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Gazzarata R, Almeida J, Lindsköld L, Cangioli G, Gaeta E, Fico G, Chronaki CE. HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) in digital healthcare ecosystems for chronic disease management: Scoping review. Int J Med Inform 2024; 189:105507. [PMID: 38870885 DOI: 10.1016/j.ijmedinf.2024.105507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/14/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The prevalence of chronic diseases has shifted the burden of disease from incidental acute inpatient admissions to long-term coordinated care across healthcare institutions and the patient's home. Digital healthcare ecosystems emerge to target increasing healthcare costs and invest in standard Application Programming Interfaces (API), such as HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) for trusted data flows. OBJECTIVES This scoping review assessed the role and impact of HL7 FHIR and associated Implementation Guides (IGs) in digital healthcare ecosystems focusing on chronic disease management. METHODS To study trends and developments relevant to HL7 FHIR, a scoping review of the scientific and gray English literature from 2017 to 2023 was used. RESULTS The selection of 93 of 524 scientific papers reviewed in English indicates that the popularity of HL7 FHIR as a robust technical interface standard for the health sector has been steadily rising since its inception in 2010, reaching a peak in 2021. Digital Health applications use HL7 FHIR in cancer (45 %), cardiovascular disease (CVD) (more than 15 %), and diabetes (almost 15 %). The scoping review revealed that references to HL7 FHIR IGs are limited to ∼ 20 % of articles reviewed. HL7 FHIR R4 was most frequently referenced when the HL7 FHIR version was mentioned. In HL7 FHIR IGs registries and the internet, we found 35 HL7 FHIR IGs addressing chronic disease management, i.e., cancer (40 %), chronic disease management (25 %), and diabetes (20 %). HL7 FHIR IGs frequently complement the information in the article. CONCLUSIONS HL7 FHIR matures with each revision of the standard as HL7 FHIR IGs are developed with validated data sets, common shared HL7 FHIR resources, and supporting tools. Referencing HL7 FHIR IGs cataloged in official registries and in scientific publications is recommended to advance data quality and facilitate mutual learning in growing digital healthcare ecosystems that nurture interoperability in digital health innovation.
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Affiliation(s)
- Roberta Gazzarata
- HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium; Healthropy Srl, Corso Vittorio Veneto 14B, Savona, 17100, Italy.
| | - Joao Almeida
- HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium; MEDCIDS - Faculty of Medicine of University of Porto, Porto, Portugal; PDH - Pharma Data Hub, Porto, Portugal.
| | - Lars Lindsköld
- European Federation for Medical Informatics, Ch de Maillefer 37, CH-1052 Le Mont-sur-Lausanne, Switzerland; SciLifeLab Datacenter, University of Uppsala, S-752 37 Uppsala, Sweden.
| | - Giorgio Cangioli
- HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium.
| | - Eugenio Gaeta
- Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, 28040 Madrid, Spain.
| | - Giuseppe Fico
- Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, 28040 Madrid, Spain.
| | - Catherine E Chronaki
- HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium; European Federation for Medical Informatics, Ch de Maillefer 37, CH-1052 Le Mont-sur-Lausanne, Switzerland.
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2
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Woods L, Dendere R, Eden R, Grantham B, Krivit J, Pearce A, McNeil K, Green D, Sullivan C. Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study. J Med Internet Res 2023; 25:e45868. [PMID: 37463008 PMCID: PMC10394505 DOI: 10.2196/45868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. OBJECTIVE We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. METHODS A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. RESULTS DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. CONCLUSIONS This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Ronald Dendere
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Rebekah Eden
- UQ Business School, The University of Queensland, Brisbane, Australia
| | - Brittany Grantham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Jenna Krivit
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Andrew Pearce
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | - Keith McNeil
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Metro North Hospital and Health Service, Brisbane, Australia
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3
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Neunaber T, Meister S. Digital Maturity and Its Measurement of General Practitioners: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4377. [PMID: 36901387 PMCID: PMC10001864 DOI: 10.3390/ijerph20054377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The work of general practitioners (GPs) is increasingly characterized by digitalization. Their progress in digitalization can be described by the concept of digital maturity and measured using maturity models. The aim of this scoping review is to provide an overview of the state of research on digital maturity and its measurement in primary care, specifically for GPs. The scoping review was conducted according to Arksey and O'Malley, considering the reporting scheme for PRISMA-ScR. For the literature search, we used PubMed and Google Scholar as the main sources of information. A total of 24 international, mostly Anglo-American studies, were identified. The understanding of digital maturity varied widely. In most studies, it was understood in a highly technical way and associated with the adoption of electronic medical records. More recent, but mostly unpublished, studies have attempted to capture overall digital maturity. So far, the understanding of digital maturity of GPs is still very diffuse-the research literature is still in its infancy. Future research should therefore aim to explore the dimensions of digital maturity of GPs to be able to develop a consistent and validated model for measuring digital maturity.
