Digital health eco-systems: An epochal review of practice-oriented research

Healthcare information management and operational cost performance: empirical evidence

Healthcare knowledge management systems can mitigate hospitals' operational inefficiency. As a healthcare information technology, the electronic health record (EHR) receives much attention from medical institutions due to its considerable impact on operational cost performance. This paper focuses on EHR systems to address operational inefficiency by which patients pay more for health care services, and many U.S. hospitals are filing for bankruptcy. From the theoretical perspective of the practice-based view, this paper introduces a path to implement EHR systems for improving cost performance. The empirical investigation is archival data of 200 hospitals collected from the U.S. healthcare agencies. Findings contribute to prior work by hypothesizing moderating and mediating roles in EHR systems implementation. This paper introduces absorptive capacity and monitoring mechanisms as enablers of implementing EHR systems. The results showed that hospital monitoring strengthens the relationship between absorptive capacity and electronic health record systems implementation, which results in better operational cost performance. Theoretically, this study supports the long-term potential benefits of EHR adoption, and its findings are consistent with optimizing efficiency through data standardization and interoperability. From a practical perspective, this study supports hospitals' investments in evolving healthcare information technology systems through the development of a knowledge-based system employing EHR, particularly when hospitals are merging or need a financial strategic plan to control expenses.

International practices in health technology assessment and public financing of digital health technologies: recommendations for Hungary

Background

Evaluating and integrating digital health technologies is a critical component of a national healthcare ecosystem in the 2020s and is expected to even increase in significance.

Design

The paper gives an overview of international practices on public financing and health technology assessment of digital health technologies (DHTs) in five European Union (EU) countries and outlines recommendations for country-level action that relevant stakeholders can consider in order to support uptake of digital health solutions in Hungary. A scoping review was carried out to identify and gather country-specific classifications and international practices on the financing DHTs in five pioneering EU countries: Germany, France, Belgium, the United Kingdom and Finland.

Results

Several frameworks have been developed for DHTs, however there is no single, unified framework or method for classification, evaluation, and financing of digital health technologies in European context. European countries apply different taxonomy, use different assessment domains and regulations for the reimbursement of DHTs. The Working Group of the Hungarian Health Economic Society recommends eight specific points for stakeholders, importantly taking active role in shaping common clinical evidence standards and technical quality criteria across in order for common standards to be developed in the European Union single market.

Conclusion

Specificities of national healthcare contexts must be taken into account in decisions to allocate public funds to certain therapies rather than others.

Digital Transformation in Healthcare: Technology Acceptance and Its Applications

Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.

Quantum computing led innovation for achieving a more sustainable Covid-19 healthcare industry

Involvement of multiple stakeholders in healthcare industry, even the simple healthcare problems become complex due to classical approach to treatment. In the Covid-19 era where quick and accurate solutions in healthcare are needed along with quick collaboration of stakeholders such as patients, insurance agents, healthcare providers and medicine supplier etc., a classical computing approach is not enough. Therefore, this study aims to identify the role of quantum computing in disrupting the healthcare sector with the lens of organizational information processing theory (OIPT), creating a more sustainable (less strained) healthcare system. A semi-structured interview approach is adopted to gauge the expectations of professionals from healthcare industry regarding quantum computing. A structured approach of coding, using open, axial and selective approach is adopted to map the themes under quantum computing for healthcare industry. The findings indicate the potential applications of quantum computing for pharmaceutical, hospital, health insurance organizations along with patients to have precise and quick solutions to the problems, where greater accuracy and speed can be achieved. Existing research focuses on the technological background of quantum computing, whereas this study makes an effort to mark the beginning of quantum computing research with respect to organizational management theory.

A digital health ecosystem ontology from the perspective of Australian consumers: a mixed-method literature analysis

This study presents an ontology that scopes the digital health ecosystem from a consumer-centered perspective. We used a mixed-method analysis on a set of papers collected for a comprehensive review to identify common themes, components, and patterns that repeatedly emerge within Australian-based digital health studies. Three major and four child themes were identified as the foundational aspects of the proposed ontology. The child themes have more precise concept definitions, inherited and distinguishing attributes. Out of 179 recognized concepts, 33 were related to the Healthcare theme; 23 concepts formed a cluster of employed devices under the Technology theme; 40 concepts were associated with Use and Usability factors. 60 other concepts formed the cluster of the consumer-user theme. The theme of Digital Health was seen as being connected to 2 independent clusters. The main cluster embodied 21 extracted concepts, semantically related to "data, information, and knowledge," whilst the second cluster embodied concepts related to "healthcare." Different stakeholders can utilize this ontology to define their landscape of digitally enabled healthcare. The novelty of this work resides in capturing a consumer-centered perspective and the method we used in deriving the ontology - formalizing the results of a systematic review based on data-driven analysis methods.

