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

Mixed Reali y Head-Moun ed Displays in Heal hca e A Design Science Pe spec i e on Requi emen s, Applica ions, and Economic Impac in Ch onic Wound Managemen and Den is y Inaugu aldisse a ion zu E langung des akademischen G ades eines Dok o s de Wi scha swissenscha en des Fachbe eichs Wi scha swissenscha en de Uni e si ä Osnab ück o geleg on Sa ah-Sab ina Ko ekamp, M.Sc. Osnab ück, Ok obe 2025 Dekan P o . D . Robe Gillenki ch Re e en en P o . D . F ank Teu ebe g P o . D . Ingma Icke o Da um de Dispu a ion: 28.10.2025 P e ace This disse a ion was w i en as pa o he p ojec Do gemeinscha 2.0 unded by he Fede al Minis y o Educa ion and Resea ch. The wo k was ini ia ed while I was wo king as a esea ch assis an a Osnab ück Uni e si y o Applied Sciences, Facul y o Managemen , Cul u e and Technology. I g ea ly app ecia e all hose who ha e accompanied, suppo ed, and encou aged me h oughou my jou ney o his disse a ion. In pa icula , I would like o hank P o- esso F ank Teu ebe g o his dedica ed supe ision o he disse a ion, his suppo in inding he opic and he me hodological o ien a ion o he con ibu ions, and o his help ul and cons uc i e eedback h oughou he en i e p ocess o w i ing he disse a- ion—including on e y sho no ice be o e deadlines, which was always g ea ly app e- cia ed. Special hanks go o P o esso Ingma Icke o o his decisi e ole in ini ia ing he doc o a e and his p ojec - ela ed suppo h oughou he doc o al pe iod. My since e hanks go o my amily and iends, who accompanied me along he way. I am especially g a e ul o my mum o he con inuous suppo in all phases o he doc o a e and o always being a ailable as my discussion pa ne on a ious opics ela ed o my wo k. I would also like o hank he o he sus ained in e es in my p og ess, e en i he en husiasm o inqui ing abou i occasionally exceeded my own. I am deeply hank ul o my husband o his cons an suppo . His mo i a ing pe se e ance con ibu ed signi ican ly o he comple ion o his disse a ion. Geo gsma ienhü e, Juni 2025 Sa ah-Sab ina Ko ekamp No es on he S uc u e o he Documen This disse a ion is di ided in o wo pa s: an in oduc o y o e iew and he esea ch con ibu ions. Sec ion 1 o he in oduc o y o e iew p esen s he cu en s a e o he a ega ding he adop ion o new echnologies in he heal hca e sys em. Sec ion 2 ou lines he mo- i a ion o his disse a ion, which o ms he basis o he objec i e and he esea ch ques ions (RQs) p esen ed in Sec ion 3. Sec ion 4 desc ibes he esea ch design used o add ess he esea ch ques ions. I also summa ises he selec ed con ibu ions and ou lines he me hodology applied. Sec ion 5 summa ises he key indings o he con ibu ions o highligh oppo uni ies and ba ie s o adop ing mixed eali y head-moun ed displays in a heal hca e con ex . In addi ion, i p esen s a amewo k o de eloping such sys ems. The discussion in Sec ion 6 p o ides implica ions o esea ch and p ac ice, iden i ies u u e esea ch oppo uni ies, and add esses limi a ions. The second pa complemen s he in oduc o y o e iew by p esen ing a summa y o he selec ed esea ch con ibu ions, including key bibliog aphic in o ma ion and ab- s ac s. Con en s 1 In oduc o y O e iew 9 1.1 S a eo heA ................................. 9 1.2 Mo i a ion ................................... 10 1.3 Objec i e & Resea ch Ques ions . . . . . . . . . . . . . . . . . . . . . . . 11 1.4 Resea chDesign ................................ 12 1.4.1 Summa y o he Resea ch Con ibu ions . . . . . . . . . . . . . . . 12 1.4.2 Spec um o Me hods . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.5 Summa y o Con ibu ions and Essen ial Findings . . . . . . . . . . . . . 19 1.5.1 Applica ions o Mixed Reali y Head-Moun ed Displays in Heal hca e 19 1.5.2 T ans o ma i e Oppo uni ies in Heal hca e . . . . . . . . . . . . . 21 1.5.3 Ba ie s o E ec i e Implemen a ion . . . . . . . . . . . . . . . . . 23 1.5.4 S uc u ed Sys em & In e ac ion F amewo k o De eloping Mixed Reali y Head-Moun ed Displays . . . . . . . . . . . . . . . . . . . . 25 1.5.5 Cos -E iciency and Economic Impac o Mixed Reali y Head-Moun ed DisplaysinHeal hca e......................... 29 1.6 Discussion.................................... 30 1.6.1 Implica ions o Resea ch . . . . . . . . . . . . . . . . . . . . . . . 31 1.6.2 Implica ions o P ac ice . . . . . . . . . . . . . . . . . . . . . . . . 32 1.6.3 Limi a ions ............................... 34 1.7 Conclusion ................................... 35 2 Resea ch Con ibu ions 42 2.1 Con ibu ion 1: IT-suppo ed Hospi al Discha ge Managemen —Findings o a Mul i-Me hod Resea ch Design . . . . . . . . . . . . . . . . . . . . . . 43 2.2 Con ibu ion 2: The Fu u e o Digi al Wo k—Use Cases o Augmen ed Reali yGlasses ................................. 58 2.3 Con ibu ion 3: Design Recommenda ions o Augmen ed Reali y Appli- ca ions—A Case S udy in Heal hca e . . . . . . . . . . . . . . . . . . . . . 65 2.4 Con ibu ion 4: Technology-Suppo ed Den al Home Visi s by Non-Medical Pe sonnel o Reduce In ec ion Risk . . . . . . . . . . . . . . . . . . . . . . 68 2.5 Con ibu ion 5: Cos -Bene i Analysis o Using Mixed Reali y in Den- is y—Keeping he Den is in he Pic u e . . . . . . . . . . . . . . . . . . 80 Lis o Figu es 1.1 Augmen ed eali y, assis ed eali y, mixed eali y and i ual eali y ac- co ding o Dwi edi e al. (2021) . . . . . . . . . . . . . . . . . . . . . . . . 10 1.2 Ca ego isa ion o he indi idual con ibu ions acco ding o he design sci- ence app oach (He ne e al., 2004) . . . . . . . . . . . . . . . . . . . . . . 15 1.3 F equency o ISIC di isions associa ed wi h mixed eali y head-moun ed display applica ion scena ios (Ko ekamp, We ning, e al., 2019) . . . . . 19 1.4 F equency o iden i ied use cases o mixed eali y head-moun ed displays (Ko ekamp, We ning, e al., 2019) . . . . . . . . . . . . . . . . . . . . . . 20 1.5 Laye s o he S uc u ed Sys em & In e ac ion F amewo k (own illus a ion) 26 Lis o Tables 1.1 In e connec ion o esea ch ques ions and indings . . . . . . . . . . . . . . 12 1.2 O e iew o con ibu ions included in his disse a ion . . . . . . . . . . . 14 1.3 O e iew o me hods used in his disse a ion . . . . . . . . . . . . . . . . 17 Lis o Abb e ia ions 3D Th ee-Dimensional AR Augmen ed Reali y BPMN Business P ocess Model and No a ion CBA Cos -Bene i Analysis DSR Design Science Resea ch ECIS Eu opean Con e ence on In o ma ion Sys ems FHIR Fas Heal hca e In e ope abili y Resou ces HDM Hospi al Discha ge Managemen HMD Head-Moun ed Display ISIC In e na ional S anda d Indus ial Classi ica ion IT In o ma ion Technology LNI Lec u e No es in In o ma ics MR Mixed Reali y RQ Resea ch Ques ion VoFI Visualisa ion o Financial Implica ions VR Vi ual Reali y WI Wi scha sin o ma ion (EN: Business In o ma ics) WKWI Wissenscha liche Kommission Wi scha sin o ma ik im Ve band de Hochschulleh e ü Be iebswi scha e.V. 1 In oduc o y O e iew 1.1 S a e o he A Mode n heal hca e sys ems ace inc easing challenges, pa ly due o ou da ed s uc u es and poli ical negligence. Po e and Gu h (2012) epo a sho age o skilled wo ke s, gaps in heal hca e p o ision, especially in u al egions, inc easing cos s, and luc ua ing ca e quali y. Inconsis en echnology s anda ds and p op ie a y in e aces lead o media discon inui ies. In e sec o al da a sha ing, in pa icula , s ill elies on pape -based da a ans e , he eby inc easing he likelihood o e o s and in o ma ion loss, and u he exace ba ing he al eady high wo kload o heal hca e p o essionals (Mille & S ie , 2014; Wong & Hogan, 2016). Cu en ly, se e al e o s aim o add ess hese challenges, pa icula ly h ough he use o echnology. In Ge many, se e al laws we e es ablished ha empowe he use o mode n echnologies o b ing heal hca e o people, including he use o elemedicine (Bundesminis e ium ü Gesundhei , 2019), and apps ha suppo pa ien s (Bundesmin- is e ium ü Gesundhei , 2020b), people in need o long- e m ca e, o ca egi ing ela i es (Bundesminis e ium ü Gesundhei , 2023). To imp o e da a ans e and a ailabil- i y, he elec onic heal h eco d (Bundesminis e ium ü Gesundhei , 2020a)—a pa ien - managed online eposi o y o heal h- ela ed da a—was in oduced. By suppo ing he in e na ional Fas Heal hca e In e ope abili y Resou ces (FHIR) s anda d (HL7 In e - na ional, 2024), au ho ised heal hca e p o essionals and he pa ien s hemsel es can place and synch onise ele an heal h documen s in his cen al space. Despi e hese e - o s, he p e iously men ioned echnologies a e only slowly gaining momen um (Schmi , 2024). The pa ame e s in luencing echnology adop ion a e mani old, as is he deg ee o echnologisa ion wi hin he heal hca e sys em. While some medical in e en ions a e suppo ed by ul a-mode n echnological achie emen s, such as he da Vinci Su gical Sys em (G ade e al., 2019), o he p ocesses emain pape -based o ely on ou da ed echnologies, such as ax sys ems, o he communica ion o pa ien da a (Ko ekamp, Süßmu h, e al., 2019). Den al p ac ices o en ha e a compa a i ely high deg ee o digi isa ion (Mühlemann e al., 2019). Technology is employed in a ious a eas, including pa ien managemen , imaging, and he ab ica ion o ce amic es o a ions. One impo an ac o in luencing echnology adop ion is he pe cei ed ad an age, such as inancial bene i s o imp o ed ea men quali y (Bhambhani e al., 2013). In his disse a ion, mixed eali y (MR) is de ined acco ding o Dwi edi e al. (2021). To e lec he g owing numbe o possible combina ions be ween physical and i ual 1.4 Resea ch Design In oduc o y O e iew o p e iously speci ied p oblems wi hin he heal hca e sys em by p o iding guidelines, equi emen s, and usage scena ios o ailo ed so wa e ha can suppo heal hca e p o- essionals. The o e all objec i e is o esea ch how echnology, pa icula ly MR HMDs, can help add ess mode n p oblems o heal hca e p o essionals. The objec i es o indi idual con i- bu ions a y depending on he ocus, including he de elopmen o design guidelines o MR HMD so wa e (Ko ekamp e al., 2020) o a cos -bene i analysis o MR HMDs in den al p ac ices (Ko ekamp e al., 2024). Each con ibu ion p esen s di e en a e ac s ha con ibu e o he o e all goal o he wo k, which is o iden i y ac o s in luencing he adop ion and use o MR HMDs in he heal hca e sec o . To add ess he opic o design and de elopmen , sys ema ic esea ch me hods like li e a u e sea ch, expe in e iews and g oup discussions we e used o de elop speci ic usage scena ios and design p inciples (Ko ekamp e al., 2020, 2021). Fu he mo e, a complex cos -bene i amewo k was de eloped o e alua e