Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
J Med Internet Res. 2024 Mar 11;26:e47715. doi: 10.2196/47715.
The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience.
This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals.
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes.
A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores.
Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, 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 health care.
医疗保健的数字化转型正在迅速推进。一个被广泛认可的医疗保健改善框架是四重目标：改善临床医生体验、改善患者体验、改善人群健康和降低医疗保健成本。医院正试图通过使用数字技术来改善医疗服务，但这些技术的有效性通常仅根据成本和质量指标来衡量，而对临床医生和患者体验的了解则较少。
本研究旨在进行系统评价和定性证据综合评估数字医院的临床医生和患者体验。
遵循 PRISMA（系统评价和荟萃分析的首选报告项目）和 ENTREQ（提高定性研究综合报告的透明度）指南。从 2010 年 1 月至 2022 年 6 月，检索了 PubMed、Embase、Scopus、CINAHL 和 PsycINFO 数据库。纳入了探索多学科临床医生或成年住院患者对数字医院（具有完整电子病历）体验的研究。使用混合方法评估工具评估研究质量。对定量研究进行了叙述性数据综合。定性证据综合通过（1）使用 Leximancer（Leximancer Pty Ltd）的自动化机器学习文本分析和（2）研究人员主导的归纳综合生成主题来进行。
共纳入 61 项研究（n=39，定量研究占 64%；n=15，定性研究占 25%；n=7，混合方法研究占 11%）。大多数研究（55/61，90%）调查了临床医生的体验，而很少（10/61，16%）研究了患者的体验。研究人群范围从 8 名到 3610 名临床医生、11 名到 34425 名患者和 5 名到 2836 名医院。定量结果表明，临床医生对数字医院总体满意度较高（17/24，71%的研究），大多数研究（11/19，58%）对可用性的评价较为积极。数据可访问性得到了积极的报告，而适应性、医患互动和工作负荷倦怠则得到了负面的报告。数字医院对患者安全和临床医生提供患者护理能力的影响好坏参半。对临床医生体验研究（n=61，30%）的定性证据综合生成了 7 个主题：数字文档记录效率低下、数据质量不一致、破坏传统医疗保健关系、接受、安全与风险、依赖混合（数字和纸质）工作流程以及患者数据隐私。有一些微弱的证据表明，数字医院与患者满意度评分之间存在正相关关系。
根据高级指标（例如总体满意度和数据可访问性），临床医生对数字医院的体验似乎是积极的，但定性证据综合揭示了实质性的紧张关系。关于数字医院内患者体验的证据还不够充分，无法得出明确的结论，但迹象表明是积极的或不确定的。未来的研究必须优先考虑公平地调查和定义数字临床医生和患者体验，以实现医疗保健的四重目标。
