IT-Enabled Revenue Cycle Transformation in Resource-Constrained Hospitals: A Collaborative Digital Options Inquiry

Multi-resource allocation and care sequence assignment in patient management: a stochastic programming approach

To mitigate outpatient care delivery inefficiencies induced by resource shortages and demand heterogeneity, this paper focuses on the problem of allocating and sequencing multiple medical resources so that patients scheduled for clinical care can experience efficient and coordinated care with minimum total waiting time. We leverage highly granular location data on people and medical resources collected via Real-Time Location System technologies to identify dominant patient care pathways. A novel two-stage Stochastic Mixed Integer Linear Programming model is proposed to determine the optimal patient sequence based on the available resources according to the care pathways that minimize patients' expected total waiting time. The model incorporates the uncertainty in care activity duration via sample average approximation.We employ a Monte Carlo Optimization procedure to determine the appropriate sample size to obtain solutions that provide a good trade-off between approximation accuracy and computational time. Compared to the conventional deterministic model, our proposed model would significantly reduce waiting time for patients in the clinic by 60%, on average, with acceptable computational resource requirements and time complexity. In summary, this paper proposes a computationally efficient formulation for the multi-resource allocation and care sequence assignment optimization problem under uncertainty. It uses continuous assignment decision variables without timestamp and position indices, enabling the data-driven solution of problems with real-time allocation adjustment in a dynamic outpatient environment with complex clinical coordination constraints.

Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis

BACKGROUND

In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources.

OBJECTIVE

This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion.

METHODS

We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes-inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes.

RESULTS

We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients' requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer.

CONCLUSIONS

Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people's fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements.

The Road Ahead and Challenges of Revenue Cycle Management in Saudi Governmental Hospitals

Healthcare providers use revenue cycle management (RCM) to track patient billing and revenue. The revenue cycle collects data from various systems and compiles it into a single RCM system connected to payers. Effective system integration improves revenue and financial stability. The aim is to assess RCM feasibility in Saudi Arabia's governmental hospitals, examine financial management, and recommend practical implementation. In this study, healthcare leaders were interviewed face-to-face and via audio recording to collect qualitative data in response to semi-structured questions. Key informants from seven main hospitals were interviewed. Respondents understood RCM and identified internal and external challenges in hospital financial management. Government hospitals face accountability obstacles. Two of the seven surveyed hospitals operate business clinics using a fee-for-service model. The billing system is not integrated with the information system. The RCM system faces challenges such as unclear vision, lack of accountability, staff resistance, process redesign, and importance of project management. Despite these challenges, respondents still value RCM and recognize its importance in improving hospital revenue management. Effective implementation of RCM requires significant transformational processes, including vision, governance, accountability, proper training, and effective monitoring and evaluation processes. Communication should also be emphasized, and the patient's perspective must be brought into focus. Involving all stakeholders can create direct and holistic patient benefits; therefore, bringing them on board is crucial. New approaches are required to enhance healthcare in Saudi Arabia, addressing gaps in revenue optimization and RCM. Future research should evaluate the move from government-funded to self-operated hospitals, providing a better understanding of the challenges and opportunities.

Emerging IT investments and firm performance: a perspective of the digital options

Purpose

This study aims to explore the mediating effect of digital options on the relationship between emerging information technology investments (ITIs) and firm performance (FP). In particular, it analyses the performance impacts of investments in five emerging technologies of IT or non-IT firms.

Design/methodology/approach

Secondary data are collected from Chinese A-share listed companies from 2010 to 2018. The authors propose an econometric model focusing on the impact of ITIs on a firm’s market value and profit. A propensity score matching model is applied to control endogeneity.

Findings

The ITIs’ effect on FP is found to be completely mediated by digital options, and the reach of digital options plays a more positive role in the relationship between ITIs and Tobin’s Q, whereas the richness of digital options is stronger between ITIs and return on net assets (ROE). The group study shows that the impact of process technologies such as cloud computing and the Internet of Things has a more profound impact on Tobin’s Q, and the knowledge technologies represented by artificial intelligence, blockchain and big data strongly affect ROE. In addition, the positive relationship between ITIs and FP is unrelated to IT/non-IT firms.

Research limitations/implications

First, the data are based on 219 publicly announced emerging ITIs in China and thus may not be generalizable to other cultural/national contexts. Second, there is a lack of a large sample data set of emerging ITI information in China, and the duration of this study is constrained to the relatively short rise of emerging technologies.

Practical implications

This study provides firm decision-makers with practical implications. The results imply that the effect of ITIs on FP depends on digital options, so both IT firms (e.g., Big Tech giants) and non-IT firms (e.g., incumbents) should discover how to balance firm value and profit in their management of emerging technology investment projects with digital options thinking.

Originality/value

To the best of the authors’ knowledge, this is the first empirical study to investigate the relationship between ITIs and FP from the perspective of digital options, exploring five emerging technologies and considering firm life, size, and state ownership in a sample of Chinese listed firms.