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Affiliation(s)
- Timo Neunaber
- Health Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Sven Meister
- Health Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
- Department Healthcare, Fraunhofer Institute for Software and Systems Engineering, 44227 Dortmund, Germany
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4
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Woods L, Eden R, Canfell OJ, Nguyen KH, Comans T, Sullivan C. Show me the money: how do we justify spending health care dollars on digital health? Med J Aust 2023; 218:53-57. [PMID: 36502453 PMCID: PMC10107451 DOI: 10.5694/mja2.51799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW
| | - Rebekah Eden
- Queensland University of Technology, Brisbane, QLD
| | - Oliver J Canfell
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW.,University of Queensland, Brisbane, QLD
| | - Kim-Huong Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Global Brain Health Institute, Trinity College Dublin and University California, San Francisco, Dublin, Ireland
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Clair Sullivan
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD
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5
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Electronic Health Records That Support Health Professional Reflective Practice: a Missed Opportunity in Digital Health. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 6:375-384. [PMID: 36744083 PMCID: PMC9892400 DOI: 10.1007/s41666-022-00123-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
A foundational component of digital health involves collecting and leveraging electronic health data to improve health and wellbeing. One of the central technologies for collecting these data are electronic health records (EHRs). In this commentary, the authors explore intersection between digital health and data-driven reflective practice that is described, including an overview of the role of EHRs underpinning technology innovation in healthcare. Subsequently, they argue that EHRs are a rich but under-utilised source of information on the performance of health professionals and healthcare teams that could be harnessed to support reflective practice and behaviour change. EHRs currently act as systems of data collection, not systems of data engagement and reflection by end users such as health professionals and healthcare organisations. Further consideration should be given to supporting reflective practice by health professionals in the design of EHRs and other clinical information systems.
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6
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Eysenbach G, Cavalini H, Shetty S, Delanerolle G. Digital Maturity Consulting and Strategizing to Optimize Services: Overview. J Med Internet Res 2023; 25:e37545. [PMID: 36649060 PMCID: PMC9890346 DOI: 10.2196/37545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 11/18/2022] Open
Abstract
The National Health Service (NHS), the health care system of the United Kingdom, is one of the largest health care entities in the world and has been successfully serving the UK population for decades. The NHS is also the fourth-largest employer globally. True to its reputation, some of the most modern and technically advanced medical services are available in the United Kingdom. However, between the acute, primary, secondary, and tertiary care providers of the NHS, there needs to be seamless integration and interoperability to provide timely holistic care to patients at a national level. Various efforts have been taken and programs launched since 2002 to achieve digital transformation in the NHS but with partial success rates. As it is important to understand a problem before trying to solve it, in this paper, we focus on tools used to assess the digital maturity of NHS trusts and organizations. Additionally, we aim to present the impact of ongoing transformation attempts on secondary services, particularly mental health. This paper considered the literature on digital maturity and performed a rapid review of currently available tools to measure digital maturity. We have performed a multivocal literature review that included white papers and web-based documents in addition to peer-reviewed literature. Further, the paper also provides a perspective of the ground reality from a mental health service provider's point of view. Assessment tools adopted from the global market, later modified and tailor-made to suit local preferences, are currently being used. However, there is a need for a robust framework that assesses status, allows target setting, and tracks progress across diverse providers.
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Affiliation(s)
| | - Heitor Cavalini
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Suchith Shetty
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Gayathri Delanerolle
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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7
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Alami H, Shaw SE, Fortin JP, Savoldelli M, Fleet R, Têtu B. The 'wrong pocket' problem as a barrier to the integration of telehealth in health organisations and systems. Digit Health 2023; 9:20552076231169835. [PMID: 37089458 PMCID: PMC10116005 DOI: 10.1177/20552076231169835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what is known as the 'wrong pocket' problem - where an organisation or sector makes expenditures and investments to address a given problem, but the benefits (return on investment) are captured by another organisation or sector (the wrong pocket). This problem is the origin of many difficulties in public policies and programmes (e.g. education, environment, justice and public health), especially in terms of sustainability and scaling-up of technology and innovation. In this essay/perspective, we address the wrong pocket problem in the context of a major telehealth project in Canada. We show how the problem of sharing investments and expenses, as well as the redistribution of economies among the different stakeholders involved, may have threatened the sustainability and scaling-up of this project, even though it has demonstrated the clinical utility and contributed to improving the health of populations. In conclusion, the wrong pocket problem may be decisive in the reduced take-up, and potential failure, of certain telehealth programmes and policies. It is not enough for a telehealth service to be clinically relevant and 'efficient', it must also be mutually beneficial to the various stakeholders involved, particularly in terms of the equitable sharing of costs and benefits (return on investment) associated with the implementation of this new service model. Finally, the wrong pocket concept offers a helpful lens for studying the success, sustainability, and scale-up of digital transformations in health organisations and systems. This needs to be considered in future research and evaluations in the field.
