Obstacles and Barriers on Healthcare Digitalization: Ways to improve its Management

¹Department of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran
²ESIC Business and Marketing School, Madrid, Spain
Department of Applied Economics II, Universidad Rey Juan Carlos, Madrid, Spain

^*Correspondence: Antonio Sánchez-Bayón, Department of Applied Economics II, Universidad Rey Juan Carlos, Madrid, Spain, Email:

Received: 03-Jul-2024, Manuscript No. IPHSJ-24-14988; Editor assigned: 05-Jul-2024, Pre QC No. IPHSJ-24-14988 (PQ); Reviewed: 19-Jul-2024, QC No. IPHSJ-24-14988 (QC); Revised: 26-Jul-2024, Manuscript No. IPHSJ-24-14988 (R); Published: 02-Aug-2024, DOI: 10.36648/1791-809X.18.S11.002

Abstract

While digitization can make the health industry faster and more efficient, there are many financial, social and organizational obstacles and barriers to its implementation. This article offers a systematic review of the main troubles detected from the literature review. Also there is a proposal of new kind of restrictions to pay attention. Finally, its offer a heterodox reading about the problem analyzed.

Keywords

Digitalization management; Healthcare digitalization; Obstacles and barriers

Journal of Economic Literature (JEL) Code: I1: health; I31: General welfare, wellbeing; K32: Energy, environmental, health, and safety law; O3: innovation, research and development, technological change, intellectual property rights.

Introduction

The digital age represents a transformative economic and social phenomenon driven by key technologies, including artificial intelligence, Internet of Things (IoT), nanotechnology, biotechnology, and robotics [1]. Digitization affects all areas of public and private-life and their management [2]: People connect with friends, family, colleagues, and businesses and exchange data with each other every day via apps and platforms [3]. However, digitization in the healthcare sector is lagging far behind [4]. Digital transformation involves using Information and Communication Technology (ICT) in basically new business capabilities, public administration, and the lives of individuals and society to enable substantial advancements like effective operations, better consumer experiences, or new business models [5,6]. The tidal wave of digital innovations, which has intensified into a technological tsunami over the past several years, has also impacted the healthcare sectors across the globe [5]. The emergence of digital technologies has significantly impacted efficiency, effectiveness, and reduced healthcare service costs [1]. Eventually, as Electronic Medical Record (EMR) provides proper management of chronic disease and other social problems, it can save up to $142–371 billion per year [7]. Applying advanced digital technologies can provide real-time accurate information access to Healthcare Workers (HCWs) and provide decision supports to healthcare professionals for better clinical care provision [7]. Thanks to digital technologies and tools in Medicine, particularly through eHealth technologies, prevention, diagnosis, treatment, monitoring and administration have been improved [8].

Digitalization of health information can help to better patient information management and improve health services; also to improve the social wellbeing [7,9]. Yet, recent reviews suggested that patients and healthcare providers continue to resist the digital transformation in the health sector despite its several applications and benefits [5]. There are important obstacles to implement these technologies to the health sector in different countries. Addressing such implementation challenges is important in designing and delivering digital health services. Current researches show that there is a gap between the current health IT ecosystem and the “HEALTH IT ECOSYSTEM” that is needed. Both the technologies themselves and the application of those technologies and the data they contain urgently need improvement to support the transition to value-based care. The existing obstacles are largely not knowledge barriers, but execution barriers [10]. That is, we know what needs to be done but not necessarily how best to do it in terms of which specific actions should be pursued by which specific stakeholders. And while the barriers to successful execution are considerable and require coordinated multi stakeholder action, they could, and should, be tackled with concerted efforts [10].

The health care industry is one of the most important industries in any society. Therefore, reducing costs, and increasing efficiency and effectiveness using digitalization of this industry is of great importance. In order to succeed in digitizing the healthcare industry, it is necessary to first identify and examine the obstacles that stand in the way of this industry. For this purpose, in this article, we are going to extract the barriers to digitalization of the healthcare industry from the research literature of this field.