he inancial alue o MR HMDs in den al p ac ices (Ko ekamp e al., 2024). Fo demons a ion and e alua ion pu poses, heo e ical demons a ions and implemen- a ion concep s illus a ed he a e ac s’ unc ionali y. Fo example, he design p inciples o MR HMD applica ions we e p esen ed based on a concep o an applica ion ha could suppo ch onic wound managemen p o essionals. The cos -bene i amewo k was e alua ed du ing expe in e iews, based on an exempla y use-case scena io. These heo e ical app oaches helped o assess he usabili y and economic iabili y o he de- eloped a e ac s. The inal s ep, communica ion, was accomplished by p esen ing he esea ch indings a a ious in e na ional con e ences, including he Eu opean Con e ence on In o ma- ion Sys ems, and publishing hem in jou nals o make hem a ailable o he scien i ic communi y and p ac i ione s. The o e all me hodological app oach ollows a mixed-me hods design (Venka esh e al., 2013), combining quali a i e and quan i a i e elemen s o p o ide a comp ehensi e unde s anding o he esea ch p oblem. Gi en he no el y o he opic o MR HMDs, pa - icula ly in he heal hca e sec o , quali a i e me hods we e he p edominan app oach. On he one hand, he lack o da a became appa en du ing he li e a u e sea ches, which, despi e using b oad sea ch e ms, yielded only a limi ed numbe o ele an e- sul s. Addi ionally, when a emp ing o collec p ac ice da a, only a ew p o essionals wi h expe ience in using MR HMDs in a medical con ex could be ound, making i im- possible o conduc quan i a i e su eys. Howe e , quan i a i e me hods we e applied whe e app op ia e, o example, in he cos -bene i analysis. Table 1.3, oge he wi h he ollowing pa ag aphs, p o ides an o e iew o he me hods used. In e iews a e a quali a i e esea ch me hod ha helps o gain deepe insigh s in o he in e iewees’ subjec i e opinions, expe iences, and pe spec i es. One o hei bene i s is ha hey allow o he explo a ion o speci ic ques ions while s ill allowing o esponses o un o eseen aspec s. In e iews a e sui able o unde s anding complex p ocesses ha depend on he in e iewees’ indi idual expe iences (Gläse & Laudel, 2010). In his dis- 16 1.4 Resea ch Design In oduc o y O e iew Resea ch Me hod Con ibu ion Re e ence 12345 Quali a i e Me hods In e iews Gläse and Laudel, 2010 G oup Discussion Flick, 2009 Shadowing McDonald, 2005 Li e a u e Re iew Vom B ocke e al., 2015; Webs e and Wa son, 2002 Quali a i e Con en Analysis May ing, 2014 Quan i a i e Me hods Cos -Bene i Analysis G ob, 1989; Heis e , 1962; Sassone and Scha e , 1978 Mon e-Ca lo Simula ion Sa ides, 1994 Table 1.3: O e iew o me hods used in his disse a ion se a ion, in e iews we e employed o gain a deep unde s anding o he daily challenges aced by heal hca e p o essionals (Ko ekamp, Süßmu h, e al., 2019) and o alida e he indings used o calcula e he VoFI ables (Ko ekamp e al., 2024). G oup discussions a e a quali a i e esea ch me hod especially sui ed o ga he collec- i e opinions, a i udes and pe cep ions on a p ede ined opic. Acco ding o Flick (2009), he pa icipan s’ in e ac ions du ing g oup discussions allow esea che s o disco e new pe spec i es and illumina e he opic in-dep h. The cha ac e o he discussions p o- mo es open exchange, allowing esea che s o analyse no only indi idual opinions bu also g oup dynamic p ocesses and collec i e iews. The me hod is especially sui ed o including di e en in e es g oups. This disse a ion employed g oup discussions o de- elop a concep o an MR-based use in e ace (Ko ekamp e al., 2020) and o iden i y po en ial use cases and challenges o using MR HMDs in den al p ac ices (Ko ekamp e al., 2021). Shadowing is a quali a i e esea ch me hod whe e he esea che obse es a pe son in hei na u al wo k en i onmen . The goal is o ollow he pe son’s ac i i ies and in e ac ions o gain a deepe unde s anding o hei asks, p ocesses and challenges. Shadowing is especially use ul o analysing wo k and decision p ocesses in a eal-wo ld con ex , as i allows he esea che o obse e no only he pe son’s ac ions bu also he si ua ional con ex and in e ac ions wi h o he ac o s (McDonald, 2005). In con as o in e iews o ques ionnai es, shadowing p o ides di ec and de ailed insigh s in o p ac- 17 1.4 Resea ch Design In oduc o y O e iew ice, elimina ing he need o e ospec i e o subjec i e epo s om pa icipan s. In his disse a ion, shadowing was used o gain an unde s anding o he daily challenges and p ocesses aced by discha ge managemen employees. This me hod unco e ed alu- able insigh s such as c i ical p ocesses and media dis up ions in in e - and in asec o al in o ma ion lows (Ko ekamp, Süßmu h, e al., 2019). Li e a u e e iew is a sys ema ic me hod ha helps o iden i y, analyse and agg ega e exis ing knowledge wi hin a speci ied esea ch opic. Using a s uc u ed app oach, li e - a u e e iews can help o iden i y esea ch gaps and pu esea ch in o con ex . Sys em- a ically selec ing and analysing scien i ic publica ions om ele an da abases ensu es holis ic and esilien indings (Vom B ocke e al., 2015; Webs e & Wa son, 2002). In his wo k, li e a u e e iews we e employed o p o ide an o e iew o he cu en s a e o he a ega ding he use o MR HMDs in heal hca e en i onmen s. Fo example, a li e a u e sea ch o o e 650 publica ions om ele an da abases, such as EBSCOhos , p o ided insigh s in o he cu en use o MR HMDs ac oss di e en ades and use cases, and allowed o he de i a ion o guidelines o decision-make s and asks o esea che s (Ko ekamp, We ning, e al., 2019). Quali a i e con en analysis is a s uc u ed me hod o sys ema ically de i ing ca e- go ies om la ge amoun s o da a, such as in e iew ansc ip s o li e a u e. May ing (2014) dis inguishes be ween an induc i e and deduc i e app oach depending on whe he he ca ego ies a e de eloped based on he ma e ial (induc i e) o based on exis ing he- o y (deduc i e). The goal is o ex ac ele an da a and s uc u e i in a clea and comp ehensible manne , allowing well- ounded insigh s o be de i ed. In his disse - a ion, quali a i e con en analysis is used o analyse da a om expe in e iews and li e a u e sea ch. Fo ins ance, o gain a holis ic pic u e o he use s’ needs, he equi e- men s analysis o MR HMD so wa e used in den al applica ions employs in e iew ansc ip s and ele an li e a u e o deduce key equi emen s and summa ise hem in o supe o dina e ca ego ies. Cos -bene i analysis is a quan i a i e me hod ha sys ema ically assesses a p ojec ’s economic ad an ages and disad an ages. Cos -bene i analysis (CBA) is sui able o e alua ing mone a y and non-mone a y cos s o p o ide a well- ounded basis o in es - men decisions (G ob, 1989). Heis e (1962) de eloped he me hod u he o make i sui able o complex p ojec s wi h mul iple a iables and unce ain ies. The me hod o e s a de ailed s uc u e o iden i ying, e alua ing and p io i ising cos s and bene i s h oughou an in es men ’s li e cycle. This disse a ion employs a CBA o e alua e he economic iabili y o using MR HMDs in den al p ac ices. To alida e he indings, VoFI ables and Mon e-Ca lo simula ions we e used o analyse possible isks ega ding u u e in es men s (Ko ekamp e al., 2024). 18 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew 1.5 Summa y o Con ibu ions and Essen ial Findings In he ollowing sec ion, he indings om he a ious con ibu ions a e hema ically g ouped o add ess he h ee o e a ching esea ch ques ions (see Sec ion 1.3). How MR HMDs can be applied in he business sec o , pa icula ly in heal hca e (RQ1) is answe ed in Sec ions 1.5.1 and 1.5.2. The esul s o Sec ions 1.5.3 and 1.5.4 con ibu e o equi emen s and design p inciples ha should be conside ed o he use o MR HMDs (RQ2), wi h Sec ion 1.5.3 highligh ing possible ba ie s and Sec ion 1.5.4 p esen ing de i ed ecommenda ions and p inciples. Sec ion 1.5.5 p o ides insigh s in o he cos - e iciency o MR HMDs (RQ3). Sec ion 1.4 o e s a de ailed o e iew o he esea ch me hods employed; he e o e, his sec ion will ocus on he indings. 1.5.1 Applica ions o Mixed Reali y Head-Moun ed Displays in Heal hca e To be e unde s and he echnological and economic con ex o he p esen ed appli- ca ion scena ios o MR HMDs in heal hca e, he In e na ional S anda d Indus ial Classi ica ion o All Economic Ac i i ies (ISIC) (Uni ed Na ions. S a is ical Di ision, 2008) is used as a amewo k. ISIC de ines 21 sec ions, u he di ided in o 78 di isions. Ko ekamp, We ning, e al. (2019) iden i ied nine sec ions and 26 di isions associa ed wi h MR HMD applica ion scena ios. Figu e 1.3 p esen s an o e iew o he ele an di isions and he equency wi h which he ade di isions a e named in he li e a u e. Among hese, he ca ego y Human heal h and social wo k ac i i ies s ands ou , wi h a equency o o e 25%, ma king i as he mos equen ly ci ed a ea. Figu e 1.3: F equency o ISIC di isions associa ed wi h mixed eali y head-moun ed dis- play applica ion scena ios (Ko ekamp, We ning, e al., 2019) 19 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew Figu e 1.4: F equency o iden i ied use cases o mixed eali y head-moun ed displays (Ko ekamp, We ning, e al., 2019) Wi hin hese ade di isions, Ko ekamp, We ning, e al. (2019) iden i ied se en ap- plica ion scena ios as shown in Figu e 1.4. In he con ex o heal hca e applica ions, h ee p ima y scena ios a e pa icula ly ele an : da a access & isualisa ion, aining & educa ion, and collabo a ion & communica ion. Acco dingly, his sec ion will ocus on hose scena ios. Wi hin he Da a Access and Visualisa ion applica ion scena io, MR HMDs a e em- ployed ac oss a ious medical use cases, including ch onic wound managemen , den al home isi s by non-medical s a , and he isualisa ion o p ocedu al s eps in den al p epa a ion, planning, and su ge y. In he con ex o ch onic wound managemen , MR HMDs can be used e ec i ely du ing wound assessmen (Ko ekamp e al., 2020). A key ad an age is hei hands- ee usage, so ha documen a ion and ea men can be pe o med simul aneously wi hou he need o e-s e ilisa ion in be ween. This acili a es mo e de ailed and p ecise documen a ion, which is c ucial o ea men success (Deu sches Ne zwe k ü Quali ä sen wicklung in de P lege, 2015). Pa ien s bene i om as e wound healing, while cos -bea e s bene i om educed ea men cos s. Especially when combined wi h sma ea u es, such as con ex -sensi i e sugges ions o app op ia e wound ma e ials, cos s can be signi ican ly educed, as cu en ly only 30% o 40% o ch onic wound ca e ma e ials a e being used e ec i ely (Made , 2016). MR HMDs could also elie e den is s by enabling allied den al pe sonnel o pe o m a ious