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Affiliation(s)
- Hassane Alami
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Hassane Alami, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jean-Paul Fortin
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada
| | | | - Richard Fleet
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, Canada
| | - Bernard Têtu
- Faculty of Medicine, Laval University, Quebec, Canada
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8
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Abstract
Public health measures associated with coronavirus disease (COVID-19) have accelerated the adoption of virtual health care across Canada. We explore the opportunities that virtual care presents in achieving the Quadruple Aim and challenges to navigate, through the lens of care for older adults. In particular, we recommend virtual care-related policies related to older adults that address (a) limited uptake among the socio-economically disadvantaged, (b) user-centered design of virtual care technologies, and (c) integration of iterative evaluations to ensure equitable and efficient achievement of desired outcomes. As virtual care accelerates forward, we must not leave older Canadians behind.
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Woods L, Eden R, Duncan R, Kodiyattu Z, Macklin S, Sullivan C. Which one? A suggested approach for evaluating digital health maturity models. Front Digit Health 2022; 4:1045685. [PMID: 36506845 PMCID: PMC9731136 DOI: 10.3389/fdgth.2022.1045685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Digital health maturity models allow healthcare organizations to evaluate digital health capability and to develop roadmaps for improving patient care through technology. There are many models available commercially for healthcare providers to use to assess their digital health maturity. Currently, there are limited evidence-based methods to assess the quality, utility, and efficacy of maturity models to select the most appropriate model for the given context. Objective To develop a framework to assess digital maturity models and facilitate recommendations for digital maturity model selection. Methods A systematic, consultative, and iterative process was used. Literature analyses and a stakeholder needs analysis (n = 23) was conducted to develop content and design considerations. These considerations were incorporated into the initial version of the framework developed by researchers in a design workshop. External stakeholder review (n = 20) and improvements strengthened and finalized the framework. Results The criteria of the framework include assessment of healthcare context, feasibility, integrity, completeness and actionability. Users can compare model performance in order to select the most appropriate model for their context. Conclusion The framework provides healthcare stakeholders with a consistent and objective methodology to compare digital health maturity models, informing approaches to choosing a suitable model. This is a critical step as healthcare evolves towards a digital health system focused on improving the quality of care, reducing costs and improving the provider and consumer experience.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia,Queensland Digital Health Centre, The University of Queensland, Herston, QLD, Australia,Correspondence: Leanna Woods
| | - Rebekah Eden
- School of Information Systems, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rhona Duncan
- School of Information Systems, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zack Kodiyattu
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sophie Macklin
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia,Queensland Digital Health Centre, The University of Queensland, Herston, QLD, Australia,Digital Metro North, Metro North Hospital and Health Service, Herston, QLD, Australia
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10
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Woods L, Eden R, Pearce A, Wong YCI, Jayan L, Green D, McNeil K, Sullivan C. Evaluating Digital Health Capability at Scale Using the Digital Health Indicator. Appl Clin Inform 2022; 13:991-1001. [PMID: 36261114 PMCID: PMC9581585 DOI: 10.1055/s-0042-1757554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background
Health service providers must understand their digital health capability if they are to drive digital transformation in a strategic and informed manner. Little is known about the assessment and benchmarking of digital maturity or capability at scale across an entire jurisdiction. The public health care system across the state of Queensland, Australia has an ambitious 10-year digital transformation strategy.
Objective
The aim of this research was to evaluate the digital health capability in Queensland to inform digital health strategy and investment.
Methods
The Healthcare Information and Management Systems Society Digital Health Indicator (DHI) was used via a cross-sectional survey design to assess four core dimensions of digital health transformation: governance and workforce; interoperability; person-enabled health; and predictive analytics across an entire jurisdiction simultaneously. The DHI questionnaire was completed by each health care system (
n
= 16) within Queensland in February to July 2021. DHI is scored 0 to 400 and dimension score is 0 to 100.
Results
The results reveal a variation in DHI scores reflecting the diverse stages of health care digitization across the state. The average DHI score across sites was 143 (range 78–193; SD35.3) which is similar to other systems in the Oceania region and global public systems but below the global private average. Governance and workforce was on average the highest scoring dimension (x̅= 54), followed by interoperability (x̅ = 46), person-enabled health (x̅ = 36), and predictive analytics (x̅ = 30).