Materials and Methods

Research on the barriers to digitalization of the healthcare industry in different countries has been conducted by various researchers. Each of these researchers suggest certain obstacles for the digitalization of the healthcare industry. Some of these researches are as follows:

Nuamir et al., implemented a mother and child health registration system in the study areas of Kenya and Lao PDR to evaluate barriers to digitalization. They conducted in-depth interviews with 20 healthcare workers (HCWs) who used the system and analyzed it qualitatively with thematic framework analysis. The results showed that workload and motivation to maintain high performance were significant obstacles to implement a digital health system. They recommend enhancing the scope and focus on human needs and satisfaction as a significant factor for digital system durability and sustainability.

Adler-Milister et al., identify a set of focal goals and associated near-term achievable actions that are critical to pursue in order to enable the health IT ecosystem to meet the acute needs of modern health care delivery [10].

Kajüter et al., with a case study on the German healthcare sector, identified six categories of barriers that inhibit digital linking in healthcare: Individual, legal, financial, institutional, technological, and workforce-related barriers. They were analyzed using the dimensions of level, IT influence, and perception and applying the actor-network theory [4].

Moetlhoa et al., presents the outcomes of a workshop conducted with key stakeholders, aiming to discern barriers and enablers in implementing digital-connected POC diagnostic models in South Africa [1]. The workshop, a component of the 2022 reassured diagnostics symposium, employed the Nominal Group Technique (NGT) and comprised two phases: Phase 1 focused on identifying barriers, while Phase 2 centered on enablers for the implementation of digital-linked POC diagnostic models. Stakeholders identified limited connectivity, restricted offline functionality, and challenges related to load shedding or rolling electricity blackouts as primary barriers. Conversely, ease of use, subsidies provided by the National Health Insurance, and 24-hour assistance emerged as key enablers for the implementation of digital-linked POC diagnostic models.

Inampudi et al., attempted to identify the potential barriers to the implementation of digital transformation in the health sector of India [5]. Barriers identified were mainly associated with limited technological and medical infrastructure, data security and privacy, and a lack of physical examination.

Results

The methodology used in this study was a Systematic Literature Review (SLR). This framework included planning, which involves the identification of the research questions; conducting the reviews; searching for relevant literature; and analyzing the literature through selection, extraction, and coding.

Following charts (Figure 1) shows the Procedure of Systematic Literature Review.

Figure 1: Stages for a systematic literature review [11].

The first step in collecting information involved defining the key terms used in the search. the process of search done on Scopus and Google Scholar as follow: a) search with (healthcare and digitalization and obstacles) in Scopus: 31 documents; b) search with (healthcare and digitalization and barriers) in Scopus: 97 documents; c) search with all-in-title: Healthcare digitalization barriers in Google Scholar 2 documents; d) search with all-in-title: healthcare digitalization obstacles in google scholar 1 document; e) search with all-in-title: Healthcare digitalization challenges: In google scholar 20 documents.

Some of found documents in search were not relevant and useful for our purpose. So we excluded them. Finally, we investigate relevant papers and searched for the answer to our research questions: What are the obstacles and barriers on healthcare digitalization? Way to improve its management?

The following table show the obstacles drawn from literature (Table 1). Many of them are repetitive and others overlap. Therefore, we coded them and presented a new category for barriers to digitalization of the healthcare system.

Obstacles & barriers for healthcare digitalization	References
Workload	[7]
Motivation to maintain high performance	[7]
Complexity of technology tools.	[12]
Data used by digital healthcare tools is still insufficient.
Telemedicine as a tool has limitations in terms of observation and accurate diagnosis.
Provision Medical education is lacking digital literacy fundamentals.
Undeveloped legal base.
Not sequential digital healthcare strategy.
Digital healthcare is still in the early stage of development.
Insufficient patient privacy and data security.
The use of digital tools may reduce healthcare specialist’s skills.
Infrastructural barriers.
Lack of funding.
Cultural and country-specific barriers.
Religious barriers limit implementation opportunities.
Poor tool functionality.
Data inaccessibility.
Lack of training.
Lack of support.
Connectivity Issues.
Unawareness of risk management plans.
Poor organizational system management.
Special skills needed.
User ignorance for the Digitalization.
Lack of understanding of the tool.
Limited connectivity.	[1]
Restricted offline functionality.
Challenges related to load shedding or rolling electricity blackouts.
Lack of network coverage and Information Technology (IT) infrastructure.	[5]
High installation and operating cost.
Lack of medical records and experts.
Lack of physical examination.
Data accuracy and misdiagnosis.
Data privacy and confidentiality.
Language and communication barriers.
User barriers, and ethical, legal, and accountability concerns.
Common basic rules have not been developed.	[13]
Each region independently followed its own way to digitize, resulting a huge variety of software products used even within one region, which makes electronic document flow between medical institutions difficult and practically impossible between regions.
Low basic digital skills in medical workers.
Low level of digital knowledge and trust among patients creates a low
Demand for digital technologies among the population.
Citizens are concerned about safety of their personal data on digital media.
Fear of medical errors in society associated with the use of telemedicine technologies.