den al asks. Ko ekamp e al. (2021) epo i e possible use cases ha could be pe o med du ing home isi s by allied den al pe sonnel based on hei aining and expe ise i equipped wi h an MR HMD. The use cases ange om ideo documen a ion o he o al ca i y pe o med by medical o nu sing s a o den al p ophylaxis pe o med 20 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew by a den al hygienis . The MR HMD can suppo he den al pe sonnel by p o iding in o ma ion abou he pa ien , guiding hem h ough p ocedu es and documen ing he ea men ou come. I necessa y, he den is o o he expe s can be consul ed ia a ideo call, allowing hem o obse e he pa ien ’s si ua ion di ec ly h ough he MR HMD’s came a eed. Ano he use case in he Da a Access and Visualisa ion applica ion scena io in ol es he u ilisa ion o MR HMDs du ing p epa a ion, planning and su ge y. Using he pa ien ’s 3D da a, ana omical s uc u es can be iewed and analysed in 3D du ing p eope a i e planning (Ko ekamp e al., 2024). Du ing su ge y, he 3D imaging da a can be o e laid on o he pa ien and enhanced wi h addi ional in o ma ion, such as he co ec d ill posi ioning and c i ical ana omic s uc u es (Song e al., 2018). In implan ology, he p eope a i ely planned placemen can be compa ed wi h he cu en implan posi ion in eal- ime (Pelleg ino e al., 2019; Yo pibulwong e al., 2022). The aining and educa ion applica ion scena io en ails use cases applicable o all s ages o den al educa ion, om s uden o specialis aining. Using he 3D isualisa ion capabili ies o MR HMDs o s udying den al ana omy by p o iding supplemen a y 3D isual ma e ial ac i a es highe -o de cogni i e skills and, hus, can enhance he lea n- ing expe ience signi ican ly (Espejo-T ung e al., 2015). Addi ionally, using MR HMDs can help simula e complex p ocedu es. Specialised simula o s combine MR HMDs wi h moni o s and hap ic de ices o simula e a wide ange o den al p oblems wi hou con- suming na u al ma e ials, allowing s uden s o ge accus omed o he co ec pos u e and de elop necessa y ine mo o skills (Li e al., 2022). Collabo a ion and communica ion is ano he applica ion scena io o MR HMDs. The collabo a i e ea u es enable in e disciplina y coope a ion by p o iding he ools o expe s om di e en speciali ies o iew he same 3D da a and join ly consul on he op imal su gical p ocedu e (Ba ella e al., 2021). Addi ionally, he use o his echnology can enhance s uden -ins uc o in e ac ions in clinical aining en i onmen s. Fo example, ins uc o s can p o ide immedia e guidance while obse ing p ocedu es om he s uden ’s pe spec i e du ing p ac ical aining sessions, which leads o mo e e ec i e supe ision (Må ell-Olsson & Jahnke, 2019). 1.5.2 T ans o ma i e Oppo uni ies in Heal hca e The abo e-men ioned usage scena ios and capabili ies o MR HMDs ha e he po en ial o p o ide se e al bene i s when using hem in heal hca e se ings. Op imised ope a ional wo k lows. Using an MR HMD can imp o e ope a ional e i- ciency and e ec i eness (Ko ekamp, Süßmu h, e al., 2019; Ko ekamp e al., 2024) by helping s eamline wo k lows, educing ea men ime and he need o suppo i e s a (Ko ekamp e al., 2024). Telecommunica ion and documen a ion ea u es could imp o e o e all ime managemen in den al p ac ices by allowing allied den al pe sonnel o ake o e de ined asks, he eby educing he doc o ’s wo kload (Ko ekamp e al., 2021). 21 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew Medical p ocess enhancemen . MR HMDs can help du ing di e en s ages o medical wo k lows. S a ing wi h p e-ope a ional planning, he 3D isualisa ion o pa ien da a can lead o a be e spa ial unde s anding o ana omical s uc u es, and hus o mo e p ecise p ocedu es (Ba ella e al., 2021). Using he elecommunica ion ea u e in his con ex can also imp o e in e disciplina y coope a ion, helping in complex cases whe e di e en medical disciplines need o collabo a e o success ul su ge y (Ba ella e al., 2021). Du ing su ge y, p ojec in o ma ion such as con ex -based da a, isual cues and 3D ana omical s uc u es can be p ojec ed di ec ly on o he pa ien o in o he su geon’s iew, helping wi h na iga ion and keeping hei ocus on he pa ien (A ms ong e al., 2016; Song e al., 2018). Howe e , MR HMDs can also be help ul in o he heal hca e se ings, such as pa ien ca e, by p o iding eal- ime da a and ins uc ions o he wea e (Ko ekamp e al., 2020). Fo example, ele an pa ien in o ma ion and guidelines can be di ec ly displayed wi hin he wea e ’s ield o iew, elimina ing he need o shi a en ion be ween documen a ion on pape o ano he sc een, he eby keeping he ocus on he pa ien (Klinke e al., 2020). This can also be used o s ep-by-s ep ins uc ions and o suppo less expe ienced s a while pe o ming complex o new asks (Ko ekamp e al., 2021). E icien da a handling in s e ile en i onmen s. A signi ican ad an age is he hands- ee usage o MR HMDs (Klinke e al., 2020; Ko ekamp, We ning, e al., 2019; Ko - ekamp e al., 2020, 2021; Mewes e al., 2017). Especially in s e ile en i onmen s, as his ea u e enables he wea e o access, isualise and edi da a wi hou he isk o con- amina ion du ing medical ea men s (Ko ekamp, We ning, e al., 2019; Ko ekamp e al., 2020, 2021). Fo example, in he case o ch onic wound ca e ea men , his can lead o imp o ed ou comes o pa ien s and heal hca e p o ide s alike, as con inuous and de ailed documen a ion is an impo an ac o o he wound healing p og ess when ea ing ch onic wounds (Ko ekamp e al., 2020; Pan il e al., 2015). Enhanced da a a ailabili y is also bene icial o o he a eas in heal hca e, as da a dis up ion emains an essen ial opic, especially when conside ing da a dis up ion in combina ion wi h in e - sec o al pa ien ans e s (Ko ekamp, Süßmu h, e al., 2019). Real- ime collabo a ion. MR HMDs echnology p o ides ideo calls and i ual mee - ings, enabling di e se applica ions o coope a ion and collabo a ion. Du ing hose mee - ings, he pa ien ’s 3D da a can be iewed by all pa icipan s so ha i can be used o in e sec o al umou boa ds o p eope a i e planning sessions o complex cases (Ko - ekamp e al., 2024; Teppe e al., 2017). When encoun e ing issues du ing medical ea men , MR HMDs can also acili a e coope a ion wi h dis an expe s who can be consul ed ia a ideo call. The ad an age is ha he expe can iew he si ua ion om he wea e ’s pe spec i e, he eby gaining a be e unde s anding o he si ua ion and he pa ien ’s condi ion (Ko ekamp e al., 2020, 2021). Apa om po en ially be e pa ien ou comes, his also has ad an ages in e ms o educed a el cos s and ime (Ko ekamp e al., 2024). 22 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew Medical educa ion and aining. P ac ical expe ience plays an impo an ole in med- ical educa ion and aining. MR HMDs can enhance on- he-job aining by p o iding con ex -sensi i e in o ma ion o emo e suppo om expe s (Ko ekamp, We ning, e al., 2019). The imp o ed spa ial unde s anding and simula ion capabili ies o specialised aining gea can enhance s uden s’ p ac ical skills wi hou equi ing physical esou ces, such as eal ee h, o s udying oo h mo phology (Mah ous e al., 2021; Mladeno ic, 2020). Using he 3D p esen a ion capabili ies, s uden s can imp o e hei knowledge o ana omic s uc u es (Espejo-T ung e al., 2015), lea n complex p ocedu es and—when combined wi h specialised gea like he Uniden al Mixed Reali y Simula o —acqui e he necessa y ine mo o skills and co ec pos u e needed o hei wo k as a den is (Li e al., 2022). Cus omised isual augmen a ion. Ano he use case, apa om medical ca e, is he use o MR HMDs by isually impai ed indi iduals. Since MR HMDs a e see- h ough and enhance eali y wi h isual in o ma ion, hey can be used o assis he wea e in hei daily li es and also help hem wi h na iga ion (Sandnes & Eika, 2017). I is also possible o highligh impo an objec s o imp o e he en i onmen ’s isual con as s o accommoda e hei wea e ’s needs (Eh lich e al., 2017). 1.5.3 Ba ie s o E ec i e Implemen a ion The ollowing subsec ion p esen s po en ial obs acles and challenges, including echno- logical limi a ions, accep ance om medical p o essionals and ques ions ega ding da a secu i y. In eg a ion and in e ope abili y challenges. The in eg a ion o new in o ma ion ech- nology (IT) sys ems in o exis ing heal hca e IT ecosys ems is o en challenging, as many manu ac u e s o heal hca e IT solu ions s ick o hei p op ie a y s anda ds. P o iding he necessa y in e aces may equi e high expendi u es o ei he de elopmen o licens- ing cos s. Howe e , o use MR HMDs e ec i ely, da a exchange and compa ibili y a e c ucial (Ko ekamp, We ning, e al., 2019). E en mo e complex is he opic o in e sec o al communica ion (Ko ekamp, Süßmu h, e al., 2019), i.e., sha ing da a be ween inpa ien and ou pa ien acili ies, as his in ol es no only echnical speci ica ions bu also p ocedu al hu dles, especially adhe ence o p i acy laws (Ko ekamp, Süßmu h, e al., 2019). Adminis a i e and ope a ional o e heads. Apa om echnical and egula o y di i- cul ies, in oducing a new IT sys em such as an MR HMD will also come wi h signi ican adminis a i e o e heads du ing he implemen a ion phase (Ko ekamp, Süßmu h, e al., 2019; Ko ekamp e al., 2024). Be o e i can be used e icien ly, p ocesses migh need ewo king, and he s a needs adequa e aining. Du ing he amilia isa ion and aining phase, he wo kload and cos s migh be highe han be o e, un il he new p ocesses wo k smoo hly and he bene i s ake e ec (Ko ekamp e al., 2024). Especially in he medical 23 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew ield, his can be a hu dle, as he wo kload is al eady high and he nega i e aspec s o he implemen a ion phase a e mo e angible han he long- e m bene i s (Ko ekamp e al., 2024). Regula o y and da a secu i y challenges. The use o new echnology is o en con- on ed wi h di e en legal ques ions. Especially on mobile de ices, conce ns ega ding he secu i y o ulne able pa ien da a a ise (Ca enzo e al., 2015; Kane sky e al., 2019; Spa wasse e al., 2018). The e o e, igo ous secu i y measu es need o be implemen ed, including hose ha comply wi h applicable egula o y equi emen s (Ko ekamp e al., 2024). Howe e , hese measu es in combina ion wi h obus secu i y p o ocols can inc ease he echnical and inancial bu dens (Ko ekamp, Süßmu h, e al., 2019), con- ibu ing u he o he discou aging e ec . In combina ion wi h equi emen s om exis ing da a p i acy egula ions, such as he GDPR (Eu opean Pa liamen and Coun- cil, 2016), ealising e icien and accessible in o ma ion, especially ac oss ins i u ional bounda ies, is o en challenged by pa ien da a p o