Medical Informatics and Digital Health Multilingual Ontology (MIMO): a tool to improve international collaborations

Background

Even if English is the leading language for international communication, it is essential to keep in mind that research runs at the local level by local teams generally communicating in their local/national language, especially in Europe among European projects.

Objective

Therefore, the European Federation for Medical Informatics - Working Group on Health Informatics for Inter-regional Cooperation” has one objective: To develop a multilingual ontology focusing on Health Informatics and Digital Health as a collaboration tool that improves international and, in particular, European collaborations.

Results

We have developed the Medical Informatics and Digital Health Multilingual Ontology (MIMO). Hosted on the Health Terminology/Ontology Portal (HeTOP), MIMO contains around 1,000 concepts, 460 MeSH Descriptors, 220 MeSH Concepts, and more than 300 newly created concepts. MIMO is continuously updated to comprise as recent as possible concepts and their translations in more than 30 languages. Moreover, the MIMO’s development team constantly improves MIMO content and supporting information. Thus, during workshop discussions and one-on-one exchanges, the MIMO team has collected domain experts’ opinions about the community’s interests and suggestions for future enhancements. Moreover, MIMO will be integrated to support the annotation and categorization of research products into the HosmartAI European project involving more than 20 countries around Europe and worldwide.

Conclusion

MIMO is hosted by HeTOP (Health Terminology/Ontology Portal), which integrates 100 terminologies and ontologies in 55 languages. MIMO is freely available online. MIMO is portable to other knowledge platforms as part of MIMO’s main aims to facilitate communication between medical librarians, translators, and researchers as well as to support students’ self-learning.

Using COMPASS (Context Optimisation Model for Person-Centred Analysis and Systematic Solutions) Theory to Augment Implementation of Digital Health Solutions

Digital health research is an emerging discipline that requires easy-to-understand theoretical frameworks and implementation models for digital health providers in health and social care settings. The COVID-19 pandemic has heightened the demand for digital health discipline-specific instruction on how to manage evidence-based digital health transformation. Access to the use of these models guarantees that digital health providers can investigate phenomena using safe and suitable approaches and methods to conduct research and identify answers to challenges and problems that arise in health and social care settings. The COMPASS theory is designed to aid transformation of health and social care environments. A navigational rose of primary quadrants is divided by four main compass points, with person-centred care being central to the philosophy. Two axes produce Cartesian planes that intersect to form a box plot, which can be used to discover human and physical resource weightings to augment digital health research design and implementation. A third continuum highlights stakeholders’ capabilities, which are critical for any multidisciplinary study. The COMPASS mnemonic guides end users through the process of design, development, implementation, evaluation, and communication of digital health transformations. The theory’s foundations are presented and explained in context of the ‘new normal’ of health and social care delivery.

The Promise of Digital Self-Management: A Reflection about the Effects of Patient-Targeted e-Health Tools on Self-Management and Wellbeing

Increasingly, people have direct access to e-Health resources such as health information on the Internet, personal health portals, and wearable self-management applications, which have the potential to reinforce the simultaneously growing focus on self-management and wellbeing. To examine these relationships, we searched using keywords self-management, patient-targeting e-Health tools, and health as wellbeing. Direct access to the health information on the Internet or diagnostic apps on a smartphone can help people to self-manage health issues, but also leads to uncertainty, stress, and avoidance. Uncertainties relate to the quality of information and to use and misuse of information. Most self-management support programs focus on medical management. The relationship between self-management and wellbeing is not straightforward. While the influence of stress and negative social emotions on self-management is recognized as an important cause of the negative spiral, empirical research on this topic is limited to health literacy studies. Evidence on health apps showed positive effects on specific actions and symptoms and potential for increasing awareness and ownership by people. Effects on more complex behaviors such as participation cannot be established. This review discovers relatively unknown and understudied angles and perspectives about the relationship between e-Health, self-management, and wellbeing.

Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England

Background

The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service.

Objective

This study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge.

Methods

We conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding.

Results

We conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas.

Conclusions

Knowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals. Policy interventions need to enhance incentives and reduce barriers to sharing across the ecosystem, be flexible in tailoring formal interventions to emerging needs, and promote informal knowledge sharing.

Promoting inter-organisational knowledge sharing: A qualitative evaluation of England's Global Digital Exemplar and Fast Follower Programme

BACKGROUND

The Global Digital Exemplar (GDE) Programme was designed to promote the digitisation of hospital services in England. Selected provider organisations that were reasonably digitally-mature were funded with the expectation that they would achieve internationally recognised levels of excellence and act as exemplars ('GDE sites') and share their learning with somewhat less digitally-mature Fast Follower (FF) sites.

AIMS

This paper explores how partnerships between GDE and FF sites have promoted knowledge sharing and learning between organisations.

