JMIR Publications

ABSTRACT

Background:

Healthcare organisations understand the importance of new technology implementations, however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand progress made towards technology-enhanced health service delivery. Existing models have been criticised for lacking depth and breadth due to their technology focus and neglect of meaningful patient and system outcomes.

Objective:

To examine the perceived impacts of digital health reported by healthcare staff employed in healthcare organisations across a spectrum of digital health maturity.

Methods:

A mixed-methods case study design was conducted. The digital health maturity of public healthcare systems in Queensland (n=16) was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups: low, intermediate and high digital health maturity based on DHI scores below lower quartile, within interquartile range, and above upper quartile respectively. Using qualitative methods, healthcare staff (n=154) participated in interviews and focus groups. Transcripts were analysed with the assistance of automated text-mining software. Impacts were grouped according to the digital maturity of the healthcare worker’s facility and mapped to the quadruple aims of healthcare: improved patient experience, improved population health, reduced healthcare cost, and the enhanced provider experience.

Results:

DHI scores ranged between 78 and 193. Healthcare systems in the high maturity category (n=4) had DHI≥166.75 (the upper quartile); low maturity sites (n=4) had DHI≤116.75 (the lower quartile); and intermediate maturity sites (n=8) had DHI score from 116.75 to 166.75 (the interquartile range). Overall, 18 perceived impacts were identified and varied among digital maturities category in terms of occurrence and sentiment. Generally, a greater number of positive impacts were reported in healthcare systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts in higher maturity sites, and telehealth enabled healthcare access and efficiencies across all maturity categories. Limited interoperability and organisational factors (e.g., strategy, policy, vision) were universally negative impacts on health service delivery. For healthcare costs, the resource burden of ongoing investments in digital health and sustaining a skilled workforce were reported. For provider experiences, negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts in low maturity sites.

Conclusions:

This is one of the first studies to show differences in perceived impacts of healthcare system digital maturity. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim of healthcare.