Folgenden werden die Szenarien dezidiert beschrieben. Das erste Szenario befasst sich mit der Video-Dokumentation des Mundraums durch med./pfleg. Fachpersonal mithilfe einer MR Brille. Ziel ist es, diese Untersuchung vornehmen zu können, wenn med./pfleg. Fachpersonal aufgrund eines Tab. 1 Mögliche Einsatzszenarien einer Mixed Reality Brille während eines zahnmedizinischen Hausbesuchs Nr Einsatzszenario Nutzende Equipment 1 Video-Dokumentation des Mundraums Med./pfleg. Fachpersonal Zahnmedizinisches Grundbesteck 2 Regelmäßige Kontrolle; Erfassung eines zahnmedizinischen Problems Med./pfleg. Fachpersonal mit Weiterbildung, zahnmedizinisches Fachpersonal Zahnmedizinisches Grundbesteck 3 Behebung von Prothesendruckstellen Erfahrene zahnmedizinisches Fachpersonal Zahnmedizinisches Grundbesteck, Fräse 4 Reparatur eines abgebrochenen Zahns (Prothese) Zahntechniker/in Individuelles zahntechnisches Equipment 5 Prophylaxe Zahnmedizinische Prophylaxehelfer/in Mobile Dentaleinheit K Technikgestützte zahnmedizinische Hausbesuche durch nicht-ärztliches Fachpersonal zur... anderen Problems bereits bei der zu behandelnden Person zu Hause ist. Das zuständige zahnärztliche Fachpersonal kann die Videoaufnahme im Anschluss in der Praxis begutachten und feststellen, ob zahnmedizinische Probleme vorliegen. Med./pfleg. Fachpersonal mit Weiterbildung könnte, in einem gut eingespielten interdisziplinären Team zudem regelmäßige Kontrollen der Zähne selbstständig durchführen oder auf Anfrage ein bestimmtes zahnmedizinisches Problem erfassen (Szenario 2). Die Durchführung durch med./pfleg. Fachpersonal hat auch hier wieder den Vorteil, dass die Untersuchung mit anderen Tätigkeiten kombiniert werden kann. Die MR Brille dient dann der Dokumentation und bei Bedarf auch der Absprache mit dem zuständigen zahnärztlichen Fachpersonal. Im Rahmen des dritten Szenarios nimmt erfahrenes zahnmedizinisches Fachpersonal Anpassungen am Sitz der Prothese der zu behandelnden Person vor, um so Druckstellen zu beheben. Zusätzlich zur MR Brille und einem zahnmedizinischen Grundbesteck wird dazu eine Fräse benötigt. Szenario vier beschreibt die Reparatur eines abgebrochenen Zahns aus einer Prothese. Diese Maßnahme kann von einer/einem Zahntechniker/in durchgeführt werden, wobei individuelles zahntechnisches Equipment vonnöten ist. Das letzte Szenario ist die Durchführung der Prophylaxe durch eine/n zahnmed. Prophylaxehelfer/in. Im Gegensatz zu den anderen Szenarien ist für diese Tätigkeit eine mobile Dentaleinheit erforderlich. Die MR Brille dient hier, zusätzlich zu Dokumentation und Rücksprache mit dem zuständigen zahnärztlichen Fachpersonal, auch der Kontrolle des Ergebnisses. 3.2 Probleme, Meta-Anforderungen und Designprinzipien Aus den, in der Literatur identifizierten, Problemen (P) wurden die Meta-Anforderungen (MA) entwickelt. Die Designprinzipien (DP) basieren auf diesen Erkenntnissen und fassen die Meta-Anforderungen praxisnah zusammen. Die Designprinzipien dienen der Eignungsprüfung der Microsoft HoloLens 2. Die genannten Probleme beziehen sich zum einen auf die Eigenschaften der MR Brillen selbst. Zum anderen auch auf die Interaktion mit der Technik sowie die Einbindung in die bestehende Infrastruktur. 3.2.1 Techniklimitationen Bezüglich der Hardware wurde mehrfach die kurze Batterielaufzeit (P1)(Sparwasser et al. 2018; Martin et al. 2020; Galati et al. 2020) bemängelt. Dies ist besonders beim Einsatz in der Chirurgie bemerkbar, da die derzeitigen Modelle mit einer Batterielaufzeit von zwei bis drei Stunden nur während kürzerer Eingriffe die gesamte Zeit über unterstützen können. Hinzu kommt die begrenzte Speicherkapazität (Talaat et al. 2019; Galati et al. 2020) und Rechenkapazität der mobilen Prozessoren (P2) (Sparwasser et al. 2018; Galati et al. 2020). Die Spezifikationen des Geräts sollten daher auf die geplante Nutzung abgestimmt werden. Bei Bedarf sollte das Gerät während der Nutzung komfortabel geladen werden können oder einen austauschbaren Akku besitzen (MA1). Bei stationären Einsatzszenarien und einem geeigneten Netzwerk sollten ressourcenintensive Prozesse in die Cloud ausgelagert werden können K 2.5 Contribution 5: Cost-Benefit Analysis for Using Mixed Reality in Dentistry—Keeping the Dentist in the Picture Contribution 5 Title Cost-Benefit Analysis for Using Mixed Reality in Dentistry—Keeping the Dentist in the Picture Authors Sarah-Sabrina Kortekamp, Patricia Kajüter Rodrigues, Ingmar Ickerott, Frank Teuteberg Year 2014 Medium Conference Outlet European Conference on Information Systems (ECIS 2024) Ranking VHB-JOURQUAL 4: A WKWI: A Bibliographic information Kortekamp, S.-S., Kajüter Rodrigues, P., Ickerott, I., & Teuteberg, F. (2024). Cost-benefit analysis for using mixed reality in dentistry—keeping the dentist in the picture. ECIS 2024 Proceedings. https://aisel.aisnet.org/ecis2024/track18_healthit/track18_healthit/8 Identification ISBN: 978-1-958200-10-0 Link https://aisel.aisnet.org/ecis2024/track18_healthit/track18_healthit/8 Abstract Digitization expands into all labour market areas, including medicine and dentistry. Mixed reality head-mounted displays (MR HMDs) can be used in dental surgeries to project holograms onto patients or allow experts to join virtually. The application could reduce treatment errors and improve treatment outcomes. Despite the advantages, dentists have hardly used the technology so far, partly due to unclear insights into cost efficiency. We identify costs and benefits of investing in an MR HMD dentistry context based on a systematic literature review to address this issue. The findings are used to develop a cost-benefit framework and evaluated using the Visualisation of Financial Implications (VoFI) method for an exemplary scenario. 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