METHODS

We conducted an independent qualitative longitudinal evaluation of the GDE Programme, collecting data across 36 provider organisations (including acute, mental health and speciality), 12 of which we studied as in-depth ethnographic case studies. We used a combination of semi-structured interviews with programme leads, vendors and national policy leads, non-participant observations of meetings and workshops, and analysed national and local documents. This allowed us to explore both how inter-organisational learning and knowledge sharing was planned, and how it played out in practice. Thematic qualitative analysis, combining findings from diverse data sources, was facilitated by NVivo 11 and drew on sociotechnical systems theory.

RESULTS

Formally established GDE and FF partnerships were perceived to enhance learning and accelerate adoption of technologies in most pairings. They were seen to be most successful where they had encouraged, and were supported by, informal knowledge networking, driven by the mutual benefits of information sharing. Informal networking was enhanced where the benefits were maximised (for example where paired sites had implemented the same technological system) and networking costs minimised (for example by geographical proximity, prior links and institutional alignment). Although the intervention anticipated uni-directional learning between exemplar sites and 'followers', in most cases we observed a two-way flow of information, with GDEs also learning from FFs, through informal networking which also extended to other health service providers outside the Programme. The efforts of the GDE Programme to establish a learning ecosystem has enhanced the profile of shared learning within the NHS.

CONCLUSIONS

Inter-organisational partnerships have produced significant gains for both follower (FF) and exemplar (GDE) sites. Formal linkages were most effective where they had facilitated, and were supported by, informal networking. Informal networking was driven by the mutual benefits of information sharing and was optimised where sites were well aligned in terms of technology, geography and culture. Misalignments that created barriers to networking between organisations in a few cases were attributed to inappropriate choice of partners. Policy makers seeking to promote learning through centrally directed mechanisms need to create a framework that enables networking and informal knowledge transfer, allowing local organisations to develop bottom-up collaboration and exchanges, where they are productive, in an organic manner.

Responsible Artificial Intelligence as a Secret Ingredient for Digital Health: Bibliometric Analysis, Insights, and Research Directions

With the unparallel advance of leading-edge technologies like artificial intelligence (AI), the healthcare systems are transforming and shifting for more digital health. In recent years, scientific productions have reached unprecedented levels. However, a holistic view of how AI is being used for digital health remains scarce. Besides, there is a considerable lack of studies on responsible AI and ethical issues that identify and suggest practitioners' essential insights towards the digital health domain. Therefore, we aim to rely on a bibliometric approach to explore the dynamics of the interplay between AI and digital health approaches, considering the responsible AI and ethical aspects of scientific production over the years. We found four distinct periods in the publication dynamics and the most popular approaches of AI in the healthcare field. Also, we highlighted the main trends and insightful directions for scholars and practitioners. In terms of contributions, this work provides a framework integrating AI technologies approaches and applications while discussing several barriers and benefits of AI-based health. In addition, five insightful propositions emerged as a result of the main findings. Thus, this study's originality is regarding the new framework and the propositions considering responsible AI and ethical issues on digital health.

Using Blueprints to promote interorganizational knowledge transfer in digital health initiatives-a qualitative exploration of a national change program in English hospitals

Objective

The Global Digital Exemplar (GDE) Program is a national attempt to accelerate digital maturity in healthcare providers through promoting knowledge transfer across the English National Health Service (NHS). “Blueprints”—documents capturing implementation experience—were intended to facilitate this knowledge transfer. Here we explore how Blueprints have been conceptualized, produced, and used to promote interorganizational knowledge transfer across the NHS.

Materials and Methods

We undertook an independent national qualitative evaluation of the GDE Program. This involved collecting data using semistructured interviews with implementation staff and clinical leaders in provider organizations, nonparticipant observation of meetings, and key documents. We also attended a range of national meetings and conferences, interviewed national program managers, and analyzed a range of policy documents. Our analysis drew on sociotechnical principles, combining deductive and inductive methods.

Results

Data comprised 508 interviews, 163 observed meetings, and analysis of 325 documents. We found little evidence of Blueprints being adopted in the manner originally conceived by national program managers. However, they proved effective in different ways to those planned. As well as providing a helpful initial guide to a topic, we found that Blueprints served as a method of identifying relevant expertise that paved the way for subsequent discussions and richer knowledge transfers amongst provider organizations. The primary value of Blueprinting, therefore, seemed to be its role as a networking tool. Members of different organizations came together in developing, applying, and sustaining Blueprints through bilateral conversations—in some circumstances also fostering informal communities of practice.

Conclusions

Blueprints may be effective in facilitating knowledge transfer among healthcare organizations, but need to be accompanied by other evolving methods, such as site visits and other networking activities, to iteratively transfer knowledge and experience.