Integrating Digital Innovation Mechanisms in Digital Infrastructures: The Case of Digital Remote Care

Digital innovation (DIN) is crucial for managing the growth of resource use in the hospital sector and for providing citizens with services aligned with the requirements of the modern world. DIN includes the co-creation of novel services, such as digital remote care (DRC) solutions. The healthcare sector, with a plethora of applications, is an example of a large digital infrastructure. Our study aims to explore how DRC initiatives can be integrated in large-scale digital infrastructures. Our in-depth case study, which explores 72 different DRC trajectories at 9 hospital health trusts in Norway, reveals the dynamic interplay among 3 key mechanisms - idealistic entrepreneurship, anchoring and remote infrastructure. Our contribution to the DIN literature is a model that shows the interplay among these key mechanisms, which increases the innovation pace, improves the innovations' scalability and provides a robust organisation that constantly implements innovations. As a contributions to DRC practice, lessons learned to speed up the innovation pace are offered: (1) Create a DRC organisational structure. (2) Ensure financial predictability. (3) secure anchoring upward in the governance structure. (4) Make the remote infrastructure appropriate for integration with the current digital infrastructure. (5) Advocate the success across the organisation to spur others to innovate.

Digital entrepreneurship from cellular data: How omics afford the emergence of a new wave of digital ventures in health

Data has become an indispensable input, throughput, and output for the healthcare industry. In recent years, omics technologies such as genomics and proteomics have generated vast amounts of new data at the cellular level including molecular, structural, and functional levels. Cellular data holds the potential to innovate therapeutics, vaccines, diagnostics, consumer products, or even ancestry services. However, data at the cellular level is generated with rapidly evolving omics technologies. These technologies use scientific knowledge from resource-rich environments. This raises the question of how new ventures can use cellular-level data from omics technologies to create new products and scale their business. We report on a series of interviews and a focus group discussion with entrepreneurs, investors, and data providers. By conceptualizing omics technologies as external enablers, we show how characteristics of cellular-level data negatively affect the combination mechanisms that drive venture creation and growth. We illustrate how data characteristics set boundary conditions for innovation and entrepreneurship and highlight how ventures seek to mitigate their impact.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12525-023-00669-w.

Multilevel IRT models for the analysis of satisfaction for distance learning during the Covid-19 pandemic

The Covid-19 pandemic played a relevant role in the diffusion of distance learning alternatives to "traditional" learning based on classroom activities, to allow university students to continue attending lessons during the most severe phases of the pandemic. In such a context, investigating the students' perspective on distance learning provides useful information to stakeholders to improve effective educational strategies, which could be useful also after the end of the emergency to favor the digital transformation in the higher educational setting. Here we focus on the satisfaction in distance learning for Italian university students. We rely on data comprising students enrolled in various Italian universities, which were inquired about several aspects related to learning distance. We explicitly take into account the hierarchical nature of data (i.e., students nested in universities) and the latent nature of the variable of interest (i.e., students' learning satisfaction) through a multilevel Item Response Theory model with students' and universities' covariates. As the main results of our study, we find out that distance learning satisfaction of students: (i) depends on the University where they study; (ii) is affected by some students' socio-demographic characteristics, among which psychological factors related to Covid-19; (iii) is affected by some observable university characteristics.

Experiences of nurses with an innovative digital diary intervention in the intensive care unit: A qualitative exploration

INTRODUCTION

Diaries have been used regularly in various intensive care units (ICUs) in international settings. Hard copy diaries written by relatives became impractical during the COVID-19 pandemic due to ICU visiting restrictions and infection control considerations. The implementation of a web based application, named the "Post-ICU" diary, offered relatives the ability to collaboratively write in a digital diary, to easily upload photos, video and audio clips and to feel engaged with the patient at a safe distance. In addition it allowed nurses to easily provide up-to-date information. The aim of this pilot study was to explore the experiences of ICU nurses with the implementation process and application of the Post-ICU diary.

METHODS

A multicentre qualitative design with focus group interviews was used with ICU nurses in November 2020. Interview data were audiotaped and transcribed verbatim, and then a thematic analysis was performed to categorize the data.

RESULTS

Participants from three hospitals (n = 14), 57% of whom were women, with a mean age of 40.6 years, described their experiences with the Post-ICU diary. The following themes emerged: implementation process, COVID-19, integration, and motivation. The results showed that ICU nurses perceived the Post-ICU diary to be applicable in daily care and endorsed the added value of the digital Post-ICU diary as a new opportunity to improve interhuman connectedness. However, the nurses also experienced barriers such as non-user-friendly access, lack of time and hesitance to write short messages.