Conclusion
The findings were incorporated into the new digital health strategy for the jurisdiction. As one of the largest single simultaneous assessments of digital health capability globally, the findings and lessons learnt offer insights for policy makers and organizational managers.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Digital Health Cooperative Research Centre, Sydney, Australia.,Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia
| | - Rebekah Eden
- School of Information Systems, Queensland University of Technology, Brisbane, Australia
| | - Andrew Pearce
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | | | - Lakshmi Jayan
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | - Damian Green
- eHealth Queensland, Queensland Health, Brisbane, Australia
| | - Keith McNeil
- Prevention Division, Queensland Health, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia.,Digital Metro North, Metro North Hospital and Health Service, Brisbane, Australia
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11
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Sharma V, Augustine T, Ainsworth J, van der Veer SN. The evaluation of digital transformation in renal transplantation in the United Kingdom: A national interview study. Int J Med Inform 2022; 164:104800. [DOI: 10.1016/j.ijmedinf.2022.104800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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12
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Cresswell K, Sheikh A, Williams R. 'Managed convergence' in health system digitalisation. J R Soc Med 2022; 115:284-285. [PMID: 35549534 PMCID: PMC9340097 DOI: 10.1177/01410768221098274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kathrin Cresswell
- Usher Institute, The University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, EH1 1LZ, UK
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13
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Sharma V, Eleftheriou I, van der Veer SN, Brass A, Augustine T, Ainsworth J. Modeling Data Journeys to Inform the Digital Transformation of Kidney Transplant Services: Observational Study. J Med Internet Res 2022; 24:e31825. [PMID: 35451983 PMCID: PMC9073622 DOI: 10.2196/31825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/27/2021] [Accepted: 02/09/2022] [Indexed: 01/20/2023] Open
Abstract
Background Data journey modeling is a methodology used to establish a high-level overview of information technology (IT) infrastructure in health care systems. It allows a better understanding of sociotechnical barriers and thus informs meaningful digital transformation. Kidney transplantation is a complex clinical service involving multiple specialists and providers. The referral pathway for a transplant requires the centralization of patient data across multiple IT solutions and health care organizations. At present, there is a poor understanding of the role of IT in this process, specifically regarding the management of patient data, clinical communication, and workflow support. Objective To apply data journey modeling to better understand interoperability, data access, and workflow requirements of a regional multicenter kidney transplant service. Methods An incremental methodology was used to develop the data journey model. This included review of service documents, domain expert interviews, and iterative modeling sessions. Results were analyzed based on the LOAD (landscape, organizations, actors, and data) framework to provide a meaningful assessment of current data management challenges and inform ways for IT to overcome these challenges. Results Results were presented as a diagram of the organizations (n=4), IT systems (n>9), actors (n>4), and data journeys (n=0) involved in the transplant referral pathway. The diagram revealed that all movement of data was dependent on actor interaction with IT systems and manual transcription of data into Microsoft Word (Microsoft, Inc) documents. Each actor had between 2 and 5 interactions with IT systems to capture all relevant data, a process that was reported to be time consuming and error prone. There was no interoperability within or across organizations, which led to delays as clinical teams manually transferred data, such as medical history and test results, via post or email. Conclusions Overall, data journey modeling demonstrated that human actors, rather than IT systems, formed the central focus of data movement. The IT landscape did not complement this workflow and exerted a significant administrative burden on clinical teams. Based on this study, future solutions must consider regional interoperability and specialty-specific views of data to support multi-organizational clinical services such as transplantation.
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Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom.,Department of Renal and Pancreatic Transplantation, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Iliada Eleftheriou
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
| | - Andrew Brass
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom.,Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, United Kingdom
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14
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Duncan R, Eden R, Woods L, Wong I, Sullivan C. Synthesizing Dimensions of Digital Maturity in Hospitals: Systematic Review. J Med Internet Res 2022; 24:e32994. [PMID: 35353050 PMCID: PMC9008527 DOI: 10.2196/32994] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/02/2021] [Accepted: 12/28/2021] [Indexed: 01/05/2023] Open
Abstract
Background Digital health in hospital settings is viewed as a panacea for achieving the “quadruple aim” of health care, yet the outcomes have been largely inconclusive. To optimize digital health outcomes, a strategic approach is necessary, requiring digital maturity assessments. However, current approaches to assessing digital maturity have been largely insufficient, with uncertainty surrounding the dimensions to assess. Objective The aim of this study was to identify the current dimensions used to assess the digital maturity of hospitals. Methods A systematic literature review was conducted of peer-reviewed literature (published before December 2020) investigating maturity models used to assess the digital maturity of hospitals. A total of 29 relevant articles were retrieved, representing 27 distinct maturity models. The articles were inductively analyzed, and the maturity model dimensions were extracted and consolidated into a maturity model framework. Results The consolidated maturity model framework consisted of 7 dimensions: strategy; information technology capability; interoperability; governance and management; patient-centered care; people, skills, and behavior; and data analytics. These 7 dimensions can be evaluated based on 24 respective indicators. Conclusions The maturity model framework developed for this study can be used to assess digital maturity and identify areas for improvement.
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Affiliation(s)
- Rhona Duncan
- School of Information Systems, Queensland University of Technology, Brisbane, Australia
| | - Rebekah Eden
- School of Information Systems, Queensland University of Technology, Brisbane, Australia
| | - Leanna Woods
- Centre for Health Services Research, The University of Queensland, Herston, Australia.,Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia.,Digital Health Research Network, The University of Queensland, Brisbane, Australia
| | - Ides Wong
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, The University of Queensland, Herston, Australia.,Digital Health Research Network, The University of Queensland, Brisbane, Australia.,Metro North Hospital and Health Service, Brisbane, Australia
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15
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Alexander GL, Liu J, Powell KR, Stone PW. Examining Structural Disparities in U.S. Nursing Homes: A National Survey of Health Information Technology Maturity (Preprint). JMIR Aging 2022; 5:e37482. [PMID: 35998030 PMCID: PMC9449826 DOI: 10.2196/37482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/07/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes.