ec ion equi emen s (Ko ekamp, Süßmu h, e al., 2019). Technical limi a ions. Technology is ad ancing apidly, bu o he cu en models, some echnical limi a ions o heal hca e use cases we e epo ed. Cu en models ha e pe o mance limi a ions ega ding hei limi ed s o age capaci y and p ocessing powe (Gala i e al., 2020; Talaa e al., 2019). The mobile p ocesso capabili ies cons ain he e icien use o complex applica ions (Gala i e al., 2020; Spa wasse e al., 2018). Addi ionally, he ba e y li e was ound o be unsa is ac o y, limi ing con inuous usage du ing p olonged p ocedu es (Gala i e al., 2020; Ma in e al., 2020; Spa wasse e al., 2018). In addi ion, many mobile MR HMD applica ions ely hea ily on ne wo k connec ions, so ha ne wo k s abili y and bandwid h issues can signi ican ly dis up usage (Ma in e al., 2020). The abo e limi a ions can be pa ly ci cum en ed by using MR HMDs ha a e no s and-alone bu a e powe ed by a desk op compu e . Howe e , he e, he equi ed cable connec ions and he mobili y loss we e deemed imp ac ical (Moosbu ne e al., 2019; Spa wasse e al., 2018). Use expe ience and in e ac ion. Using MR HMDs in a p o essional con ex also means ha he sys em is used daily o mo e ex ended pe iods. This makes com o an impo an ac o (K ichenbaue e al., 2014). While he i s Mic oso HoloLens had a on -hea y design ha nega i ely impac ed he use pos u e du ing p olonged use (Gala i e al., 2020), he newe model shi ed cen al componen s like he compu ing uni and ba e y o he back o he headse , esul ing in a mo e balanced composi ion and an enhanced wea ing com o e en du ing longe usage pe iods (Pose-Díez-de-la-Las a e al., 2022). As one o he mos c i ical capabili ies, he isualisa ion o 3D da a and objec s con- ibu es essen ially o he o e all use expe ience. MR HMDs o en su e om a limi ed 24 1.5 Summa y o Con ibu ions and Essen ial Findings In oduc o y O e iew isual ield ha is smalle han he na u al human ield o iew. This can lead o o ien- a ion issues, especially i i ual da a o in o ma ion lies ou side he HMDs’ isual ield (Moosbu ne e al., 2019; Pelleg ino e al., 2019). Al hough help ul o ce ain asks, he i ual o e lays can also ha e a nega i e impac du ing su ge y, as he esponse o un o eseen e en s migh be slowe (Kane sky e al., 2019). Due o he e sa ile usage possibili ies, he con en design o MR HMDs aces some challenges. The de ices a e used in he e ogeneous usage condi ions wi h di e en ligh ing and eal-li e si ua ions (Ko ekamp e al., 2020). This means ha in o ma ion mus be displayed in a manne ha ex and isual con en emain clea and legible ac oss en i onmen s (Emme ich e al., 2017). This also leads o a mix o i ual and eal en i onmen s (Klose e al., 2019) so ha possible dange s migh be o e seen (de Belen & Bedna z, 2019; Klose e al., 2019). As a esul o he a o emen ioned challenges, he usabili y o such de ices is simul a- neously c i ical and challenging. Add essing issues such as com o and use in e ace design is c ucial o b oade accep ance in heal hca e se ings (Be kemeie e al., 2017). Issues named include he calib a ion p ocess o op ical se ings being cumbe some, espe- cially in sha ed-use scena ios (Moosbu ne e al., 2019), and us a ing e o s in oice and ges u e ecogni ion (Gala i e al., 2020; Moosbu ne e al., 2019). The la e is especially p oblema ic o use cases in heal hca e and po en ially s e ile en i onmen s. Use accep ance also depends on success ully in eg a ing he sys em in o he exis ing wo k lows o medical p o essionals. While sys em design plays an impo an ole, o gan- isa ional measu es a e also necessa y, o example, conside ing he expe ience and usage con ex , adap ing exis ing wo k lows o c ea ing incen i es (Ghosh e al., 2017). Adop ion and in eg a ion ba ie s. Va ious conce ns, including e iciency and he cos s associa ed wi h implemen a ion and aining, con ibu e o poo adop ion o MR HMDs (Ko ekamp e al., 2024; Zobel e al., 2016). Ano he poin is ha he e ec i e use o MR HMDs demands a high le el o digi isa ion, such as he a ailabili y o 3D pa ien da a and adequa e ne wo k in as uc u e. To ensu e hese p e equisi es, addi ional in es men s in suppo ing echnologies, such as in a-o al scanne s, migh be necessa y (Ko ekamp e al., 2024). Fu he , cu en so wa e solu ions o MR HMDs a e o en no ce i ied o medical use o don’ ma ch he quali y o adi ional 2D ools, po en ially limi ing hei e ec i eness (Ko ekamp e al., 2024). 1.5.4 S uc u ed Sys em & In e ac ion F amewo k o De eloping Mixed Reali y Head-Moun ed Displays The ollowing sec ion will summa ise he equi emen s om di e en con ibu ions and uni e hem in a s uc u ed sys em and in e ac ion amewo k, in ended o guide he u he de elopmen and adop ion o MR HMDs in medical con ex s. Figu e 1.5 gi es an o e iew o he six laye s ha we e induc i ely de ined by g ouping he indi idual equi emen s in o meaning ul chunks. The laye s build on each o he , s a ing wi h en i onmen al p e equisi es (Laye 1) and p og essing o mo e speci ic equi emen s, 25 1.6 Discussion In oduc o y O e iew addi ion, Con ibu ion 4 supplemen s he knowledge base wi h p inciples o he design o MR sys ems in mobile medical esea ch by p esen ing issues, me a- equi emen s and design p inciples (Ko ekamp e al., 2021). In his con ex , u u e esea ch should ocus on speci ying and e alua ing he design ecommenda ions and design p inciples. Possible cul u al di e ences should also be conside ed. One possibili y would be o es he p esen ed applica ion scena ios in p ac ice, wi h a ocus on usabili y and use accep ance. In addi ion, i could be analysed o wha ex en exis ing design ecommenda ions o iden i ied p oblems om ela ed a eas, such as VR, can also be ans e ed o MR. Ano he i al poin p o ides he implemen a ion concep om Con ibu ion 4 (Ko - ekamp e al., 2021). By linking echnological, o ganisa ional and medical equi emen s wi hin he a eas o heal hca e, in o ma ics and e gonomics, he concep suppo s he demand o in e disciplina y design p ocesses. These indings con ibu e o and suppo he concep s o human-cen ed design (Bødke & Kyng, 2018). Fu he esea ch and es ing a e needed o explo e possible applica ions and he p ac- ical sui abili y o MR o den al home isi s. In e disciplina i y and he indi idual should be conside ed as decisi e ac o s. Con ibu ion 5 success ully ans e s he VoFI me hod o he new con ex o den is y (Ko ekamp e al., 2024). Combined wi h a cos axonomy and a bene i amewo k, i is shown ha hese me hods can be success ully applied o he use case o IT in es men s in he heal hca e sec o . Besides, he ca ego ised cos s and bene i s can be adap ed easily o indi idual scena ios. Mo eo e , a esea ch gap is iden i ied, pa icula ly wi h ega d o he cos s and possi- ble disad an ages o using MR HMDs in he heal hca e sec o , which unde lines he need o co esponding analyses in his a ea (Ko ekamp e al., 2024). Acco dingly, po en ial economic disad an ages and cos s should be u he esea ched o enable he de elop- men o mo e eliable cos ac o s and calcula ions. Case s udies conduc ed wi h den al p ac ices can also be help ul in gene a ing eal-li e da a. In his con ex , u he adop ion pa ame e s should be iden i ied and possible wo k lows analysed. Socio- echnical aspec s also play an impo an ole, which should no be igno ed in u u e esea ch p ojec s. The p esen ed con ibu ions ad ance he scien i ic knowledge base o business in o - ma ics and heal h IT by u he de eloping me hodological app oaches, de i ing ele an design guidelines, and in eg a ing economic and echnological conside a ions. Fu u e esea ch should ocus on empi ically alida ing he p oposed models and u he in es- iga ing he in eg a ion possibili ies o new digi al echnologies in o exis ing heal h IT in as uc u es. 1.6.2 Implica ions o P ac ice The p esen con ibu ions iden i ied se e al challenges ega ding heal h IT and he use o MR HMD de ices. By add essing hese challenges, possible solu ions and implica ions o manu ac u e s and decision-make s could be de i ed. Con ibu ion 1 iden i ied se e al media dis up ions and ine icien p ocesses ha occu speci ically when in o ma ion is sha ed ac oss di e en heal h sec o s, po en ially lead- 32 1.6 Discussion In oduc o y O e iew ing o in o ma ion loss and ca e p oblems du ing in e -o ganisa ional ansi ions. This indica es a need o in e ope able IT sys ems ha enable seamless da a ans e be ween inpa ien and ou pa ien acili ies. In his se ing, IT sys ems ha allow o he sha - ing and accessing o up- o-da e pa ien da a can suppo in e sec o al communica ion and eamwo k, ee up ime esou ces, and elimina e possible sou ces o e o s. These ad an ages can enhance he e iciency and e ec i eness o he wo ke ’s asks. Decision- make s can use hese indings as a basis o hei indi idual equi emen s analysis be o e in es ing in new so wa e ha can simpli y in e disciplina y communica ion and educe manual adminis a i e e o . So wa e manu ac u e s may d aw on hese insigh s as a basis o de eloping use -cen ed sys ems. He e, egula eedback loops can help o con inuously adap he IT sys em o cu en equi emen s (Ko ekamp, Süßmu h, e al., 2019). The ade classi ica ion and use case ca ego isa ion om Con ibu ion 2 p o ides de el- ope s and decision-make s wi h an o e iew o he ades and a eas in which MR HMDs a e al eady being used success ully (Ko ekamp, We ning, e al., 2019). Decision-make s and de elope s may ind his in o ma ion help ul be o e in oducing new MR HMDs in o ades o use cases. I allows hem o ocus i s on easily accessible ades and use cases, whe e MR HMDs a e al eady in use. These scena ios allow hem o u ilise he a ailable eal-li e da a as a basis o ho ough e alua ion and decision-making. Also associa ed wi h a ela i ely low isk a e ade and use cases ha a e simila o hose whe e MR HMDs a e al eady in use. The knowledge om ela ed use cases can be ans e ed o he new use case (Ko ekamp, We ning, e al., 2019). O e all, Con ibu ion 2 o e s ecommenda ions o de eloping new use cases, pa ic- ula ly in indus ies whe e MR HMDs a e less es ablished, such as ag icul u e o wa e managemen . Decision-make s can bene i om he syne gies and inc eased ma ke ac- cep ance ha he ans e o use cases o new indus ies b ings (Ko ekamp, We ning, e al., 2019). Ano he challenge is suppo ing medical s a in a ious ac i i ies wi hin a s e ile en i onmen . This includes e ie ing pa ien da a, documen ing medical ac i i ies pe - o med, and p o iding isual suppo du ing ope a ions by displaying ana omical s uc- u es. MR HMDs enable hands- ee access o his in o ma ion and unc ions (Ko ekamp e al., 2020, 2021, 2024). Con ibu ion 4 and 5 add ess issues ela ed o IT adop ion wi hin he den al sec o . This in o ma ion can be used as a basis o adop ion and de elopmen s a egies. The de ined applica ion scena ios o home isi s, he p ac ical implemen a ion concep using he Mic oso HoloLens 2, and he o e iew o possible applica ions, wi h a ocus on he den al su ge y sec o , enable s akeholde s o make in o med decisions ega ding IT adop ion (Ko ekamp e al., 2021, 2024). Addi ionally, he esul s o Con ibu ion 4 o e guidance o den is s. They help decision-make s o ca ego ise which applica ion scena ios exis , which equi emen s a e necessa y, which implemen a ion app oaches a e al eady a ailable and which p oblems could po en ially a ise. Fo so wa e manu ac u e s, he esul s can be help ul by showing possible applica ions ha new MR HMD sys ems should be able o co e and which 33 1.6 Discussion In oduc o y O e iew indi idual equi emen s he espec i e speciali y places on he sys em (Ko ekamp e al., 2021). The de elopmen o e ec i ely usable digi al heal h applica ions is complex due o he combina ion o a ious egula o y, unc ional and non- unc ional equi emen s in conjunc ion wi h a b oad s akeholde base. The di e en na u e o MR HMDs in e ms o in e ac ion and con en p esen a ion makes he de elopmen o in ui i e applica ions in he medical ield pa icula ly challenging. Con ibu ion 3 and 4 add ess his issue, wi h he o me ocusing on design ecommenda ions o MR HMD applica ions (Ko e- kamp e al., 2020). The la e ocuses on he de ini ion o me a- equi emen s and design p inciples o MR HMDs hemsel es (Ko ekamp e al., 2021). The esul s can se e as a basis o so wa e and ha dwa e manu ac u e s. In e dis- ciplina y use and he ea ly in ol emen o po en ial use g oups a e also emphasised. Apa om ha , he indings can also help in e es ed decision-make s de ine equi e- men s ailo ed o he indi idual si ua ion, he eby simpli ying he selec ion and success- ul in eg a ion o new echnologies in o exis ing in as uc u e and p ocesses. The e a e se e al adop ion ba ie s, especially when i comes o eme ging echnologies wi hin he heal hca e sec o . Howe e , one o he key ques ions is whe he he in es men is p o i able. To add ess his issue, Con ibu ion 5 p o ides a cos - axonomy and bene i amewo k. Decision-make s can apply hese indings o hei own use case o be e conside he po en ial impac s o new in es men s. The exempla y cos -bene i analysis o he use o MR HMDs in a den al p ac ice shows ha MR HMDs ha e he po en ial o be economically ad an ageous unde ce ain condi ions (Ko ekamp e al., 2024). Decision-make s can u ilise he Excel ool o adap he VoFI analysis o hei own needs, allowing hem o base hei decision on ac s a he han eelings. Mo eo e , he indings o Con ibu ion 5 sugges se e al ecommenda ions o decision- make s be o e in es ing in MR HMDs, including ha he MR HMD sys ems need o be ailo ed o hei indi idual needs and equi emen s, and ha he sys em needs o be co ec ly in eg a ed in o exis ing p ocesses o be used e ec i ely (Ko ekamp e al., 2021). The con ibu ions demons a e ha digi al echnologies can enhance inpa ien and ou pa ien ca e in a ious scena ios. Howe e , success depends on a use -cen ed design o he de ice and applica ion, an indi idual assessmen o he si ua ion and economic impac , as well as a close in eg a ion in exis ing wo k p ocesses. 1.6.3 Limi a ions This disse a ion is subjec o se e al limi a ions. Rega ding me hodological and em- pi ical aspec s, mos con ibu ions ely hea ily on indings om li e a u e, al hough s akeholde s we e included whe e possible (Ko ekamp, Süßmu h, e al., 2019; Ko e- kamp e al., 2020). Po en ial use s and heal hca e p o essionals should be included in u he esea ch and de elopmen p ocesses. Besides, he de eloped a e ac s, such as he design guidelines and me a- equi emen s, we e p esen ed h ough concep s. Al hough hose we e based on he indings, a eal-li e e alua ion is s ill pending (Ko ekamp, We ning, e al., 2019; Ko ekamp e al., 2021). Addi ionally, his disse a ion ocuses 34 In oduc o y O e iew mainly on echnical success ac o s o he use o MR HMDs. Socio- echnological and en i onmen al ac o s, such as pa ien and s a accep ance, as well as he in luence o changing en i onmen s du ing e e yday use, should also be aken in o accoun . Ano he ac o is he a ailable echnology. MR HMDs and applica ions a e o en no ully de eloped and lack he necessa y ce i ica ions o use in he medical sec o (Ko ekamp e al., 2024). The echnology and applica ions a e cons an ly being u he de eloped, demanding a con inuous e alua ion. Economic and egula o y limi a ions also play a ole due o esea ch gaps, especially ega ding po en ial cos s o disad an ages o using MR HMD de ices in medical scena - ios. O he ac o s in luencing echnology adop ion besides po en ial cos s and bene i s, such as he legal amewo k, socio- echnological aspec s and echnological ma u i y, mus also be conside ed (Ko ekamp e al., 2024). 1.7 Conclusion This disse a ion aims o explo e he applica ion o MR HMDs in heal hca e se ings, wi h a ocus on ch onic wound ca e and den is y. To answe he de ined esea ch ques ions, he design science app oach was used o ga he ele an in o ma ion om scien i ic li e a u e and ele an s akeholde s. RQ1 is answe ed by iden i ying use cases o suppo ing hospi al discha ge manage- men wo ke s, p o iding an o e iew o indus y sec o s MR HMDs a e cu en ly used in, and de i ing po en ial applica ion scena ios o using MR HMDs in den al p ac- ices. These indings illus a e how hese de ices can be applied in he business sec o , pa icula ly in heal hca e. By de ining equi emen s o a so wa e sys em ha assis s hospi al discha ge manage- men wo ke s, de i ing bes p ac ices o designing MR HMD in e aces and highligh ing issues, me a- equi emen s and design p inciples o MR HMDs his disse a ion gi es in- sigh in o answe s o he ques ion which equi emen s and design p inciples should be conside ed o he use o MR HMDs in heal hca e, and, hus add esses RQ2. The cos -e iciency o MR HMDs in heal hca e se ings is examined by p esen ing a cos axonomy and bene i amewo k o he adop ion o MR HMDs in den al p ac ices in combina ion wi h a sample cos -bene i assessmen , he eby answe ing RQ3. 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In INFORMATIK 2016 (pp. 1727–1740). Gesellscha ü In o ma ik e.V. In addi ion o he sys ema ic li e a u e sea ch, s a u o y equi emen s ega ding he discha ge managemen as well as he expe s anda d discha ge managemen in heal hca e [Ex09] we e analysed. 3 Analysis and Findings 3.1 Consolida ed equi emen s and use cases Use cases a e qualiĄed o a clea p esen a ion o unc ional equi emen s. They p o ide a ool o desc ibing he asks and goals o he in ol ed ac o s as well as he desi ed sys em beha iou in di e en si ua ions. The esul can be used in o de o deba e he le el o he sys em de elopmen in a g oup and o p esen he planning o an in e disciplina y eam o s akeholde s [Co08]. We used he p inciples desc ibed in [Co08] o gain sho and meaning ul use cases. We iden iĄed a o al o 37 equi emen s based on he semis uc u ed in e iews, he shadowing and he sys ema ic li e a u e sea ch. In o de o p o ide a clea and mo e help ul o e iew, we g ouped he equi emen s wi h simila ai s and used his as a basis o he de elopmen o he use cases. Ele en equi emen s a e alid o all in e ac ions wi h he so wa e. They we e assigned o he h ee induc i ely o med ca ego ies: documen a ion and inpu o pa ien da a,in e ope abili y and secu i y (c . Table 1). Ca ego y Requi emen s In e ope abili y Adap s he e minology depending on he use Šs p o ession c,[Hü15; MS14] P o ides a use and igh s managemen c,[Ra16] Is accessible by di e en use s a he same ime a,b,c,[Ra16] Enables all au ho ised s a o access ele an pa ien da a a,c,[Hä17] In eg a es seamlessly in all wo k p ocesses b,c,[Hü15] Suppo s s anda dised p ocesses and esponsibili ies c,[Hä17; HK13; MS14; PK11] Documen a ion and inpu o pa ien da a Runs a eal- ime alidi y check du ing da a inpu b,c,[Ra16] P o ides help unc ionali y o Ąlling ou p edeĄned o ms and epo s b,c,[Ra16] Is able o de ec e o s du ing da a inpu c,[MS14; Ra16; WH16] Secu i y Suppo s he e iĄca iono sen and ecei edelec onicdocumen s b,c,[Ra16] Suppo s high da a secu i y s anda ds a,c,[Ra16] aIn e iews; bShadowing; cLi e a u e Tab. 1: Supe o dina e equi emen s The equi emen s in he ca ego y named In e ope abili y cons i u e he sys emŠs basis. Due o he b oad ange o di e en elec onic hospi al in o ma ion sys ems, i is essen ial ha he desc ibed sys em is compa ible wi h he exis ing one when i comes o e ms o da a inpu and e ie al. In his way, all ele an ac o s can access and edi he pa ien Šs da a. IT-suppo ed Hospi al Discha ge Managemen 69 Di ec ly linked o he Ą s ca ego y, is he ca ego y Documen a ion and inpu o pa ien da a. The sys em suppo s he inpu and modiĄca ion o da a. Po abili y ensu es ha da a can be inpu whe e i is collec ed. The p omp inpu o da a diminishes he chance o incomple e and ou da ed in o ma ion. To u he dec ease he chance o aul y da a, he IT sys em should be able o check he en e ed in o ma ion o alidi y and inconsis encies. Also, da a can be used o Ąll in, send and expo o mulas au oma ically. Manually exchanging da a and edundan da a se s we e a common issue o he in e iewees. Fo example, he p ocess o pa ien admission o pa ien discha ge a he hospi al in ol ed Ą e da a ansi ions om digi al o non-digi al da a and ice e sa ega ding a pa ien Šs medica ion in o ma ion. The las ca ego y Secu i y holds a pa icula posi ion in he managemen o heal h ca e da a. I is no only necessa y o deny unau ho ised pe sons access o he da a bu also o e i y he consigno . Table 2 shows he emaining 26 equi emen s on he le and he de i ed use cases on he igh . Each equi emen ega ding he discha ge managemen o a pa ien ha in ol es in e ac ion wi h he so wa e is ep esen ed in one o ou een use cases. They a e numbe ed consecu i ely o c oss- e e encing in he ex and Ągu e 1. One c i ical ac o in hese use cases is ha use s can di ec ly en e new o missing pa ien da a in he sys em (1). Due o low capaci ies a ollow-up ca e acili ies, he discha ge managemen wo ke has o plan a pa ien Šs hospi al discha ge as soon as possible. The e o e, he iden iĄca ion o ulne able pa ien s is essen ial (2). On he one hand, his ensu es ea ly de ec ion o pa ien s equi ing discha ge managemen and on he o he hand, no esou ces a e was ed on pa ien s no equi ing discha ge managemen . In doing so, an IT-suppo ed sys ema ic assessmen should be implemen ed, and he epo ing o eligible pa ien s mus be as easy as one click (3). In o de o no miss impo an deadlines (e.g. o cos e unds) o gua an ee a seamless ansi ion o he new ca e o ehab acili y, i is he ime componen ha ma e s. In no case should he IT-sys em hinde he discha ge managemen wo ke bu ins ead suppo and au oma ise asks. The e o e, he IT sys em helps by assigning epo ed pa ien s o he esponding wo ke and p o iding help ul o e iews ega ding pa ien s, asks and deadlines (4). Addi ionally, i p o ides an o e iew o possible ollow-up ca e acili ies and medical aids (8, 9). Fu he suppo is gi en, by p o iding an easy and as way o documen he whole p ocess as well as expo ing o mulas o applica ions and accoun ing (7, 10). The discha ge managemen wo ke has di ec con ac o he pa ien in o de o access he p e-hospi al li ing si ua ion as well as wishes ega ding pos -hospi al heal h ca e, e.g. s a u o y o ambulan ca e and he a ou ed ca e p o ide (5, 6). Also, he ac o s a e subjec o conside able cons ain s ega ding hei ime managemen . Recei ing and sendingmessageswi hou heneed o wai o hei coun e pa sa es aluable ime. Time is also a ac o when i comes o he elec onic exchange o pa ien in o ma ion and da a (11-14). Being able o send da a igh om he IT sys em o ollow-up ca e acili ies 70 Sa ah-Sab ina Ko ekamp e al. Use Cases Requi emen s 1 Inpu pa ien da a in o IT sys em Suppo sinpu ands o ageo all necessa y pa ien da a a,b,c,[Ra16] 2 Assess c i ical pa ien s Suppo s a sys ema ic ulne abili y assessmen o new pa ien s a 3 Repo c i ical pa ien s Suppo s a one-click epo o c i ical pa ien s a Inhibi s edundan epo s o c i ical pa ien s a,b 4 Plan asks Assigns epo ed pa ien s au oma ically o he speciĄed esponsi- ble wo ke , e.g. based on he pa ien Šs wa d a Gi es an o e iew o epo ed c i ical pa ien s incl. so ing unc ions a,b,c,[B 13; Ra16] Suppo s ull calenda unc ionali y a Shows asks in a calenda iew a Shows an o e iew o all due asks b,c,[Ex09; Ra16] Suppo s eminde s and p io i y se ings o scheduled e en s a,b,c,[B 13; Hä15; HK13; Ra16] Shows he esponsible discha ge managemen wo ke b,c,[Ra16] 5 Ob ain in o med consen om pa ien Allows he documen a ion o he in o med consen c,[Hä15; Hä17; KS16; MS14] 6 Assess pa ien s needs and wishes Allows simple inpu o da a acqui ed du ing pa ien in e iews on- he-go a,c,[Ex09; Ra16] Mus be po able b Allows o sea ch and access s uc u ed da a and applica ion equi ed o he cos uni a,b,c,[Ra16] 7 Reques e und a cos uni Suppo s he documen a ion, accoun ing da a and appica ion equi ed o he cos uni a,b,c,[Ra16] 8 Reques medical aids Shows in o ma ion ega ding u he ea men possibili ies a 9 Look o ee capaci ies o ollow-up ca e acili ies P o ides an in e ac i e o e iew o possible ollow-up ca e acili ies and home ca e a,b,c,[MS14; Ra16] P o ides an o e iew unc ion showing ee capaci ies om ollow-up ca e p o ide s a,b 10 D aw up and send s a emen o accoun o cos uni Gene a es documen s such as ans e shee s om sa ed pa ien da a a,b 11- 14 Communica ion wi h ollow-up ca e p o ide / acili y Is linked o all necessa y s akeholde s such as anspo a ion a Enables he exchange o da a and in o ma- ion wi h all ele an ollow-up ca e gi e s a,b,c,[B 15; Ex09; Hä12; HK13; Me17; MS14; Os15; Ro13] Is able o exchange elec onic documen s wi h all ele an ollow- up ca e gi e s a Enables in e nal and ex e nal synch onous communica ion b Enables asynch onous communica ion wi h s a iona y and ambu- lan s akeholde s b,c,[Ra16] P o ides eedback unc ion o all ele an s akeholde s a,c,[Ex09] aIn e iews; bShadowing; cLi e a u e Tab. 2: Iden iĄed use cases and esponding equi emen s IT-suppo ed Hospi al Discha ge Managemen 71 leads o highe a ailabili y o pa ien da a wi hou he po en ial o losing da a and ime which may esul om a manual ansmission. The emphasis lies he e on da a secu i y s anda ds including he e iĄca ion o sen and ecei ed documen s. Pa ien da a is highly sensi i e, and in Ge many, in o med consen o he pa ien is necessa y o he ac o s in o de o be able o send hose da a. 3.2 Visualisa ion o he use cases h ough a p ocess model The ŞBusiness P ocess Modeling No a ionŤ (bpmn) is sui ed o documen exis ing p ocesses, in oduce new p ocesses and o isualise changes made by digi ising exis ing p ocesses [FR14]. The no a ion is a he simple wi h s ic ly deĄned elemen s and ules ha can be combined o pic u e complex p ocesses. In his case, he aim is o suppo an exis ing p ocess by implemen ing an IT sys em. Figu e 1 shows he use cases s a ed abo e in bpmn. The p ocess shows ou lanes, one o each p ima y ac o . The lanes a e clus e ed depending on he supe o dina ed ins i u ion. He e, hese a e he hospi al on he one hand and he ollow-up ca e acili y on he o he . Each lane accommoda es he asks ( ec angles) and e en s (ci cles) ha e e o he esponding p ima y ac o . Th ee di e en lines link he sepa a e elemen s. A solid line wi h a Ąlled a ow deĄnes he sequence o asks and e en s, a dashed line wi h an emp y a ow indica es he Ćow o messages, and a do ed line wi h a cu ed a ow links a e ac s. The a e ac s used in his bpmn-p ocess a e he da a s o age and he da a objec . The Ą s exis s independen ly om he p ocess. Fo example, s o ed da a is s ill a ailable a e he p ocess o discha ging a pa ien has ended. The la e ep esen s in o ma ion ha only exis s du ing he un ime o he p ocess Şdischa ge managemen Ť [FR14], i.e. da a is no longe a ailable a e wa ds. The p ocess o a pa ien sŠ discha ge s a s wi h he admission o he pa ien o he hospi al. When en e ing he cen al pa ien admission, he soon- o-be pa ien makes con ac Ą s wi h he nu ses. They collec he pa ien Šs pe sonal in o ma ion and en e he da a in o he IT sys em. Nex , hey conduc a s anda dised assessmen o he pa ien sŠ need o discha ge managemen . The esul is en e ed in o he IT sys em. I he pa ien equi es discha ge managemen , he discha ge managemen wo ke is in o med. I no , he p ocess ela ed o discha ge managemen ends. When a pa ien equi es discha ge managemen , he IT sys em no iĄes he discha ge managemen wo ke . The nex s ep is he analysis o he equi ed p oceedings and asks. The IT sys em suppo s he discha ge managemen wo ke wi h an o e iew o epo ed pa ien s. I also helps wi h so ing ou daily asks. The discha ge managemen wo ke hen isi s he pa ien in o de o gi e in o ma ion abou he upcoming p ocedu e and ask o in o med consen . An assessmen ega ding he pa ien Šs needs and wishes is ca ied ou . The wo ke di ec ly en e s all he acqui ed in o ma ion in he IT sys em, and hus makes i a ailable o ollowing asks and au ho ised s a . Especially when ega ding pa ien s in 72 Sa ah-Sab ina Ko ekamp e al. Fig. 1: Use case dependencies (bpmn P ocess) IT-suppo ed Hospi al Discha ge Managemen 73 need o discha ge managemen , i is possible ha hey a e no able o make decisions on hei own. In his case, he discha ge managemen wo ke consul s he pa ien Šs cus odian. A e he necessa y s eps o a gapless discha ge a e so ed ou , he discha ge managemen wo ke s a s o ganising he ollow-up ca e. The Ą s s ep is o Ąle applica ions o he esponding cos uni s o he discussed i ems, such as Ąnancing nu sing ca e o medical aids. I a e und is declined, he wo ke will discuss o he possibili ies o adequa e ollow-up ca e wi h he pa ien o cus odian. Two main asks when o ganising he ollow-up ca e a e o de ing needed medical aids and Ąnding a acili y ha p o ides s a iona y o ambula o y ca e. I depends on he needs and wishes o he pa ien , wha measu emen s a e aken. I he pa ien needs medical aids, he espec i e o m can be Ąlled ou au oma ically wi h he a ailable pa ien in o ma ion om he IT sys em. The o m can also be adjus ed manually and hen expo ed o di ec ly sen o he p o ide . Since communica ion wi h ollow-up ca e p o ide s is necessa y, he second ask is mo e di icul . In o de o ci cum en manually calling a lis o ca e acili ies, he IT sys em shows a lis wi h ee capaci ies o he discha ge managemen wo ke . The ca e acili ies p o ide hei s a us in o ma ion a egula ime in e als. The esul s shown can be so ed o limi ed o ma ch he needs o he cu en pa ien . I a ca e acili y is sui able, he IT sys em sends a eques o he chosen acili y. I includes essen ial pa ien in o ma ion such as age, sex and necessa y ca e. The ca e acili y can hen e alua e whe he hey can p o ide he needed ca e o he pa ien . They answe back o he discha ge managemen wo ke ia email. In case o a nega i e answe , he IT sys em sends a new eques o ano he sui able ca e acili y, is he answe posi i e, he wa d o he pa ien is also no iĄed. The nu ses a he wa d main ain con ac wi h he ollow-up ca e acili y and p o ide mo e de ailed in o ma ion ha helps he ca e acili y o plan o he pa ien Šs a i al Ů hus ensu ing gapless ca e a e discha ge. The nu ses a e also esponsible o communica ing he ime and da e o he planned discha ge as well as changes o he plan. A e he success ul ansi ion, he discha ge managemen wo ke is esponsible o d awing up he s a emen o accoun and sending i o he cos uni . Since all execu ed s eps a e documen ed in he IT sys em, he in o ma ion can be used o Ąll ou he p edeĄned o ms au oma ically. The Ąnished o ms can be expo ed o sen di ec ly o he cos uni . 4 Discussion and Conclusion In his pape he esea ch ques ion ŞWha use cases can he IT-sys em suppo o a hospi al discha ge managemen and wha equi emen s o such a sys em exis ?