CONCLUSION

ICU nurses reported that the Post-ICU diary had added value for patients and their relatives. However, in the beginning they also experienced barriers such as lack of time, insufficient integration with their own work processes, and challenges regarding writing short messages themselves. For structural embedding of the intervention, tailored strategies are needed to support ICU nurses in using this innovative Post-ICU diary.

Experiences of Norwegian child and school health nurses with the "Starting Right™" child health assessment innovation: a qualitative interview study

Background

Although child health services are well established in Norway, the use of information technology for the systematic collection of evidence-based child- and proxy-reported health measures may be beneficial in the early identification of child development problems. The Norwegian “Starting Right™” health service innovation consists of parent- and child-reported online structured health assessments tools, including practical routines for child and school health assessments. The aim of this study was to explore the experiences of child and school health nurses with the Starting Right innovation.

Methods

We used a qualitative design and conducted three focus group interviews with 18 child and school health nurses from three child health centres one year after the implementation of the innovation.

Results

The experiences of professionals with the Starting Right innovation were captured by three themes: (1) the digital innovation could be used to obtain a good overview of a child’s health and development; (2) interpreting the questionnaires was a challenge; and (3) implementing the new digital innovation was time-consuming.

Conclusions

Overall, the child and school health nurses experienced that the Starting Right innovation was useful for providing a comprehensive overview of child development and health. The challenges related to interpreting the parents’ scores and follow-up of children, as well as providing the questionnaires in relevant foreign languages, should be addressed to allow all children and families to be reached.

Leveraging 5G network for digital innovation in small and medium enterprises: a conceptual review

Small- and medium-sized enterprises (SMEs) play a crucial role within a country's economy considering that they provide a source of skills and innovation for entrepreneurship and their capacity for introducing, integrating and disseminating new technologies is incomparable. However, the world may be looking at an impending devastating recession delivered by the coronavirus pandemic. As governments intensify restrictions on business to halt the spread of the pandemic, the fear of the virus also reconfigures the very concept of business and the workplace. Therefore, there is a need for a greater focus on digital transformation considering that physical distancing requirements to curb the spread of this virus may become a cultural orientation for businesses and the workplace. A real digital transition is anticipated for small businesses with the 5G network technology. 5G network will not just be a technological connection but will affect different socio-economic sectors and will stimulate innovation in small companies. The goal of this paper was to carry out a literature review on the potential ways small businesses can leverage on 5G network for digital innovation. The paper proposed that small and medium businesses can leverage the 5G Mobile Technology through enhanced interpersonal communication, expanded remote work opportunities, innovative digital tools and supply chain efficiency. Finally, while many individuals and small business owners will profit from 5G technology some will work to undermine it. As a result, companies must keep this in mind when implementing 5G, or other new technology, and adjust their security protocols accordingly to remain secure.

Digital Innovation, Data Analytics, and Supply Chain Resiliency: A Bibliometric-based Systematic Literature Review

In recent times, the literature has seen considerable growth in research at the intersection of digital innovation, data analytics, and supply chain resilience. While the number of studies on the topic has been burgeoning, due to the absence of a comprehensive literature review, it remains unclear what aspects of the subject have already been investigated and what are the avenues for impactful future research. Integrating bibliometric analysis with a systematic review approach, this paper offers the review of 262 articles at the nexus of innovative technologies, data analytics, and supply chain resiliency. The analysis uncovers the critical research clusters, the evolution of research over time, knowledge trajectories and methodological development in the area. Our thorough analysis enriches contemporary knowledge on the subject by consolidating the dispersed literature on the significance of innovative technologies, data analytics and supply chain resilience thereby recognizing major research clusters or domains and fruitful paths for future research. The review also helps improve practitioners' awareness of the recent research on the topic by recapping key findings of a large amount of literature in one place.

Super Divya to the rescue! Exploring Nurse Mentor Supervisor perceptions on a digital tool to support learning and engagement for simulation educators in Bihar, India

BACKGROUND

Since 2014, the Government of Bihar and CARE India have implemented a nurse mentoring program that utilizes PRONTO International's simulation and team trainings to improve obstetric and neonatal care. Together they trained simulation educators known as Nurse Mentor Supervisors to conduct simulation trainings in rural health facilities across the state. Sustaining the knowledge and engagement of these simulation educators at a large-scale has proven difficult and resource intensive. To address this, the University of Utah with PRONTO International and with input from the University of California San Francisco, created an interactive, virtual education module based on a comic superhero named Super Divya to reinforce simulation educator concepts. This study examined the perceptions of Nurse Mentor Supervisors on Super Divya's accessibility, usefulness, and potential after implementation of Super Divya: Origin Story.