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Affiliation(s)
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, United States
| | - Kimberly R Powell
- Sinclair School of Nursing, University of Missouri, Jefferson City, MO, United States
| | - Patricia W Stone
- School of Nursing, Columbia University, New York, NY, United States
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16
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MERDİN D, ERSÖZ F, TAŞKIN H. Digital Transformation: Digital Maturity Model for Turkish Businesses. GAZI UNIVERSITY JOURNAL OF SCIENCE 2022. [DOI: 10.35378/gujs.982772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Perera UT, Heeney C, Sheikh A. Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development. Digit Health 2022; 8:20552076221085074. [PMID: 35340903 PMCID: PMC8941697 DOI: 10.1177/20552076221085074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Electronic prescribing systems offer considerable opportunities to enhance
the safety, effectiveness and efficiency of prescribing and medicines
management decisions but, despite considerable investments in health IT
infrastructure and healthcare professional training, realising these
benefits continues to prove challenging. How systems are customised and
configured to achieve optimal functionality is an increasing focus for
policymakers. We sought to develop an overview of the policy landscape
currently supporting optimisation of hospital ePrescribing systems in
economically developed countries with a view to deriving lessons for the
United Kingdom (UK). Methods We conducted a review of research literature and policy documents pertaining
to optimisation of ePrescribing within hospitals across Organisation for
Economic Co-operation and Development (OECD) countries on Embase, Medline,
National Institute for Health (NIH), Google Scholar databases from 2010 to
2020 and the websites of organisations with international and national
health policy interests in digital health and ePrescribing. We designed a
typology of policies targeting optimisation of ePrescribing systems that
provides an overview of evidence relating to the level at which policy is
set, the aims and the barriers encountered in enacting these policies. Results Our database searches retrieved 11 relevant articles and other web resources
mainly from North America and Western Europe. We identified very few
countries with a national level strategy for optimisation of ePrescribing in
hospitals. There were hotspots of digital maturity in relation to
ePrescribing at institutional, specialisation, regional and national levels
in the US and Europe. We noted that such countries with digital maturity
fostered innovations such as patient involvement. Conclusions We found that, whilst helpful to achieve certain aims, coordinated strategies
within and across countries for optimisation of ePrescribing systems are
rare, even in countries with well-established ePrescribing and digital
health infrastructures. There is at present little policy focus on
maximising the utility of ePrescribing systems.
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Affiliation(s)
- Uditha T Perera
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Catherine Heeney
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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18
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Faulkenberry JG, Luberti A, Craig S. Electronic health records, mobile health, and the challenge of improving global health. Curr Probl Pediatr Adolesc Health Care 2022; 52:101111. [PMID: 34969611 DOI: 10.1016/j.cppeds.2021.101111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Technology continues to impact healthcare around the world. This provides great opportunities, but also risks. These risks are compounded in low-resource settings where errors in planning and implementation may be more difficult to overcome. Global Health Informatics provides lessons in both opportunities and risks by building off of general Global Health. Global Health Informatics also requires a thorough understanding of the local environment and the needs of low-resource settings. Forming effective partnerships and following the lead of local experts are necessary for sustainability; it also ensures that the priorities of the local community come first. There is an opportunity for partnerships between low-resource settings and high income areas that can provide learning opportunities to avoid the pitfalls that plague many digital health systems and learn how to properly implement technology that truly improves healthcare.
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Affiliation(s)
- J Grey Faulkenberry
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia.
| | - Anthony Luberti
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
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19
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Kabukye JK, Kakungulu E, Keizer ND, Cornet R. Digital health in oncology in Africa: A scoping review and cross-sectional survey. Int J Med Inform 2021; 158:104659. [PMID: 34929545 DOI: 10.1016/j.ijmedinf.2021.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied. AIMS To describe the current landscape of digital health interventions in oncology in Africa. METHODS We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer. RESULTS The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship. Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows. CONCLUSION Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of life.
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Affiliation(s)
- Johnblack K Kabukye
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands; Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Edward Kakungulu
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
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20
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Krasuska M, Williams R, Sheikh A, Franklin B, Hinder S, TheNguyen H, Lane W, Mozaffar H, Mason K, Eason S, Potts H, Cresswell K. Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme. BMJ Health Care Inform 2021; 28:e100429. [PMID: 34921060 PMCID: PMC8685936 DOI: 10.1136/bmjhci-2021-100429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale national health information technology change programme aiming to promote digitally-enabled transformation in secondary healthcare provider organisations by supporting relatively digitally mature provider organisations to become international centres of excellence. AIM To qualitatively evaluate the impact of the GDE programme in promoting digital transformation in provider organisations that took part in the programme. METHODS We conducted a series of in-depth case studies in 12 purposively selected provider organisations and a further 24 wider case studies of the remaining organisations participating in the GDE programme. Data collected included 628 interviews, non-participant observations of 190 meetings and workshops and analysis of 9 documents. We used thematic analysis aided by NVivo software and drew on sociotechnical theory to analyse the data. RESULTS We found the GDE programme accelerated digital transformation within participating provider organisations. This acceleration was triggered by: (1) dedicated funding and the associated requirement for matched internal funding, which in turn helped to prioritise digital transformation locally; (2) governance requirements put in place by the programme that helped strengthen existing local governance and project management structures and supported the emergence of a cadre of clinical health informatics leaders locally; and (3) reputational benefits associated with being recognised as a centre of digital excellence, which facilitated organisational buy-in for digital transformation and increased negotiating power with vendors. CONCLUSION The GDE programme has been successful in accelerating digital transformation in participating provider organisations. Large-scale digital transformation programmes in healthcare can stimulate local progress through protected funding, putting in place governance structures and leveraging reputational benefits for participating provider organisations, around a coherent vision of transformation.
