JMIR Publications

ABSTRACT

Background:

How are health systems in the United States embracing digital technologies? Many health systems are overwhelmed. Others have tried to stay current with the dramatic changes of the past year by leapfrogging selected digital technologies during the COVID-19 pandemic. It appears that almost all health systems have developed some form of customer-facing digital technologies and worked to align those to their existing electronic health records to accommodate the surge in remote and virtual care deliveries. Still, others have developed analytics-driven decision-making capabilities. However, even with all these developments, there seems to yet a gap in health systems’ ability to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of a reliable and reported estimate of the current digital orientation of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies.

Objective:

To explore and assess US health systems’ differences in digital orientations in the post-COVID-19 “new normal” in 2021. Differences were assessed in four dimensions: 1) Analytics and Intelligence Oriented Digital Technologies (AODT) 2) Customer Oriented Digital Technologies (CODT) 3) Growth and Innovation Oriented Digital Technologies (GODT), and 4) Futuristic and Experimental Digital Technologies (FEDT) The earlier two are foundational to health systems’ digital orientation, while the latter two will prepare for future disruptions.

Methods:

We surveyed a robust group of health system CEOs (total 625) across the United States during Feb-Mar 2021. Twenty-two percent of the CEOs (135) responded to our survey. We considered the above four broad digital technology orientations and ratified with experts’ consensus. Secondary data was collected from AHRQ Hospital Compendium, leading to the matched usable dataset for 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and factors that were earlier reported widely as barriers or facilitators to technology adoption.

Results:

We found that health systems have a lower level of customer (CODT mean= 4.70) or growth (GODT mean= 4.54) orientations, compared to analytics and intelligence digital orientation (AODT mean= 5.03); while health systems have the least futuristic digital orientation (FEDT mean= 4.31). The ordered logistic estimation results provided nuanced insights. Medium (P<.001) and large-sized(P<.05), major teaching (P<.001), and systems with a high burden hospital (P<.001) are doing worse in AODT orientations, raising some concerns. Health systems with medium (P<.001) and large sizes (P<.05), major teaching (P<.1), high revenue (P<.05), and with a high burden hospital (P<.001) have less customer-oriented digital technology or CODT. Interestingly, we found that health systems in Midwest (P<.05) and South (P<.05) are more likely to adopt growth-orientated technologies, while high revenue (P<.01) and investor ownership (P<.05) deters from GODT. Health systems in with the medium size and are in Midwest (P<.001), South (P<.001), and West (P<.05) are more adept to FEDT; while medium (P<.001) and high revenue (P<.001), and those with a high discharge (P<.05) or high burden hospital (P<.01) have subdued FEDT orientations.

Conclusions:

Not surprisingly, almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions of lower adoptions in some sets of health systems. Comparatively, fewer groups of health systems have growth or futuristic digital orientations. The transformative power of digital technologies can be leveraged ONLY by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated digital orientation direction across the United States remains elusive. This lack of consistency exacerbates different outcomes across different health systems and regions in the United States. Accordingly, the authors suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern.