JMIR Publications

ABSTRACT

Background:

Digital maturity is a priority for creating efficient, patient-centered health systems, yet Integrated Care Systems (ICS) often face challenges like a lack of interoperability and weak data governance. A systematic mapping of strategies is essential to guide these organizations identify areas for improvement and define sustainable actions to ensure technology adds value to all stakeholders.

Objective:

To map the development strategies and interventions implemented in ICS to promote digital maturity, while identifying the associated facilitators, barriers, and recommendations described in the literature.

Methods:

A search was conducted on PubMed, Scopus, and Web of Science on October 17th, 2025, for English articles published since January 1st 2015. Following Joanna Briggs Institute methodology, two independent reviewers performed study selection and data extraction, and quality appraisal using the Mixed Methods Appraisal Tool, with a third reviewer resolving any conflicts, and the obtained results were synthesized through descriptive analysis and thematic grouping.

Results:

Eighteen articles were included, featuring mixed-methods and case study designs, predominantly set in the United States, as well as several multi-country studies set in Europe. The results identified that most strategies were technological (telehealth, electronic health records and care coordination tools) or structural (governance frameworks). Key facilitators included strong organizational leadership, pre-existing digital infrastructure, and stakeholder engagement, while significant barriers included a lack of interoperability and inadequate funding. Regulation was found to be an obstacle to digital tools development and implementation, as privacy legislation often prevents from fully achieving interoperability, making it essential to use frameworks like “Privacy by Design” to address privacy concerns during digital solutions development phase. Several frameworks surfaced, with both the Chronic Care Model and eHealth Enhanced Chronic Care Model being the most prevalent. Stakeholder engagement emerged as a pivotal enabler, yet significant resistance persists due to low digital literacy, misconceptions and an aging workforce, making it critical not only to develop formal and continuous training, but actively involving them in problem-solving though a co-creation process.

Conclusions:

Developing digital maturity in ICS requires a multidimensional approach that extends beyond technological adoption to include multidisciplinary governance, national eHealth policies, and value-based funding models. Addressing low digital literacy through formal training for staff and patients is critical for health care system´s sustainability. The review provides a foundational framework for healthcare managers and future research and development of digital maturity guidelines in ICS.