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Affiliation(s)
- Marta Krasuska
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | - Hung TheNguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh School of Social and Political Science, Edinburgh, UK
| | | | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | | | | | - Henry Potts
- Institute of Health Informatics, University College London, London, UK
| | - Kathrin Cresswell
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
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21
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Parums DV. Editorial: Global Initiatives Support the Use and Regulation of Digital Health Technology During the COVID-19 Pandemic. Med Sci Monit 2021; 27:e935123. [PMID: 34657930 PMCID: PMC8532519 DOI: 10.12659/msm.935123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022] Open
Abstract
The development and use of digital health technology have increased during the global COVID-19 pandemic. Artificial intelligence (AI)-powered digital tools have been increasingly used to diagnose and screen for SARS-CoV-2 infection. Digital technology, in the form of mobile phone applications (apps), has been adopted by several countries to track infected individuals as infection prevention and surveillance measures. Global best practice guidelines, technology approvals, and patient care models have only recently begun to catch up with the developments in digital technology. In 2021, the WHO published a global strategy on digital health (eHealth) and mobile health (mHealth) for 2020 to 2025. The US Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) now evaluates software as a medical device (SaMD) and software that is in a medical device (SiMD) through the International Medical Device Regulators Forum (IMDRF). This Editorial aims to discuss how the COVID-19 pandemic has driven global initiatives to support the use and regulation of digital health technology and the requirements for digital health evidence frameworks and new approaches to regulatory approvals.
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Affiliation(s)
- Dinah V Parums
- Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA
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22
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Malden S, Heeney C, Bates DW, Sheikh A. Utilizing health information technology in the treatment and management of patients during the COVID-19 pandemic: Lessons from international case study sites. J Am Med Inform Assoc 2021; 28:1555-1563. [PMID: 33713131 PMCID: PMC7989249 DOI: 10.1093/jamia/ocab057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023] Open
Abstract
Objective To develop an in-depth understanding of how hospitals with a long history of health information technology (HIT) use have responded to the COVID-19 pandemic from a HIT perspective. Materials and methods We undertook interviews with 44 healthcare professionals with a background in informatics from six hospitals internationally. Interviews were informed by a topic guide and were conducted via videoconferencing software. Thematic analysis was employed to develop a coding framework and identify emerging themes. Results Three themes and six sub-themes were identified. HITs were employed to manage time and resources during a surge in patient numbers through fast-tracked governance procedures, and the creation of real-time bed capacity tracking within electronic health records. Improving the integration of different hospital systems was identified as important across sites. The use of hard-stop alerts and order sets were perceived as being effective at helping to respond to potential medication shortages and selecting available drug treatments. Utilizing information from multiple data sources to develop alerts facilitated treatment. Finally, the upscaling/optimization of telehealth and remote working capabilities was used to reduce the risk of nosocomial infection within hospitals. Discussion A number of the HIT-related changes implemented at these sites were perceived to have facilitated more effective patient treatment and management of resources. Informaticians generally felt more valued by hospital management as a result. Conclusions Improving integration between data systems, utilizing specialized alerts, and expanding telehealth represent strategies that hospitals should consider when using HIT for delivering hospital care in the context of the COVID-19 pandemic.
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Affiliation(s)
- Stephen Malden
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Catherine Heeney
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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23
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Harris S. I Don't Want My Algorithm to Die in a Paper: Detecting Deteriorating Patients Early. Am J Respir Crit Care Med 2021; 204:4-5. [PMID: 33735601 PMCID: PMC8437119 DOI: 10.1164/rccm.202102-0459ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Steve Harris
- Critical Care DepartmentUniversity College Hospital London,London United Kingdom
- Institute of Health InformaticsUniversity College LondonLondon, United Kingdom
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24
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Lo B, Nagle LM, White P, Kleib M, Kennedy MA, Strudwick G. Digital and informatics competencies: Requirements for nursing leaders in Canada. Healthc Manage Forum 2021; 34:320-325. [PMID: 34018421 DOI: 10.1177/08404704211015428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of health information technologies continues to grow, especially with the increase in virtual care in response to COVID-19. As the largest health professional group in Canada, nurses are key stakeholders and their active engagement is essential for the meaningful adoption and use of digital health technologies to support patient care. Nurse leaders in particular are uniquely positioned to inform key technology decisions; therefore, enhancing their informatics capacity is paramount to the success of digital health initiatives and investments. The purpose of this commentary is to reflect on current projects relevant to the development of informatics competencies for nurse leaders in the Canadian context and offer our perspectives on ways to enhance current and future nurse leaders' readiness for participation in digital health initiatives. Addressing the digital health knowledge and abilities of nurse leaders will improve their capacity to champion and lead transformative health system changes through digital innovation.
