Reconceptualising the digital maturity of health systems

Cresswell, Kathrin; Sheikh, Aziz; Krasuska, Marta; Heeney, Catherine; Franklin, Bryony Dean; Lane, Wendy; Mozaffar, Hajar; Mason, Kathy; Eason, Sally; Hinder, Susan; Potts, Henry W W; Williams, Robin

doi:10.1016/s2589-7500(19)30083-4

Cited by 64 publications

(51 citation statements)

References 6 publications

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“…They also often have no definite end point and there is at times no consensus about strategic direction. We have previously discussed this in the context of digital maturity, which is a somewhat contested concept [29]. Different kinds of programme management and evaluation tools may be needed that give cognisance to this kind of evolution.…”

Section: The Evolving Nature Of Hit Programmes Over Timementioning

confidence: 99%

Theoretical and methodological considerations in evaluating large-scale health information technology change programmes

Cresswell

Sheikh

Franklin

et al. 2020

BMC Health Serv Res

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Background: Attempts to achieve digital transformation across the health service have stimulated increasingly large-scale and more complex change programmes. These encompass a growing range of functions in multiple locations across the system and may take place over extended timeframes. This calls for new approaches to evaluate these programmes. Main body: Drawing on over a decade of conducting formative and summative evaluations of health information technologies, we here build on previous work detailing evaluation challenges and ways to tackle these. Important considerations include changing organisational, economic, political, vendor and markets necessitating tracing of evolving networks, relationships, and processes; exploring mechanisms of spread; and studying selected settings in depth to understand local tensions and priorities. Conclusions: Decision-makers need to recognise that formative evaluations, if built on solid theoretical and methodological foundations, can help to mitigate risks and help to ensure that programmes have maximum chances of success.

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Section: The Evolving Nature Of Hit Programmes Over Timementioning

confidence: 99%

Theoretical and methodological considerations in evaluating large-scale health information technology change programmes

Cresswell

Sheikh

Franklin

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

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“…Indeed, numerous accounts of organizations leapfrogging undermine the tacit idea of stage-based models going through a fixed sequence of stages [ 29 ]. Stage-based models are popular, perhaps because they promise a simple way to measure progress, but give little scope for health systems and individual organizations to articulate their local priorities [ 12 ]. Furthermore, ‘one size fits all’ assessment criteria enforce a common standard even under circumstances where achieving this may not be appropriate or impose disproportionate costs.…”

Section: Discussionmentioning

confidence: 99%

“…Despite substantive worldwide efforts to promote digital excellence, there is no consensus on how to conceptualize it, what capabilities characterize a digitally excellent hospital, and how to best measure progress in a changing environment [ 12 ]. New models are beginning to emerge that acknowledge the importance of locally formed priorities and the changing nature of what constitutes digital excellence over time.…”

Section: Introductionmentioning

confidence: 99%

Technological Capabilities to Assess Digital Excellence in Hospitals in High Performing Health Care Systems: International eDelphi Exercise

Krasuska¹,

Williams²,

Sheikh³

et al. 2020

J Med Internet Res

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Background Hospitals worldwide are developing ambitious digital transformation programs as part of broader efforts to create digitally advanced health care systems. However, there is as yet no consensus on how best to characterize and assess digital excellence in hospitals. Objective Our aim was to develop an international agreement on a defined set of technological capabilities to assess digital excellence in hospitals. Methods We conducted a two-stage international modified electronic Delphi (eDelphi) consensus-building exercise, which included a qualitative analysis of free-text responses. In total, 31 international health informatics experts participated, representing clinical, academic, public, and vendor organizations. Results We identified 35 technological capabilities that indicate digital excellence in hospitals. These are divided into two categories: (a) capabilities within a hospital (n=20) and (b) capabilities enabling communication with other parts of the health and social care system, and with patients and carers (n=15). The analysis of free-text responses pointed to the importance of nontechnological aspects of digitally enabled change, including social and organizational factors. Examples included an institutional culture characterized by a willingness to transform established ways of working and openness to risk-taking. The availability of a range of skills within digitization teams, including technological, project management and business expertise, and availability of resources to support hospital staff, were also highlighted. Conclusions We have identified a set of criteria for assessing digital excellence in hospitals. Our findings highlight the need to broaden the focus from technical functionalities to wider digital transformation capabilities.

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“…Besides Turkey, Portugal is also considering to use EMRAM as a country-wide measure for digital transformation [54], and Canada applied a customized version of it for community-based physicians [55]. Since it is an EHR adoption model, EMRAM does not focus on human and organizational capabilities but the technological functionality of the hospital [56].…”

Section: Electronic Health Record Capability In Turkeymentioning

confidence: 99%

Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes

Kose

Rayner²,

Birinci

et al. 2020

BMC Health Serv Res

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Background Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size. Methods EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated. Results We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals. Conclusion Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.

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Reconceptualising the digital maturity of health systems

Cited by 64 publications

References 6 publications

Theoretical and methodological considerations in evaluating large-scale health information technology change programmes

Theoretical and methodological considerations in evaluating large-scale health information technology change programmes

Technological Capabilities to Assess Digital Excellence in Hospitals in High Performing Health Care Systems: International eDelphi Exercise

Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes

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