Efficacy and pitfalls of digital technologies in healthcare services: A systematic review of two decades

Best Practices in Organizing Digital Transformation: Qualitative Case Study in Dutch Hospital Care

BACKGROUND

The health care sector faces increasing pressure, with demand outpacing supply and multiple challenges in accessibility, affordability, and quality. The current organization of health care systems is unsustainable-exacerbated by labor shortages and escalating expenditures in Europe, particularly the Netherlands. To address these issues, hospitals are increasingly adopting digital transformation strategies. This digital transformation involves the systematic implementation of digital technologies and processes. To achieve high-quality hybrid care, hospitals must integrate digital health care seamlessly into existing workflows. However, there is no definitive strategy for implementing these transformations.

OBJECTIVE

This study examines how Dutch hospitals organize their digital transformation, the strategies they employ, and the best practices they follow, to provide evidence-based recommendations for hospitals embarking on similar initiatives.

METHODS

A qualitative multicase study was conducted using purposive sampling. A total of 11 Dutch hospitals were invited, and 8 participated. Professionals-project or program managers of digital care, or advisors in policy, management, strategy, or related positions-from these hospitals took part in semistructured interviews. Topics included digital transformation strategies, organizational structures, barriers and facilitators, and lessons learned. All interviews were recorded, transcribed verbatim, and analyzed using directed content analysis.

RESULTS

Although hospitals organize their digital transformation in different ways and with different teams or departments, they encounter similar facilitators and barriers. Inspired by the Consolidated Framework for Implementation Research, the ExpandNet Scaling Up framework, and the Hybrid Health Care Quality Assessment, these factors were grouped into the following categories: the structure of the digital program, cultural factors within the organization, financial factors (internal or external), political factors (internal or external), patient needs, resources and skills, and technical factors.

CONCLUSIONS

Despite variations in implementation, hospitals share key challenges and enablers in digital transformation. Common factors-such as organizational culture, financial resources, and technical infrastructure-may serve as foundational elements for effective digital transformation in hospital care.

The Emergence of AI in Public Health Is Calling for Operational Ethics to Foster Responsible Uses

This paper discusses the responsible use of artificial intelligence (AI) in public health and in medicine, and questions the development of AI ethics in international guidelines from a public health perspective. How can a global ethics approach help conceive responsible AI development and use for improving public health? By analysing key international guidelines in AI ethics (UNESCO, WHO, European High-Level Expert Group on AI) and the available literature, this paper advocates conceiving proper ethical and legal frameworks and implementation tools for AI in public health, based on a pragmatic risk-based approach. It highlights how ethical AI principles meet public health objectives and focuses on their value by addressing the meaning of human-centred innovations, transparency, accountability, diversity, equity, privacy protection, technical robustness, environmental protection, and post-marketing surveillance. It concludes that AI technology can reconcile individual and collective ethical approaches to public health, but requires specific legal frameworks and interdisciplinary efforts. Prospects include the development of supporting data infrastructures, of stakeholders' involvement to ensure long-term commitment and trust, of the public's and users' education, and of international organisations' capacity to coordinate and monitor AI developments. It formulates a proposal to reflect on an integrated transparent public health functionality in digital applications processing data.

Challenges experienced by health care providers working in both hospital and home-based palliative care units in Dhaka city: A multi-center based cross-sectional study

BACKGROUND

Palliative care is paramount in the modern clinical field worldwide. However, in Bangladesh, its acceptance is limited compared to other related sectors, despite the country suffering from a huge burden of life-limiting diseases. Besides, PC teams and their approach to care are entirely different from the conventional clinical approach. This study aimed to explore the challenges faced by healthcare providers working in the palliative care unit in Bangladesh, including all groups.

DESIGN

This was a cross-sectional descriptive survey involving palliative care providers.

METHODS

A self-administered pre-tested questionnaire was used for data collection. Data was analyzed using descriptive statistics and Chi-square at p <0.05.