Lack of interoperability between systems	[14]
Significant risks in digital transformation implementation
Lack of awareness, evidence, and funding for E-health initiatives.
Legal hurdles and shortage of qualified human resources in healthcare.
Structural and spatial disparities in medical facilities and practitioners.	[15]
Exodus of general practitioners and specialists in rural regions.	[15]
Poor standardization of information exchange protocols between sources (devices)	[16]
Regulatory requirements and legal uncertainties	[17]
Sociological, economical, and infrastructure obstacles	[18]
Ethical issues of digitalization in healthcare organizations.	[19]
Doctors claim that Electronic Health Record (EHR) distracts them from their regular clinical effectiveness.	[20]
They believe that their time spent on Electronic Health Record (HER) could have been better used on patients.	[20]
Data transparency, traceability, immutability, audit, data provenance, flexible access, trust, privacy, and security.	[21]
Rigger fears and insecurities in patients	[22]
Regulatory, commercial, and technical barriers hinder healthcare digitalization adoption.	[23]
Potential obstacles include digital divide, cybersecurity risks, and biased algorithms
Educate patient about healthcare digitalization.
Data breaches, malware, viruses, legacy systems, and network security risks.	[24]
Poor quality and validation of clinical data.	[25]
Lack of understanding and underdevelopment of analytic tools.	[25]
Cost management	[23]
IT Infrastructure of a country.
Functionality problems of the service	[26,27]
Low compatibility (not all healthcare facilities can provide the required network access).
A lack of data often leads to poor data integrity and quality.
Barriers resulting from workflow deficiency.
Lack of integration in the clinical work.
Issues around physicians include that they simply have no time for non-patient related concerns.
Hierarchical deficiency includes missing top-management support, low change management, and scattered key players that operate independently within the organization causing unclear roles and responsibilities
Cultural barriers which evolve around the issue of differences in adopting and accessing digital resources.	[28]
Barriers occur on an individual, like attitude toward technology or devoid intrinsic motivation and knowledge.
Low perceived usefulness and confidence in technology in general.
Mistrust toward their technologies.
fear of more transparency about the medical processes, which results in a loss of control and strengthens the patient’s position.
Fear and doubts also arise from missing social contact when switching to digital solutions such as online consultations.
Lack of business education of healthcare professionals often leads to ignorance toward anticipated healthcare benefits.
Monetary problems concerning digital innovations range from verification issues to missing public funds.
Market-entry barrier for startups.
Costs are a barrier, because high implementation costs often represent a deterrent, and the amount of lifecycle costs is sometimes difficult to estimate.
general lack of (external) financial incentives for the introduction and use of digital innovations in healthcare.
Data security and privacy issues are relevant for both users and providers.
differences in legislation at federal and state levels even increase the legal complexity
Structural barriers.
Issues of standardization, certification, approval, and cooperation.
High costs
Lack of interoperability of technology
Frequent software Updates
Privacy concerns
Technological disruption
Network coverage issues
Ethical challenges related to patient privacy and data security	[29]
Algorithm understanding	[29]
Challenges in methodology, implementation, and evaluation	[30]
Lack of digitally qualified workforce	[30]
Technological cyber security challenges	[31]
Digitalized analysis and process	[32]
Medical data sharing
Infrastructure resources
Regulation and constraints
Operational issue
The dearth of expertise in digitalization
Shortcomings of inadequate
Experience
Limitations of traditional realization and storage of relational data
Regulation and responsibilities
Health barriers	[33]
Support networks
Application interface/design
Digital literacy
Lack of awareness
Online security
Access to digital devices and the internet
Relationship with healthcare provider
In-person preference
Trust in technology	[34]
Financial Barriers	[34]
Rules	[35,36]
Data collection challenges	[35,36]
Lack of practitioners’ awareness’	[37]
Lack of education.
Lack of clinical evidence.
Low level of digital literacy among health care providers.	[13]
Low level of motivation to make changes in organizational processes.
Significant gaps in basic digital skills among health professionals.
Low level of digital knowledge and patients’
Standardization and interoperability among various healthcare systems, devices, and platforms.	[38]
Data Governance and Security.
Infrastructure and Technical Requirements.
Governance and Stakeholder Engagement.
Adoption and Implementation Support.
Regulatory barriers.
Lack of infrastructure.
Funding and investment.
Data privacy and security
Concerns.
Cultural and organizational factors.
Organizational barriers.
Lack of digital literacy among healthcare specialists.
Deficiency in legal regulations.
Structural problems.	[39]
Timing of the introduction.
Insufficient information and communication measures.
Human, technical, ethical–legal, and economic barriers	[40]
Management technologies, data security, organizational structure, and societal acceptance	[41,42]

Table 1: Systematic review of obstacles & barriers for healthcare digitalization.

After excluding the duplicate and overlaps obstacles, our systematization offers 20 categories of barriers on healthcare digitalization (including new types detected): (Table 2)

1	Obstacles related to high cost of digitalization
2	Obstacles related to the fear of healthcare industry employees of reducing accuracy and productivity with the use of technology
3	Obstacles related to quantity and quality of data
4	Obstacles related to security and privacy of patients data
5	Obstacles related to complexity of using technology
6	Obstacles related to limitations of digital tools
7	Obstacles related to lack of education, skills and knowledge about digitalization
8	Obstacles related to inappropriate rules
9	Obstacles related to lack of strategy
10	Obstacles related to infrastructure
11	Obstacles related to country culture and organizational culture
12	Obstacles related to lack of support
13	Obstacles related to lack of integrity and connectivity between technological tools
14	Obstacles related to healthcare management
15	Obstacles related to rolling electricity blackouts and internet weakness
16	Obstacles related to ethical concerns
17	Obstacles related to organizational structure
18	Obstacles related to workload and time limitation
19	Obstacles related to motivation of healthcare employees
20	Obstacles related to supply chain of technologies providers and healthcare organizations

Table 2: Main categories of obstacles on healthcare digitalization

Discussion

Although the obstacles and barriers to the digitalization of the health industry vary in different countries, many of these troubles are in common among all of them. In various studies, these obstacles have been examined and various categories have been made for them. Some of these barriers are related to the structure and culture of health organizations and the lack of skills to use digital tools in these organizations. Others are related to the culture of society and the degree of social acceptance of digitalization and technology. Another category of these obstacles is related to the cost of setting up and updating technologies. While the other part of these obstacles and barriers are related to the weakness of technology tools, the other is related to the lack of government and shareholders' support for digitalization. There are also concerns about patient data security and lack of appropriate rules to protect patient privacy. Various studies have suggested a variety of solutions to eliminate these barriers, the most common of which are the regulation of protocols and frameworks for protecting patient data and training the skills needed to digitize health care to industry employees.

Conclusion

Why there are not any improvements in the digitalization of the healthcare industry? According to the mainstream literature, the main obstacle and barriers are exogenous factors, related with the state of the art of technology and its popularization (to become part of the business culture and the labor relations). Under a heterodox analysis (specially, Austrian economics and new-institutional approaches) the troubles are others: The main obstacle and barrier is the public interventionism, with bureaucracy and resistance to the change. Maybe, the problem is linked with the think-tanks of healthcare sector, because in Europe, the main patron is the public sector, for this reason there is not enough critics to the current system and proposals to improve it. There is a synchrony between the official speech and the literature review, as it was confirmed in this research.

Acknowledgments

Research supported by GESCE‐Universidad Rey Juan Carlos (URJC) and GID‐TICTAC CCEESS‐URJC and CIELO‐ESIC Business and Marketing School.

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Citation: Tajodin A, Sánchez-Bayón A, Sastre FJ (2024) Obstacles and Barriers on Healthcare Digitalization: Ways to Improve its Management. Health Sci J Vol.18 No.S11:002