Assessing digital maturity of hospitals: Comparing national approaches in five countries (Preprint)

Abstract

BACKGROUND Digital maturity assessments can inform strategic decision making. However, national approaches to assessing digital maturity of health systems are in their infancy, and there is limited insight into context and processes associated with such assessments. OBJECTIVE To describe and compare national approaches to assessing digital maturity of hospitals. METHODS We performed a narrative review of five national approaches to assessing digital maturity of hospitals in Queensland (Australia), Germany, the Netherlands, Norway, and Scotland. Data was collected in narrative form exploring context, drivers, and approaches to measure digital maturity in each country. We then performed a qualitative thematic analysis to compare approaches with the help of NVivo 12 to facilitate coding. RESULTS We observed a common focus on interoperability, and assessment findings were used to shape national digital health strategies. Indicators were broadly aligned, but four of five countries developed their own tailored indicator sets. Key topic areas across countries included interoperability, capabilities, leadership, governance, and infrastructure. Analysis of indicators was centralised, but data was shared with participating organisations. Only one setting conducted an academic evaluation. Major challenges of digital maturity assessment included the high cost and time required for data collection, questions about measurement accuracy, difficulties in consistent long-term tracking of indicators, and potential biases due to self-reporting. We also observed tensions between practical feasibility of the process with the depth and breadth required by the complexity of the topic, and tensions between national and local data needs. CONCLUSIONS There are several key challenges in national assessments of digital maturity in hospitals that influence the validity and reliability of outputs. These need to be explicitly acknowledged when making decisions informed by assessments and monitored over time.