RESULT

The mean age of the respondents was 33.59 ± 8.05 years, and barely most (82.5%) had served for 7-9 years. More than half (51%) of doctors and 31% of nurses claimed patient agitation as a challenge. Almost all groups of respondents exhibit ethical dilemma as a barrier, although a significant relationship was found between professional level and ethical dilemma. More than half of doctors (51%), 41.5% of nurses, and 29.5% of PCA-ward staff mentioned the lack of telemedicine facilities as a challenge. Nearly half (47.1%) of doctors and nurses claimed that patients' families had made patient care difficult, on the other hand, PCA-ward staff (70%) group ignorance of family did the same thing. Opioid phobia of other health professionals restricted the growth mentioned by the majority of all four groups of respondents. A significant relationship was found between limited dose formulation and experience of HPs (p<0.07). At the institutional level, 93.3% of nursing staff agreed that the lack of supporting staff was a drawback. A significant relationship was also found between the type of institution and the lack of a support system to conduct home-based care (p<0.002). Moreover, the majority (83.3%) of PCA-WS exhibit a lack of career development opportunities (p<0.001) as a barrier, besides, more than 7 out of 10 doctors (7.2%) felt social discrimination as a challenge(p<0.001).

CONCLUSION

Introducing new concepts comes with obstacles, but proper planning and awareness can make it necessary. Incorporating it into primary healthcare can create new job opportunities and increase familiarity among the general population. Training healthcare professionals on opioid handling can also increase its acceptance.

Robot-assisted surgery and artificial intelligence-based tumour diagnostics: social preferences with a representative cross-sectional survey

BACKGROUND

The aim of this study was to assess social preferences for two different advanced digital health technologies and investigate the contextual dependency of the preferences.

METHODS

A cross-sectional online survey was performed among the general population of Hungary aged 40 years and over. Participants were asked to imagine that they needed a total hip replacement surgery and to indicate whether they would prefer a traditional or a robot-assisted (RA) hip surgery. To better understand preferences for the chosen method, the willingness to pay (WTP) method was used. The same assessment was conducted for preferences between a radiologist's and AI-based image analysis in establishing the radiological diagnosis of a suspected tumour. Respondents' electronic health literacy was assessed with the eHEALS questionnaire. Descriptive methods were used to assess sample characteristics and differences between subgroups. Associations were investigated with correlation analysis and multiple linear regressions.

RESULTS

Altogether, 1400 individuals (53.7% female) with a mean age of 58.3 (SD = 11.1) years filled in the survey. RA hip surgery was chosen by 762 (54.4%) respondents, but only 470 (33.6%) chose AI-based medical image evaluation. Those who opted for the digital technology had significantly higher educational levels and electronic health literacy (eHEALS). The majority of respondents were willing to pay to secure their preferred surgical (surgeon 67.2%, robot-assisted: 68.8%) and image assessment (radiologist: 70.9%; AI: 77.4%) methods, reporting similar average amounts in the first (p = 0.677), and a significantly higher average amount for radiologist vs. AI in the second task (p = 0.001). The regression showed a significant association between WTP and income, and in the hip surgery task, it also revealed an association with the type of intervention chosen.

CONCLUSIONS

Individuals with higher education levels seem to accept the advanced digital medical technologies more. However, the greater openness for RA surgery than for AI image assessment highlights that social preferences may depend considerably on the medical situation and the type of advanced digital technology. WTP results suggest rather firm preferences in the great majority of the cases. Determinants of preferences and real-world choices of affected patients should be further investigated in future studies.

Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature

PURPOSE OF REVIEW

There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges.

RECENT FINDINGS

There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality.

SUMMARY

Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.

Digital stressors and resources perceived by emergency physicians and associations to their digital stress perception, mental health, job satisfaction and work engagement

BACKGROUND

Digital technologies are increasingly being integrated into healthcare settings, including emergency departments, with the potential to improve efficiency and patient care. Although digitalisation promises many benefits, the use of digital technologies can also introduce new stressors and challenges among medical staff, which may result in the development of various negative work and health outcomes. Therefore, this study aims to identify existing digital stressors and resources among emergency physicians, examine associations with various work- and health-related parameters, and finally identify the potential need for preventive measures.