Ť was examined. Thehospi aldischa gemanagemen isanin e disciplina ymul i-use p ocess.Theimplemen- a ion o an IT sys em can enhance he e iciency and e ec i i y o he accomplished asks 74 Sa ah-Sab ina Ko ekamp e al. and goals. The au ho s conduc ed mul i-me hod esea ch in o de o analyse equi emen s o an IT sys em and de i e ele an use cases. Mos equi emen s could be iden iĄed solely by analysing he in e iews and he shadowing p o ocol (32 o 37 equi emen s; 86.5%). Only ele en o he equi emen s esul ed om bo h me hods. The li e a u e analysis, in combina ion wi h he analysis o he s a u e and he expe s anda d Śdischa ge managemen in heal hca eŠ, esul ed in 24 ou o 37 equi emen s (64,9%). Thus, by combining he di e en me hods, a mo e holis ic iew o he opic could be o med. Especially he Śexpe s anda d discha ge managemen Š in heal hca e yielded only a ew equi emen s. The eason migh become e iden when ega ding i s aim. The expe s anda d p o ides an ins umen o secu ing and de eloping quali y in heal h ca e, wi h a ocus on he imp o emen o he coope a ion be ween inpa ien and ou pa ien ca e. I does no cons i u e a se o ules o o ganisa ional p ocesses. The s udy iden iĄed mainly unc ional equi emen s. Non- unc ional equi emen s we e nei he named du ing he in e iews no ound when analysing he li e a u e. The only excep ion is he equi emen Śpo abili yŠ which o igina es om he shadowing. Rega ding he ou come o he li e a u e sea ch, he lack o non- unc ional equi emen s migh be due o he na u e o he ound li e a u e. The publica ions ocus mainly on he inĆuence o new s a u es ega ding discha ge managemen o on enhancing he p ocesses om he pa ien sŠ poin o iew. Howe e , he de elopmen o implemen a ion o IT sys ems is missing. Ne e heless, non- unc ional equi emen s such as usabili y, an in ui i e in e ace, eliabili y andsuppo o lea ningmus be akenin oaccoun , whende elopingITsys ems.Fo una ely, mos o hese equi emen s a e uni e sal and he e o e al eady desc ibed in he scien iĄc li e a u e (c . [Ba11]) as well as in DIN s anda ds (c . [E 06]). The discha ge o a hospi al pa ien is a highly in e disciplina y p ocess. Fo success, communica ion and eamwo k a e key aspec s. The p ocess in ol es no only se e al wa ds wi hin one ins i u ion bu can also equi e se e al independen ambula o y heal h ca e p o essionals. Being able o sha e he da a a he han ha ing o ( e)collec , ( e)inpu and ( e)p in hem anew in e e y ins i u ion o wa d, would ha e wo main ad an ages. Fi s , i would ee mo e ime esou ces ha a e e y ha d in need a he momen (also ega ding he ongoing lack o skilled wo ke s). Second, i would assu e ha up- o-da e pa ien da a is a ailable whe e i is needed and when i is needed. E o s ha may happen by manual ansi ion can be diminished. In addi ion o he p ac ical beneĄ s lis ed abo e, he de elopmen o such IT s uc u es equi es in e disciplina y esea ch in o de o unde s and he ull ange o p oblems and hei solu ions. Also, esea ch ega ding ac o s ha ensu e he pa icipa ion o heal h ca e ins i u ions on he one hand and so wa e de elopmen en e p ises on he o he could be help ul. The lack o so wa e in e aces and he associa ed in e ope abili y o he sys ems migh be one limi e ega ding in e sec o al communica ion. The e o e, we deduced he ollowing implica ions o u u e de elopmen and esea ch: IT-suppo ed Hospi al Discha ge Managemen 75 1. The IT-sys ems should suppo in e sec o al coope a ion and mo i a e he educ ion o hie a chical s uc u es. 2. The sha ing o necessa y pa ien da a wi h heal h ca e p o essionals aking pa in he pa ien Šs ca e should be simpliĄed. 3. Fu he esea ch should be conduc ed wi h an in e disciplina y eam. The same e e s o he de elopmen o so wa e sys ems. The p esen ed esea ch is subjec o some limi a ions. On he one hand, he in e iews and shadowing ely on one hospi al wi h adjoining ca e suppo poin in a u al a ea. On he o he hand, al hough he au ho s in e iewed a ious p o essionals in he hospi al, only one discha ge managemen wo ke was obse ed in he cou se o he shadowing. E en hough he discha ge managemen wo ke occupies he cen al posi ion ega ding he analysed p ocesses, he o he ac o s should be aken in o accoun as well. In u u e esea ch, addi ional s akeholde s such as physicians and pha macis s should be included. Table 3 p o ides an o e iew o he cu en esea ch agenda. Each s ep includes a ee alua ion o he p e ious Ąndings. The aim is o p o ide a holis ic app oach o IT-suppo ed discha ge managemen , comp ised o an in ui i e IT sys em ha suppo s he in e disciplina y p ocesses o he discha ge managemen and guidelines o he ans e o he IT sys ems o ollow up heal hca e ins i u ions. Aim Me hods Findings 1 P o o yping De elopmen o a p o- o ype based on he e- qui emen s S o yboa ds Click-P o o ypes Fo ma i e Analysis IT sys em in p o o- ypic s age ha can be used o ealwo ld es 2 Implemen a ion and Valida ion E alua ion o he p o- o ype Cogni i e Walk- h ough Usabili y S udy Summa i e Analysis Summa i ee alua ion o he de eloped p o- o ype 3 T ans e Concep o ans e o o he heal hca e ins i- u ions Cos -beneĄ analysis Quan i a i e s udy Guideline o gene al- isa ion o IT sys em o o he ins i u ions Tab. 3: Resea ch agenda The implica ions o p ac ice and esea ch highligh he impo ance o IT-sys ems ha can suppo and mo i a e skilled wo ke s owa ds a mo e in e disciplina y and in e sec o al app oach. 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MIS Qua e ly,26(2), xiii–xxiii. h ps://www.js o .o g/s able/ 4132319 2.4 Con ibu ion 4: Technology-Suppo ed Den al Home Visi s by Non-Medical Pe sonnel o Reduce In ec ion Risk Con ibu ion 4 Ti le Technikges ü z e zahnmedizinische Hausbesuche du ch nich -ä z liches Fachpe sonal zu Min- de ung des Ans eckungs isikos Au ho s Sa ah-Sab ina Ko ekamp, Ingma Icke o , F ank Teu ebe g Yea 2021 Medium Jou nal Ou le HMD P axis de Wi scha sin o ma ik Ranking VHB-JOURQUAL 4: C WKWI: B Bibliog aphic in o ma ion Ko ekamp, S.-S., Icke o , I., & Teu ebe g, F. (2021). Technikges ü z e zahnmedizinische Hausbesuche du ch nich -ä z liches Fachpe sonal zu Minde ung des Ans eckungs isikos. HMD P axis de Wi scha sin o ma ik,58, 754–764. h ps://link.sp inge .com/10.1365/s40702-021- 00733-z Iden i ica ion DOI: 10.1365/s40702-021-00733-z Link h ps://link.sp inge .com/a icle/10.1365/s40702-021-00733-z Abs ac Ziel des Bei ags is die Iden i ika ion on P oblemen, Me a-An o de ungen und Designp inzipien ü den Einsa z on Mixed und Vi ual Reali y B illen zu Un e s ü zung nich -ä z lichen Fach- pe sonals bei zahnmedizinischen Hausbesuchen. Im Rahmen on zwei G uppendiskussionen und einem Expe enin e iew wu den zunächs mögliche Einsa zszena ien iden i izie . Anschließend wu de eine sys ema ische Li e a u eche che in den Da enbanken CINAHL, Business Sou ce P e- mie und MEDLINE du chge üh . In de ge undenen Li e a u konn en 14 P obleme bei de Anwendung on Mixed und Vi ual Reali y B illen iden i izie we den. Da au basie end wu den 14 Me a-An o de ungen abgelei e und in ün Designp inzipien zusammenge ass . Abschließend wu den die E gebnisse mi den Spezi ika ionen de Mic oso HoloLens 2 abgeglichen, um eine Eignung ü die Un e s ü zung de geplan en Hausbesuche es zus ellen. Zudem wu de ein Um- se zungskonzep skizzie . Die E gebnisse dienen als wich ige Emp ehlungen ü die p axisnahe Umse zung zukün ige Konzep e bezüglich de Anwendung on Mixed und Vi ual Reali y B illen im (zahn-)medizinischen Kon ex . Die Li e a u eche che zeig eine Fo schungslücke im Be eich zahnmedizinische Hausbesuche au . Die E gebnisse dieses Bei ags scha en dahe eine solide Basis ü die zukün ige Fo schung. SCHWERPUNKT h ps://doi.o g/10.1365/s40702-021-00733-z HMD Technikges ü z e zahnmedizinische Hausbesuche du ch nich -ä z liches Fachpe sonal zu Minde ung des Ans eckungs isikos Sa ah-Sab ina Ko ekamp · Ingma Icke o · F ank Teu ebe g Eingegangen: 15. Janua 2021 / Angenommen: 19. Ap il 2021 © De /die Au o (en) 2021 Zusammen assung Ziel des Bei ags is die Iden i ika ion on P oblemen, Me a- An o de ungen und Designp inzipien ü den Einsa z on Mixed und Vi ual Reali- y B illen zu Un e s ü zung nich -ä z lichen Fachpe sonals bei zahnmedizinischen Hausbesuchen. Im Rahmen on zwei G uppendiskussionen und einem Expe enin- e iew wu den zunächs mögliche Einsa zszena ien iden i izie . Anschließend wu - de eine sys ema ische Li e a u eche che in den Da enbanken CINAHL, Business Sou ce P emie und MEDLINE du chge üh . In de ge undenen Li e a u konn en 14 P obleme bei de Anwendung on Mixed und Vi ual Reali y B illen iden i izie we den. Da au basie end wu den 14 Me a-An o de ungen abgelei e und in ün Designp inzipien zusammenge ass . Abschließend wu den die E gebnisse mi den Spezi ika ionen de Mic oso HoloLens 2 abgeglichen, um eine Eignung ü die Un e s ü zung de geplan en Hausbesuche es zus ellen. Zudem wu de ein Umse - zungskonzep skizzie . Die E gebnisse dienen als wich ige Emp ehlungen ü die p axisnahe Umse zung zukün ige Konzep e bezüglich de Anwendung on Mixed und Vi ual Reali y B illen im (zahn-)medizinischen Kon ex . Die Li e a u eche - che zeig eine Fo schungslücke im Be eich zahnmedizinische Hausbesuche au . Die E gebnisse dieses Bei ags scha en dahe eine solide Basis ü die zukün ige Fo schung. Schlüsselwö e Designp inzipien · Mixed Reali y · Vi ual Reali y · Head- Moun ed De ices · Zahnmedizinische Hausbesuche S.-S. Ko ekamp () · I. Icke o Ins i u ü Managemen und Kul u , Hochschule Osnab ück, Lingen, Niede sachsen, Deu schland E-Mail: s[email p o ec ed] S.-S.Ko ekamp·F.Teu ebe g Fachgebie ü Un e nehmens echnung und Wi scha sin o ma ik, Uni e si ä Osnab ück, Osnab ück, Niede sachsen, Deu schland K S.-S. Ko ekamp e al. Technology-assis ed den al home isi s by nondoc o al p o essionals o educe he isk o in ec ion Abs ac The aim o his pape is o iden i y p oblems, me a- equi emen s and design p inciples o he use o mixed and i ual eali y glasses o suppo nondoc- o al p o essionals du ing den al home isi s. In he cou se o wo g oup discussions and one expe in e iew, possible applica ion scena ios we e i s iden i ied. Sub- sequen ly, a sys ema ic li e a u e sea ch was conduc ed in he da abases CINAHL, Business Sou ce P emie and MEDLINE. The li e a u e e ealed 14 p oblems in he applica ion o mixed o i ual eali y glasses. Based on his, 14 me a- equi emen s we e de i ed and summa ised in i e design p inciples. Finally, he esul s we e compa ed wi h he speci ica ions o he Mic oso HoloLens 2 o de e mine sui abil- i y. An implemen a ion concep was also ou lined. The esul s se e as impo an ecommenda ions o he p ac ical implemen a ion o u u e concep s ega ding he applica ion o mixed and i ual eali y glasses in a (den al) medical con ex . The li e a u e e iew e eals a esea ch gap in he ield o den al home isi s. The e o e, he esul s o his pape p o ide a solid basis o u u e esea ch. Keywo ds Design p inciples · Mixed eali y · Vi ual eali y · Head-moun ed de ices · Den al home isi s 1 Einlei ung Au g und de Co ona-Pandemie wu den in ielen Lände n Maßnahmen ge o en, die eine Ausb ei ung on Co id-19 möglichs eindämmen sollen. Bes imm e Pe - soneng uppen, wie äl e e Menschen mi ch onischen E k ankungen, sind du ch ein e höh es In ek ions isiko und mögliche weise schwe e K ankhei s e läu e besonde s be o en (Jo dan e al. 2020; Zhou e al. 2020). De Besuch beim Zahna z s ell ü diese Pe soneng uppen du ch den engen Kon ak zu ande en Pe sonen o z so g äl ige Hygienemaßnahmen ein e höh es Ans eckungs isiko da . Ein Auslassen de Kon oll e mine ode das Igno ie en on Beschwe den kann alle dings ebenso g a ie ende Folgen haben. So können In ek- ionen im Mund aum