JMIR Publications

ABSTRACT

Background:

The digital transformation of healthcare is advancing rapidly. A well-accepted framework for healthcare improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health and reduced healthcare costs. Many hospitals are attempting to improve care by using digital technologies. The success of these technologies is often narrowly measured against cost and quality indicators and less is known about the clinician and patient experience.

Objective:

To conduct a systematic review and meta-synthesis of qualitative studies to assess the impact of digital hospitals on clinician and patient experience.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Transparency in Reporting the Synthesis of Qualitative Research Guidelines (ENTREQ) were followed. The databases PubMed, Embase, Scopus, CINAHL and PsycINFO were searched from inception to June 2022. Studies were included that explored (a) multidisciplinary clinician or (b) adult inpatient experience of digital hospitals (with a full electronic medical record). Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Meta-synthesis of qualitative studies was performed by (a) automated machine learning text analytics with Leximancer and (b) researcher-led inductive synthesis to generate themes.

Results:

A total of 61 studies (n=39 quantitative, n=15 qualitative, n=7 mixed) were included. The majority (n=55) investigated clinician experience, and few investigated the patient experience (n=10). Study populations ranged from 8-3,610 clinicians, 11-34,425 patients and 5-2,836 hospitals. Quantitative outcomes indicated clinicians had positive overall satisfaction (70.8%) with digital hospitals and most studies (57·9%) reported a positive sentiment to usability. Data accessibility was reported positively whereas adaptation, clinician-patient interaction and workload-burnout were negative. The impact of digital hospitals on patient safety and clinician ability to deliver patient care was mixed. The qualitative meta-synthesis of 18 clinician experience studies generated seven themes, including inefficient digital documentation, inconsistent data quality, disruptions to conventional healthcare relationships, acceptance, safety versus risk, reliance on hybrid (digital/paper) workflows and patient data privacy. There was weak evidence that supported a positive association between digital hospitals and patient satisfaction scores.

Conclusions:

Clinician experience of digital hospitals appeared positive in high-level indicators (e.g., overall satisfaction, data accessibility); however, qualitative meta-synthesis revealed substantive tensions that require health system attention. There is insufficient evidence to draw a definitive conclusion on the impact of digital hospitals on patient experience, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of healthcare.