Artificial intelligence and digitisation in hospitals

The Order of the Brothers Hospitallers operates a wide variety of medical facilities with state-of-the-art technology.

The Order of the Brothers Hospitallers, known as Barmherzige Brüder in German, operates around 400 health and social care facilities on all continents. In the spirit of hospitality, 981 friars, about 64,000 full-time and 29,000 volunteers care for the sick and elderly, people with disabilities, people at the end of their life, people battling with drug addiction, homeless people and children who need help. The Brothers Hospitallers Austria (with locations also in Slovakia, the Czech Republic and Hungary) work with almost 9,400 employees in the spirit of the order’s founder John of God (1495-1550). Without regard to a person’s origin, nationality, religion, gender or social status, the Brothers Hospitallers want to be there for all those in need of help and support people. Director Adolf Inzinger tells us more.

The Brothers Hospitallers have existed as a Catholic order for more than 450 years. What does this historical heritage mean to you and how does it affect your daily work?

Adolf Inzinger: Soon after the death of our order’s founder, the first friars took Christian hospitality to all continents – starting from Iberian Europe and, through the seafarers of Spain and Portugal, very soon also to South America. In 1605, the order’s first hospital north of the Alps was founded in Valtice in what is now the Czech Republic, and a dense network of branches soon developed in Central and Northern Europe, which in its heyday stretched from the Baltic to Northern Italy and from Westphalia to the Banat. The services offered were always adapted to medical and nursing progress, so that today the order is one of the most progressive in Europe. Based on all the good things of the past we can lead the institutions into a good future today

How would you characterise the Brothers Hospitallers?
Inzinger: I think the following two formulations hit the mark – courageously and innovatively helping where we are needed, further developing our tradition and actively carrying it into the future.

How do you deal with the shortage of skilled workers in the health sector?
Inzinger: Attracting more people to nursing is one of the most important goals of Austrian health policy. The Brothers Hospitallers have been involved in training for centuries. Currently, the facilities in Kainbach and Kritzendorf are offering lateral entrants the opportunity to train as nursing assistants while working. Our hospital in Linz has also started a similar model in cooperation with the BFI institute. The Hospital of Brothers Hospitallers Eisenstadt, in turn, has been promoting midwife training for many years. The Elisabethinen Hospital in Klagenfurt and the Brüderkrankenhaus Vienna cooperate with regional universities of applied sciences and enable students to gain experience in training stations lasting several weeks. The Austrian Province of the Order has been cooperating with the Indian Province in training nurses for almost 40 years. While in the first decades members of the order came to Austria for training, in the future academically trained nurses from India will come to work in our hospitals and care facilities.

What is your experience as an employer with the influx of foreign workers?
Inzinger: One of the biggest hurdles to being able to work in Austria, apart from learning the German language, is the procedure for the recognition of foreign qualifications, the so-called nostrification, the residence and employment permit and, for members of the health and nursing professions as well as the higher medical-technical services, the registration in the health professionals registry. We are in a very competitive environment in an important segment of the labour market for health professions. It would be important that the procedures for obtaining a work permit in Austria, which are certainly necessary, are streamlined and simplified in the sense of a one-stop shop

Is it difficult to work in a multicultural environment?
Inzinger: As already mentioned, mastering the German language is indispensable, and yes, there are clearly also differences in culture and mentality. But what unites us is again the example of our order’s founder. He lived in a time when the Moors were expelled from the Iberian Peninsula and during pogroms against Jews. And what did he do? Under the archway of the house of a friendly Moorish family, today one would say in the driveway of the house, he began to care for people in need. For him, the person seeking help was in the foreground, not his origin, social status or religion.

From your point of view, how has the health system changed over the past decades? What are the big trends?
Inzinger: I would like to highlight the areas of cooperation, interdisciplinarity and digitisation. The past two decades have been characterised by new types of cooperation in the health system like never before. The construction of the Vienna Donaustadt Dialysis Centre as a cooperation project of the Vienna Convent of the Brothers Hospitallers with the Austrian Health Insurance Fund and the Vienna Health Association, for example. Or the cooperation in the Elisabeth Hospice in Linz and Ried im Innkreis, which also spans several institutions; the founding of a laboratory network in Graz, the cooperation with the Elisabethinen Hospital in Klagenfurt or the opening of external, dislocated outpatient clinics such as in Zeltweg or in Dunajská Lužná and Pezinok in Slovakia are projects of unprecedented quality.