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Affiliation(s)
- Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lynn M Nagle
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Peggy White
- Canadian Nurses' Association, Ottawa, Ontario, Canada
| | - Manal Kleib
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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25
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Konchak CW, Krive J, Au L, Chertok D, Dugad P, Granchalek G, Livschiz E, Mandala R, McElvania E, Park C, Robicsek A, Sabatini LM, Shah NS, Kaul K. From Testing to Decision-Making: A Data-Driven Analytics COVID-19 Response. Acad Pathol 2021; 8:23742895211010257. [PMID: 33959677 PMCID: PMC8060741 DOI: 10.1177/23742895211010257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 01/19/2023] Open
Abstract
In March 2020, NorthShore University Health System laboratories mobilized to
develop and validate polymerase chain reaction based testing for detection of
SARS-CoV-2. Using laboratory data, NorthShore University Health System created
the Data Coronavirus Analytics Research Team to track activities affected by
SARS-CoV-2 across the organization. Operational leaders used data insights and
predictions from Data Coronavirus Analytics Research Team to redeploy critical
care resources across the hospital system, and real-time data were used daily to
make adjustments to staffing and supply decisions. Geographical data were used
to triage patients to other hospitals in our system when COVID-19 detected
pavilions were at capacity. Additionally, one of the consequences of COVID-19
was the inability for patients to receive elective care leading to extended
periods of pain and uncertainty about a disease or treatment. After shutting
down elective surgeries beginning in March of 2020, NorthShore University Health
System set a recovery goal to achieve 80% of our historical volumes by October
1, 2020. Using the Data Coronavirus Analytics Research Team, our operational and
clinical teams were able to achieve 89% of our historical volumes a month ahead
of schedule, allowing rapid recovery of surgical volume and financial stability.
The Data Coronavirus Analytics Research Team also was used to demonstrate that
the accelerated recovery period had no negative impact with regard to iatrogenic
COVID-19 infection and did not result in increased deep vein thrombosis,
pulmonary embolisms, or cerebrovascular accident. These achievements demonstrate
how a coordinated and transparent data-driven effort that was built upon a
robust laboratory testing capability was essential to the operational response
and recovery from the COVID-19 crisis.
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Affiliation(s)
| | - Jacob Krive
- NorthShore University Health System, Evanston, IL, USA.,University of Illinois at Chicago, IL, USA.,University of Chicago, IL, USA
| | - Loretta Au
- NorthShore University Health System, Evanston, IL, USA
| | | | - Priya Dugad
- NorthShore University Health System, Evanston, IL, USA
| | | | | | | | | | | | | | | | - Nirav S Shah
- NorthShore University Health System, Evanston, IL, USA.,University of Chicago, IL, USA
| | - Karen Kaul
- NorthShore University Health System, Evanston, IL, USA.,University of Chicago, IL, USA
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Abstract
INTRODUCTION Electronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites. METHODS AND ANALYSIS Qualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic. ETHICS AND DISSEMINATION The Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)-an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process.
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Affiliation(s)
- Catherine Heeney
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Stephen Malden
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
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27
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Kose I, Rayner J, Birinci S, Ulgu MM, Yilmaz I, Guner S. Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes. BMC Health Serv Res 2020; 20:967. [PMID: 33087106 PMCID: PMC7580017 DOI: 10.1186/s12913-020-05767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 09/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size. METHODS EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated. RESULTS We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals. CONCLUSION Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.
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Affiliation(s)
- Ilker Kose
- Department of Health System Engineering, Istanbul Medipol University, 34810 Istanbul, Turkey
| | - John Rayner
- HIMSS Analytics for Europe and Latin America, Huddersfield, UK
| | | | | | | | - Seyma Guner
- Istanbul Medipol University, 34810 Istanbul, Turkey
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Cresswell K, Sheikh A, Dean Franklin B, Krasuska M, Nguyen H, Hinder S, Lane W, Mozaffar H, Mason K, Eason S, Potts H, Williams R. Formative independent evaluation of a digital change programme in the English National Health Service: study protocol for a longitudinal qualitative study. BMJ Open 2020; 10:e041275. [PMID: 33033100 PMCID: PMC7545630 DOI: 10.1136/bmjopen-2020-041275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/03/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Many countries are launching large-scale, digitally enabled change programmes as part of efforts to improve the quality, safety and efficiency of care. We have been commissioned to conduct an independent evaluation of a major national change programme, the Global Digital Exemplar (GDE) Programme, which aims to develop exemplary digital health solutions and encourage their wider adoption by creating a learning ecosystem across English National Health Service (NHS) provider organisations. METHODS AND ANALYSIS This theoretically informed, qualitative, longitudinal formative evaluation comprises five inter-related work packages. We will conduct a combination of 12 in-depth and 24 broader qualitative case studies in GDE sites exploring digital transformation, local learning and mechanisms of spread of knowledge within the Programme and across the wider NHS. Data will be collected through a combination of semistructured interviews with managers, implementation staff (clinical and non-clinical), vendors and policymakers, plus non-participant observations of meetings, site visits, workshops and documentary analysis of strategic local and national plans. Data will be analysed through inductive and deductive methods, beginning with in-depth case study sites and testing the findings against data from the wider sample and national stakeholders. ETHICS AND DISSEMINATION This work is commissioned as part of a national change programme and is therefore a service evaluation. We have ethical approval from the University of Edinburgh. Results will be disseminated at six monthly intervals to national policymakers, and made available via our publicly accessible website. We will also identify lessons for the management and evaluation of large-scale evolving digital health change programmes that are of international relevance.