METHODS

We conducted qualitative interviews with 17 Nurse Mentor Supervisors in Bihar, India. In light of the COVID-19 pandemic, interviews were conducted virtually via Zoom™ using a semi-structured interview guide in Hindi and English. Participants were identified with strict inclusion criteria and convenience sampling methods. Interviews were analyzed using a framework analysis.

RESULTS

Nurse Mentor Supervisors found Super Divya to be engaging, innovative, relatable, and useful in teaching tips and tricks for simulation training. Supervisors thought the platform was largely accessible with some concerns around internet connectivity and devices. The majority reacted positively to the idea of distributing Super Divya to other simulation educators in the nurse mentoring program and had suggestions for additional clinical and simulation educator training topics.

CONCLUSIONS

This study demonstrates the potential of Super Divya to engage simulation educators in continuous education. At a time when virtual education is increasingly important and in-person training was halted by the COVID-19 pandemic, Super Divya engaged Supervisors in the nurse mentoring program. We have incorporated suggestions for improvement of Super Divya into future modules. Further research can help understand how knowledge from Super Divya can improve simulation facilitation skills and behaviors, and explore potential for reinforcing clinical skills via this platform.

ETHICAL APPROVAL

This study was approved by the institutional review board at the University of California San Francisco (IRB # 20-29902).

From reverse innovation to global innovation in animal health: A review

Reverse innovation refers to learning from or diffusion of innovations developed in low income settings and further translated to industrialized countries. There is lack of consensus regarding terminology, but the idea that innovations in low-income countries are promising for adoption in high-income contexts is not new. However, in healthcare literature globally, the vast majority of publications referring to 'disruptive innovation' were published in the last ten years. To assess the potential of innovative developments and technologies for improving animal health, we initiated a literature review in 2020. We used a combined approach, incorporating targeted searching in PubMed using a key word algorithm with a snowball technique, to identify 120 relevant publications and extract data for qualitative coding. Heterogeneity of articles precluded meta-analysis, quality scoring and risk of bias analysis. We can distinguish technical innovations like new digital devices, diagnostic tests and procedures, and social innovations of intersectoral cooperation. We profile two case studies to describe potential global innovations: an integrated surveillance and response system in Somali Regional State, Ethiopia and a blockchain secured One Health intervention to optimally provide post-exposure prophylaxis for rabies exposed people in West Africa. Innovation follows no borders and can also occur in low-income settings, under constraints of cost, lack of services and infrastructure. Lower administrative and legal barriers may contribute to produce innovations that would not be possible under conditions of high density of regulation. We recommend using the term global innovation, which highlights those emanating from international partnership to solve problems of global implications.

Clinical Trials for Idiopathic Pulmonary Fibrosis and the Role of Health Systems

We are in the midst of transformative innovation in health care delivery and clinical trials in idiopathic pulmonary fibrosis (IPF). Health systems are uniquely positioned at the crossroad of these shifting paradigms, equipped with the resources to expand the research pipeline in IPF through visionary leadership and targeted investments. The authors hope that by prioritizing development of health information technology, supporting a broader range of clinical trial designs, and cultivating broad stakeholder engagement, health systems will generate data to address knowledge-evidence-practice gaps in IPF. This will continue to improve the ability to deliver high-quality, safe, and effective care.

Digital transformation as an interaction-driven perspective between business, society, and technology

Digital transformation, a term introduced to talk about the various changes in business and society due to the increased usage of digital technologies, has recently gained much attention both in research and in practice. However, an analysis of 41 digital transformation frameworks following a developmental literature review shows that several areas can be expanded upon. We propose a novel framework that deals with the underrepresented areas by consolidating the various concepts found in the literature, explicitly including the role of society, highlighting the evolution over time, and including the drivers of digital transformation that we classified into 23 'digital transformation interactions' across six categories. This novel perspective contributes to our macro-understanding of digital transformation and can be used as a lens for further research to generate fresh insights into unanswered research avenues. Ultimately, this paper can be the first step towards a unified understanding of digital transformation.

Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a novel hybrid device

Background

Promoting a disruptive innovation in microsurgery, exoscopes promise alleviation of physical strain and improved image quality through digital visualization during microneurosurgical interventions. This study investigates the impact of a novel 3D4k hybrid exoscope (i.e., combining digital and optical visualization) on surgical performance and team workflow in preclinical and clinical neurosurgical settings.

Methods

A pre-clinical workshop setting has been developed to assess usability and implementability through skill-based scenarios (neurosurgical participants n = 12). An intraoperative exploration in head and spine surgery (n = 9) and a randomized clinical study comparing ocular and monitor mode in supratentorial brain tumor cases (n = 20) followed within 12 months. Setup, procedure, case characteristics, surgical performance, and user experience have been analyzed for both ocular group (OG) and monitor group (MG).

Results

Brain tumor cases using frontal, frontoparietal, or temporal approaches have been identified as favorable use cases for introducing exoscopic neurosurgery. Mean monitor distance and angle were 180 cm and 10°. Surgical ergonomics when sitting improved significantly in MG compared with OG (P = .03). Hand-eye coordination required familiarization in MG. Preclinical data showed a positive correlation between lateral camera inclination and impact on hand-eye coordination (r_s = 0.756, P = .01). There was no significant added surgical time in MG. Image quality in current generation 3D4k monitors has been rated inferior to optic visualization yet awaits updates.

Conclusions

The hybrid exoscopic device can be integrated into established neurosurgical workflows. Currently, exoscopic interventions seem most suited for cranial tumor surgery in lesions that are not deep-seated. Ergonomics improve in monitor mode compared to conventional microsurgery.

Electronic supplementary material

The online version of this article (10.1007/s00701-020-04361-2) contains supplementary material, which is available to authorized users.

Assessing the digital economy: aims, frameworks, pilots, results, and lessons

The article discusses the motivations for a holistic assessment of the digital economy. It outlines the pilot assessment program initiated by the World Bank Group and describes the assessment frameworks, tools, and processes deployed in selected pilot countries. It identifies the common challenges faced and lessons learned from applying these assessments in different contexts. These challenges include prioritizing digital diagnosis objectives, addressing inequality and poverty issues, securing participation and partnership of stakeholders, addressing implementation challenges, and integrating digital transformation strategy into a country development strategy. Other challenges include harnessing digital innovation and entrepreneurship, mobilizing local demand for the new technologies, engaging business in digital diagnosis, and adopting multi-disciplinary and whole-of-society approaches. The article addresses the implications of these challenges and draws broad lessons and practical recommendations for developing countries and aid agencies.

Real-time data-driven motion correction in PET

PET imaging has been, and continues to be, an evolving diagnostic technology. In recent years, the modernizing digital landscape has opened new opportunities for data-driven innovation. One such facet has been data-driven motion correction (DDMC) in PET. As both research and industry propel this technology forward, we can recognize prospects and opportunities for further development. The concept of clinical practicality is supported by DDMC approaches—it is what sets them apart from traditional hardware-driven motion correction strategies that have largely not gained acceptance in routine diagnostic PET; the ease of use of DDMC may help propel acceptance of motion correction solutions in clinical practice. As we reflect on the present field, we should consider that DDMC can be made even more practical, and likely more impactful, if further developed to fit within a real-time acquisition framework. This vision for development is not new, but has been made more feasible with contemporary electronics, and has begun to be revisited in contemporary literature. The opportunities for development lie on a new forefront of innovation where medical physics integrates with engineering, data science, and modern computing capacities. Real-time DDMC is a systems integration challenge, and achieving it will require cooperation between hardware and software developers, and likely academia and industry. While challenges for development do exist, it is likely that we will see real-time DDMC come to fruition in the coming years. This effort may establish groundwork for developing similar innovations in the emerging digital innovation age.

Limitations of recreational camera traps for wildlife management and conservation research: a practitioner's perspective

The availability of affordable 'recreational' camera traps has dramatically increased over the last decade. We present survey results which show that many conservation practitioners use cheaper 'recreational' units for research rather than more expensive 'professional' equipment. We present our perspective of using two popular models of 'recreational' camera trap for ecological field-based studies. The models used (for >2 years) presented us with a range of practical problems at all stages of their use including deployment, operation, and data management, which collectively crippled data collection and limited opportunities for quantification of key issues arising. Our experiences demonstrate that prospective users need to have a sufficient understanding of the limitations camera trap technology poses, dimensions we communicate here. While the merits of different camera traps will be study specific, the performance of more expensive 'professional' models may prove more cost-effective in the long-term when using camera traps for research.