How does digitisation change the everyday life of a health facility?
Inzinger: The Covid pandemic is considered a driver of digitisation. Online trade is booming, online meetings are reducing business trips, and administrative procedures are increasingly being carried out digitally and from home. In the Austrian facilities of the Brothers Hospitallers, however, digitisation already took hold more than 20 years ago. The initial spark was the introduction of digital nursing documentation in 2002. New software modules have been introduced continuously. And since 2017, we have completely paperless, multimedia and digital patient documentation.
What was only a vision in the beginning is now reality and unthinkable without it. Completely paperless, multimedia digital patient documentation exists in all hospitals, retirement homes and care facilities of the Brothers Hospitallers Austria. Patient histories, including fever charts, nursing documentation, medication data, images and findings from medical equipment, findings brought in by patients and much more, are available in a single interface for medical, care and therapeutic services. With this interdisciplinary project, which is probably unique in its entirety, the Brothers Hospitallers are setting a milestone for optimal patient care in the German- speaking world.

Does artificial intelligence also play a role in healthcare?
Inzinger: At present, it is increasingly coming to the fore. This is mainly due to the fact that a lot of data accumulates in the healthcare sector that is difficult to evaluate using conventional means. At our Linz hospital, for example, we are the first in Austria to have a computer tomograph whose software analyses the data using artificial intelligence after examining the brain and can thus detect strokes. The evaluation of health data by means of AI can certainly help the health system in the future to recognise certain events earlier and to react to them, or to gain new insights relevant to health policy from the wealth of Austria-wide data. However, it is very important to me to emphasise that all data may only be used in strict compliance with data protection and that in the patient-oriented area AI-based findings or recommendations must be validated again by a person authorised and qualified to do so.

How did you manage to implement this project smoothly in the facilities?
Inzinger: The high level of acceptance of digital documentation from the very beginning is primarily based on the involvement of staff in the continuous further development of the individual software products in order to create solutions from practice for practice

What role does sustainability play in hospitals that consume a lot of energy and water?

Inzinger: Environmental protection and sustainability are fundamental concerns of the Brothers Hospitallers. For example, a text of the Order from the year 2000 already states that we must ‘develop strategies that promote a responsible approach to the environment that belongs to all of us and is entrusted to us only for stewardship’. The environmental management of the Brothers Hospitallers therefore extends to all areas of the facilities and ranges from the purchase of regional food to the collection of waste materials and photovoltaic systems. Climate protection is therefore possible almost everywhere, even in an operating theatre, where we have recently started recycling anaesthetic gases. In addition to our staff, a central purchasing department is a key position in environmental protection. A procurement catalogue for the sustainable purchase of medical and nursing consumables was developed with the central purchasing department and introduced at all sites.

What fascinates you personally about the Order of Brothers Hospitallers?
Inzinger: That the facilities of the Brothers Hospitallers are places of hope. Christian hospitality is the basic mission of the Brothers Hospitallers. This has always included that the Brothers, in addition to caring for and treating sick people, also help those who are on the fringes of society or for whose suffering and need no one else feels responsible. Brothers and staff live and work according to this principle in many places around the world. I am thinking, for example of the friars in Madang (Papua New Guinea), who are involved in special programmes in the social sector, or the ‘Hostel of St. John of God’ centre in Quito (Ecuador), which cares for the homeless and mentally ill adults without relatives. For more than a year, the Brothers in Drohobycz in Ukraine have been caring for the people around their monastery and looking after internally displaced persons. This list could be extended to many more places, such as Batibo (Cameroon), Tanguieta (Burkina Faso) or Nampula (Mozambique), where civil war is raging and jihadist groups are active.
The friars and staff deliberately stay in these places and try to maintain health care or social care for the local population. They choose to stay by the side of the population and risk their own health or even their lives for other people – such as during the last outbreak of Ebola in West Africa. For me, it is always moving to experience how employees in Austria show solidarity for these religious institutions. Fundraising, information events or flea markets are organised to help sick and needy people in other parts of the world.