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Affiliation(s)
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Hung Nguyen
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Susan Hinder
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Wendy Lane
- NHS Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | | | - Kathy Mason
- NHS Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Sally Eason
- NHS Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Henry Potts
- Centre for Health Informatics and Multiprofessional Education, University College London, London, UK
| | - Robin Williams
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Krasuska M, Williams R, Sheikh A, Franklin BD, Heeney C, Lane W, Mozaffar H, Mason K, Eason S, Hinder S, Dunscombe R, Potts HWW, Cresswell K. Technological Capabilities to Assess Digital Excellence in Hospitals in High Performing Health Care Systems: International eDelphi Exercise. J Med Internet Res 2020; 22:e17022. [PMID: 32808938 PMCID: PMC7463397 DOI: 10.2196/17022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hospitals worldwide are developing ambitious digital transformation programs as part of broader efforts to create digitally advanced health care systems. However, there is as yet no consensus on how best to characterize and assess digital excellence in hospitals. OBJECTIVE Our aim was to develop an international agreement on a defined set of technological capabilities to assess digital excellence in hospitals. METHODS We conducted a two-stage international modified electronic Delphi (eDelphi) consensus-building exercise, which included a qualitative analysis of free-text responses. In total, 31 international health informatics experts participated, representing clinical, academic, public, and vendor organizations. RESULTS We identified 35 technological capabilities that indicate digital excellence in hospitals. These are divided into two categories: (a) capabilities within a hospital (n=20) and (b) capabilities enabling communication with other parts of the health and social care system, and with patients and carers (n=15). The analysis of free-text responses pointed to the importance of nontechnological aspects of digitally enabled change, including social and organizational factors. Examples included an institutional culture characterized by a willingness to transform established ways of working and openness to risk-taking. The availability of a range of skills within digitization teams, including technological, project management and business expertise, and availability of resources to support hospital staff, were also highlighted. CONCLUSIONS We have identified a set of criteria for assessing digital excellence in hospitals. Our findings highlight the need to broaden the focus from technical functionalities to wider digital transformation capabilities.
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Affiliation(s)
- Marta Krasuska
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bryony Dean Franklin
- UCL School of Pharmacy, London, United Kingdom
- National Institute for Health Research Imperial Patient Safety Translational Research Centre, London, United Kingdom
| | - Catherine Heeney
- Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, United Kingdom
| | - Wendy Lane
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, United Kingdom
| | - Hajar Mozaffar
- Business School, University of Edinburgh, Edinburgh, United Kingdom
| | - Kathy Mason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, United Kingdom
| | - Sally Eason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, United Kingdom
| | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel Dunscombe
- Imperial College, London, United Kingdom
- KLAS Research's Arch Collaborative, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
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Cresswell K, Sheikh A, Franklin BD, Krasuska M, Nguyen HT, Hinder S, Lane W, Mozaffar H, Mason K, Eason S, Potts HWW, Williams R. Theoretical and methodological considerations in evaluating large-scale health information technology change programmes. BMC Health Serv Res 2020; 20:477. [PMID: 32460830 PMCID: PMC7254705 DOI: 10.1186/s12913-020-05355-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/24/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Attempts to achieve digital transformation across the health service have stimulated increasingly large-scale and more complex change programmes. These encompass a growing range of functions in multiple locations across the system and may take place over extended timeframes. This calls for new approaches to evaluate these programmes. MAIN BODY Drawing on over a decade of conducting formative and summative evaluations of health information technologies, we here build on previous work detailing evaluation challenges and ways to tackle these. Important considerations include changing organisational, economic, political, vendor and markets necessitating tracing of evolving networks, relationships, and processes; exploring mechanisms of spread; and studying selected settings in depth to understand local tensions and priorities. CONCLUSIONS Decision-makers need to recognise that formative evaluations, if built on solid theoretical and methodological foundations, can help to mitigate risks and help to ensure that programmes have maximum chances of success.
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Affiliation(s)
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Bryony Dean Franklin
- University College London School of Pharmacy, London, UK
- NIHR Imperial Patient Safety Translational Research Centre, London, UK
| | - Marta Krasuska
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hung The Nguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
| | - Wendy Lane
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, UK
| | - Kathy Mason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Sally Eason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, UK
| | - Henry W W Potts
- University College London Institute of Health Informatics, London, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK
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