JMIR Publications

ABSTRACT

Background:

The literature has increasingly discussed alternative approaches to analyze and evaluate healthcare investments in state-of-the-art technologies, especially with the advent of Healthcare 4.0 technologies or e-health. These investments generally involve computer hardware and software that deals with the storage, retrieval, sharing, and use of healthcare information, data, and knowledge for communication and decision-making. Besides, the utility of these technologies significantly increases when addressed in bundles. However, there has not been a structured and holistic approach for analyzing Healthcare 4.0 technologies investment.

Objective:

This study aims to analyze previous research related to the evaluation of Healthcare 4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with Hospitals 4.0 investment decisions and suggests research directions for this topic.

Methods:

To achieve our goal, we carried out the standard procedure for scoping review. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords "investment," "health," "industry 4.0," "investment," "health technology assessment," "healthcare 4.0," and "smart" in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all databases. After removing papers before 2011, duplicates, and performing further screening, we ended with 244 articles, which we analyzed in depth. Finally, after close reading and analysis, we selected 33 studies to compose the final publications' portfolio.

Results:

Our findings show the multidisciplinary nature of research related to the evaluation of hospital investments in H4.0. We detect that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominates over bundle analysis, value considerations of H4.0, and multiple decision-maker involvement. Findings were surprising given the interrelated nature of H4.0 and its multidimensional impact. Given the absence of a more holistic approach for H4.0 investment decisions, we first propose a framework for the research related to H4.0 investment and suggest five main research directions for this topic.

Conclusions:

We conclude by suggesting the following research directions: (1) Need for more research effort into developing economic valuation methodologies for healthcare 4.0 technologies, (2) Account for technology interrelations in the form of bundles, (3) Account for uncertainties in the process of evaluating such technologies, (4) How to integrate administrative, medical and patient perspectives in the evaluation process and finally, (5) How to balance and handle complexity in the decision-making process.