METHODS

In this quantitative cross-sectional study, an online questionnaire was used to examine the relationship between digital stressors (technostress creators), digital resources (technostress inhibitors), technostress perception as well as mental health, job satisfaction and work engagement among 204 physicians working in German emergency medicine departments. Data collection lasted from December 2022 to April 2023. Validated scales were used for the questionnaire (e.g. "Technostress"-scale and the Copenhagen Psychosocial Questionnaire (COPSOQ). Descriptive and multiple regression analyses were run to test explorative assumptions.

RESULTS

The study found medium levels of technostress perception among the participating emergency physicians as well as low levels of persisting technostress inhibitors. The queried physicians on average reported medium levels of exhaustion symptoms, high levels of work engagement and job satisfaction. Significant associations between digital stressors and work- as well as health-related outcomes were analyzed.

CONCLUSION

This study provides a preliminary assessment of the persistence of digital stressors, digital resources and technostress levels, and their potential impact on relevant health and work-related outcomes, among physicians working in German emergency departments. Understanding and mitigating these stressors is essential to promote the well-being of physicians and ensure optimal patient care. As digitisation processes will continue to increase, the need for preventive support measures in dealing with technology stressors is obvious and should be expanded accordingly in the clinics. By integrating such support into everyday hospital life, medical staff in emergency departments can better focus on patient care and mitigate potential stress factors associated with digital technologies.

Failures and fallacies of eHealth initiatives: Are we finally able to overcome the underlying theoretical and practical orthodoxies?

The growing and ubiquitous digitalization trends embodied in eHealth initiatives have led to the widespread adoption of digital solutions in the healthcare sector. These initiatives have been heralded as a potent transformative force aiming to improve healthcare delivery, enhance patient outcomes and increase the efficiency of healthcare systems. However, despite the significant potential and possibilities offered by eHealth initiatives, the article highlights the importance of critically examining their implications and cautions against the misconception that technology alone can solve complex public health concerns and healthcare challenges. It emphasizes the need to critically consider the sociocultural context, education and training, organizational and institutional aspects, regulatory frameworks, user involvement and other important factors when implementing eHealth initiatives. Disregarding these crucial elements can render eHealth initiatives inefficient or even counterproductive. In view of that, the article identifies failures and fallacies that can hinder the success of eHealth initiatives and highlights areas where they often fall short of meeting rising and unjustified expectations. To address these challenges, the article recommends a more realistic and evidence-based approach to planning and implementing eHealth initiatives. It calls for consistent research agendas, appropriate evaluation methodologies and strategic orientations within eHealth initiatives. By adopting this approach, eHealth initiatives can contribute to the achievement of societal goals and the realization of the key health priorities and development imperatives of healthcare systems on a global scale.

Artificial intelligence and digital medicine for integrated home care services in Italy: Opportunities and limits

Home healthcare in the Italian health system has proven to be an essential factor in adequately responding to the health needs of an increasingly aging population. The opportunities offered by digitization and new technologies, such as artificial intelligence (AI) and robotics, are a lever for making home care services more effective and efficient on the one hand, and on the other for improving remote patient monitoring. Telemedicine devices have enormous potential for telemonitoring and telerehabilitation of patients suffering from chronic disabling diseases; in particular, AI systems can now provide very useful managerial and decision-making support in numerous clinical areas. AI combined with digitalization, could also allow for the remote monitoring of patients' health conditions. In this paper authors describe some digital and healthcare tools or system of AI, such as the Connected Care model, the Home Care Premium (HCP) project, The Resilia App and some professional service robotics. In this context, to optimize potential and concrete healthcare improvements, some limits need to be overcome: gaps in health information systems and digital tools at all levels of the Italian National Health Service, the slow dissemination of the computerized medical record, issues of digital literacy, the high cost of devices, the poor protection of data privacy. The danger of over-reliance on such systems should also be examined. Therefore the legal systems of the various countries, including Italy, should indicate clear decision-making paths for the patient.