du ch eine Ve schleppung on Keimen beispielsweise eine Aspi a ionspneumonie auslösen (Baumga ne e al. 2015). Hausbesuche könn en hie eine mögliche Al e na i e da s ellen, die eine zahn- medizinische Ve so gung e möglich und dabei das Ans eckungs isiko ulne able Pe sonen möglichs minimie . Die Du ch üh ung on zusä zlichen Hausbesuchen s ell abe auch gleichzei ig eine höhe e Belas ung des zahnä z lichen Pe sonals da . Im hausä z lichen Be eich exis ie en be ei s sei Länge em Fo bildungen ü nich -ä z liche P axisassis enzen. Dies e möglich die Delega ion on ansons en ä z - lichen Tä igkei en an nich -ä z liches medizinisches Pe sonal. Nich ä z liches Fach- pe sonal kann so e schiedene Maßnahmen im Rahmen on Hausbesuchen selbs - s ändig du ch üh en (Gisbe Mi alles e al. 2020). Dieses Angebo bes eh alle dings noch nich ü zahnmedizinische P axen (BARMER In e ne edak ion 2020). K Technikges ü z e zahnmedizinische Hausbesuche du ch nich -ä z liches Fachpe sonal zu ... Auch in de Fo schung is dieses Thema kaum ep äsen ie . Eine explo a i e Li- e a u eche che mi hil e on Google Schola e gab zwa iele E gebnisse zum Ein- sa z on Mixed Reali y (MR) B illen zu Ausbildung ode Un e s ü zung wäh end Ope a ionen im zahnmedizinischen Be eich. Wissenscha liche Bei äge zu Hausbe- suchen du ch nich -ä z liches Fachpe sonal im Allgemeinen ode in Ve bindung mi MR B illen konn en nich ge unden we den. Das Ziel diese Fo schung is dahe die E p obung on Hausbesuchen du ch nich -ä z liches zahnmedizinisches Pe sonal. Dabei soll beispielha die Mic oso HoloLens 2 un e s ü zend eingese z we den. Die Fo schungs agen dieses Bei ags lau en: Welche Behandlungen können im Rahmen eines zahnmedizinischen Hausbesuchs mi nich -ä z lichem Fachpe sonal und un e s ü z du ch MR B illen du chge üh we den? Welche An o de ungens ell dieses Nu zungsszena io an Ha dwa e und So wa e? Inwie e n wi d die Mic oso HoloLens 2 diesen An o de ungen ge ech ? Im nächs en Abschni wi d das me hodische Vo gehen besch ieben, be o die E gebnisse im d i en Abschni in Fo m on Einsa zszena ien, Designp inzipien und einem Umse zungskonzep da ges ell we den. Im le z en Abschni we den die E gebnisse, die Limi a ionen des Bei ags sowie die p ak ische und heo e ische Signi ikanz disku ie . 2 Me hode Im Rahmen des Design Science Ansa zes (G ego and He ne 2013) wi d ein i e- a i es Vo gehen an isie . En sp echend we den bes ehende E gebnisse o lau end übe p ü und im Falle neu gewonnene E kenn nisse übe a bei e . 2.1 G uppendiskussion und Expe enin e iew Zu Bean wo ung de e s en F age wu den zwei in e disziplinä e, o mal gelei e e G uppendiskussionen du chge üh (Flick 2009). Un e den ün und ach Teilneh- menden be anden sich ein Zahna z und Pe sonen aus den Be eichen de In o ma i- ons- und Kommunika ions echnik, de Wi scha sin o ma ik sowie de E gonomie. Die e s e G uppendiskussion dien e dem Finden mögliche Einsa zszena ien ü nich -ä z liche zahnmedizinische Hausbesuche mi Un e s ü zung du ch die Mic o- so HoloLens 2. Die da au olgende G uppendiskussion sowie ein halbs uk u ie es Expe enin e iew mi einem p ak izie enden Zahna z dien en de Konk e isie ung de sondie en Szena ien. 2.2 Sys ema ische Li e a u eche che Um die zwei e F age zu bean wo en, wu de eine sys ema ische Li e a u eche - che du chge üh ( om B ocke e al. 2015). Da ü wu den CINAHL und Business Sou ce P emie als ele an e Da enbanken ü die Wi scha sin o ma ik ausgewähl . K S.-S. Ko ekamp e al. Au g und des medizinischen Themas wu de MEDLINE in die Reche che einge- schlossen. Eine Fokussie ung au MR in einem zahnmedizinischen Kon ex wa in olge de ge ingen ele an en T e e nich möglich. Au g und de hema ischen Ve wand scha wu de dahe auch Li e a u inkludie , die sich mi Vi ual Reali y (VR) in einem gene ellen medizinischen Se ing beschä ig . Fü die Suche wu den die Beg i e „Augmen ed Reali y“, „Mixed Reali y“ und „Vi ual Reali y“ mi den Beg i en „den al*“, „den is *“, „medicine“, „ca e“ und „ eleheal h“ kombinie . Die ge undenen Bei äge wu den sys ema isch au die Nen- nung on P oblemen bei de Nu zung on Mixed ode Vi ual Reali y B illen un e - such . Inklusionsk i e ien wa en die Nu zung eine solchen B ille du ch medizini- sches Fachpe sonal. Aus- und Wei e bildungsszena ien wu den au g und zu un e - schiedliche Pa ame e ausgeschlossen. Insgesam konn en zehn ele an e Bei äge iden i izie we den. Zu Bean wo ung de d i en F age wu den die iden i izie en Me a-An o de un- gen und Designp inzipien mi den Eigenscha en de Mic oso HoloLens 2 e gli- chen (s. Abschn. 3.3). 3 E gebnisse 3.1 Einsa zszena ien Es konn en insgesam ün Einsa zszena ien ü die Anwendung on MR B illen bes imm we den, die in Tab. 1, Spal e 1, da ges ell sind. In de zwei en Spal e we den die Mindes an o de ungen an die Quali ika ion besch ieben und in Spal e 3 das Equipmen , das zusä zlich zu MR B ille e o de lich is . Im Folgenden we den die Szena ien dezidie besch ieben. Das e s e Szena io be ass sich mi de Video-Dokumen a ion des Mund aums du ch med./p leg. Fachpe sonal mi hil e eine MR B ille. Ziel is es, diese Un- e suchung o nehmen zu können, wenn med./p leg. Fachpe sonal au g und eines Tab. 1 Mögliche Einsa zszena ien eine Mixed Reali y B ille wäh end eines zahnmedizinischen Hausbesuchs N Einsa zszena io Nu zende Equipmen 1 Video-Dokumen a ion des Mund aums Med./p leg. Fachpe sonal Zahnmedizinisches G undbes eck 2 Regelmäßige Kon olle; E assung eines zahnmedizini- schen P oblems Med./p leg. Fachpe sonal mi Wei- e bildung, zahnmedizinisches Fachpe sonal Zahnmedizinisches G undbes eck 3 Behebung on P o hesend uck- s ellen E ah ene zahnmedizinisches Fach- pe sonal Zahnmedizinisches G undbes eck, F äse 4 Repa a u eines abgeb ochenen Zahns (P o hese) Zahn echnike /in Indi iduelles zahn- echnisches Equip- men 5 P ophylaxe Zahnmedizinische P ophylaxehel- e /in Mobile Den alein- hei K Technikges ü z e zahnmedizinische Hausbesuche du ch nich -ä z liches Fachpe sonal zu ... ande en P oblems be ei s bei de zu behandelnden Pe son zu Hause is . Das zu- s ändige zahnä z liche Fachpe sonal kann die Videoau nahme im Anschluss in de P axis begu ach en und es s ellen, ob zahnmedizinische P obleme o liegen. Med./p leg. Fachpe sonal mi Wei e bildung könn e, in einem gu eingespiel- en in e disziplinä en Team zudem egelmäßige Kon ollen de Zähne selbs s ändig du ch üh en ode au An age ein bes imm es zahnmedizinisches P oblem e assen (Szena io 2). Die Du ch üh ung du ch med./p leg. Fachpe sonal ha auch hie wiede den Vo eil, dass die Un e suchung mi ande en Tä igkei en kombinie we den kann. Die MR B ille dien dann de Dokumen a ion und bei Beda auch de Absp ache mi dem zus ändigen zahnä z lichen Fachpe sonal. Im Rahmen des d i en Szena ios nimm e ah enes zahnmedizinisches Fachpe - sonal Anpassungen am Si z de P o hese de zu behandelnden Pe son o , um so D ucks ellen zu beheben. Zusä zlich zu MR B ille und einem zahnmedizinischen G undbes eck wi d dazu eine F äse benö ig . Szena io ie besch eib die Repa a u eines abgeb ochenen Zahns aus eine P o- hese. Diese Maßnahme kann on eine /einem Zahn echnike /in du chge üh we - den, wobei indi iduelles zahn echnisches Equipmen onnö en is . Das le z e Szena io is die Du ch üh ung de P ophylaxe du ch eine/n zahnmed. P ophylaxehel e /in. Im Gegensa z zu den ande en Szena ien is ü diese Tä igkei eine mobile Den aleinhei e o de lich. Die MR B ille dien hie , zusä zlich zu Do- kumen a ion und Rücksp ache mi dem zus ändigen zahnä z lichen Fachpe sonal, auch de Kon olle des E gebnisses. 3.2 P obleme, Me a-An o de ungen und Designp inzipien Aus den, in de Li e a u iden i izie en, P oblemen (P) wu den die Me a-An o de- ungen (MA) en wickel . Die Designp inzipien (DP) basie en au diesen E kenn nis- sen und assen die Me a-An o de ungen p axisnah zusammen. Die Designp inzipien dienen de Eignungsp ü ung de Mic oso HoloLens 2. Die genann en P obleme be- ziehen sich zum einen au die Eigenscha en de MR B illen selbs . Zum ande en auch au die In e ak ion mi de Technik sowie die Einbindung in die bes ehende In as uk u . 3.2.1 Techniklimi a ionen Bezüglich de Ha dwa e wu de meh ach die ku ze Ba e ielau zei (P1)(Spa was- se e al. 2018; Ma in e al. 2020; Gala i e al. 2020) bemängel . Dies is besonde s beim Einsa z in de Chi u gie beme kba , da die de zei igen Modelle mi eine Ba - e ielau zei on zwei bis d ei S unden nu wäh end kü ze e Eing i e die gesam e Zei übe un e s ü zen können. Hinzu komm die beg enz e Speiche kapazi ä (Talaa e al. 2019; Gala i e al. 2020) und Rechenkapazi ä de mobilen P ozesso en (P2) (Spa wasse e al. 2018; Gala i e al. 2020). Die Spezi ika ionen des Ge ä s soll en dahe au die geplan e Nu zung abges imm we den. Bei Beda soll e das Ge ä wäh- end de Nu zung kom o abel geladen we den können ode einen aus auschba en Akku besi zen (MA1). Bei s a ionä en Einsa zszena ien und einem geeigne en Ne z- we k soll en essou cenin ensi e P ozesse in die Cloud ausgelage we den können K 2.5 Con ibu ion 5: Cos -Bene i Analysis o Using Mixed Reali y in Den is y—Keeping he Den is in he Pic u e Con ibu ion 5 Ti le Cos -Bene i Analysis o Using Mixed Reali y in Den is y—Keeping he Den is in he Pic u e Au ho s Sa ah-Sab ina Ko ekamp, Pa icia Kajü e Rod igues, Ingma Icke o , F ank Teu ebe g Yea 2014 Medium Con e ence Ou le Eu opean Con e ence on In o ma ion Sys ems (ECIS 2024) Ranking VHB-JOURQUAL 4: A WKWI: A Bibliog aphic in o ma ion Ko ekamp, S.-S., Kajü e Rod igues, P., Icke o , I., & Teu ebe g, F. (2024). Cos -bene i analysis o using mixed eali y in den is y—keeping he den is in he pic u e. ECIS 2024 P oceedings. h ps://aisel.aisne .o g/ecis2024/ ack18_heal hi / ack18_heal hi /8 Iden i ica ion ISBN: 978-1-958200-10-0 Link h ps://aisel.aisne .o g/ecis2024/ ack18_heal hi / ack18_heal hi /8 Abs ac Digi iza ion expands in o all labou ma ke a eas, including medicine and den is y. Mixed eali y head-moun ed displays (MR HMDs) can be used in den al su ge ies o p ojec holog ams on o pa ien s o allow expe s o join i ually. The applica ion could educe ea men e o s and imp o e ea men ou comes. Despi e he ad an ages, den is s ha e ha dly used he echnology so a , pa ly due o unclea insigh s in o cos e iciency. We iden i y cos s and bene i s o in es ing in an MR HMD den is y con ex based on a sys ema ic li e a u e e iew o add ess his issue. The indings a e used o de elop a cos -bene i amewo k and e alua ed using he Visualisa ion o Financial Implica ions (VoFI) me hod o an exempla y scena io. 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