digitalization of patient journey

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In this paper, we will investigate how digitalization has transformed the patient journey and why mapping the digital patient journey in place of the traditional patient journey offers myriad of opportunities for pharma to understand, reach, and support patients, enhancing their experiences and outcomes. We will also explore a framework that pharma companies can employ to successfully map a digital patient journey and become patient-centric during the process.

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The Digitalization of the Patient Journey

timelapse photo of road during nighttime

We talk a great deal about digital technology and the way it can be used to augment the patient experience during the healthcare delivery process. However, what we don’t focus on so often is how digitalization impact the patient’s entire journey through a healthcare system.

When we think of digitalization applied to healthcare patient experience, we often think of direct models of contact such as telehealth or methods of measurement and reporting such as survey data, but the patient journey involves dozens of digital touchpoints, from the moment symptoms develop – or even before then – up until treatment has concluded – or has settled into an ongoing routine in the case of chronic conditions.

So, let’s take a deep[ish] dive into the current patient journey and explore how digital technology has transformed the experience in recent years.

The Digital Patient Journey

The digital patient journey begins with what can be loosely defined as the digital front door. The digital front door is a group of digital touchpoints which represent a patient’s first few steps along the healthcare journey. The digital front door can be made of everything from social media posts and adverts and your portal/website, to contact center comms, self-scheduling tools, and beyond.

By studying the patient journey as it sprouts from the digital front door, you can gain a deeper understanding of how each patient comes into contact with your organization and track how the experience grows from that point. Who visits your healthcare organization? Who doesn’t? What makes your patients choose you over a competitor? What factors keep them coming back as a return service user?

All these questions can help your organization identify roadblocks on the patient journey which prevent patients from engaging. Outdated scheduling platforms, a lack of digital communication tools, and more can all impede the patient journey and prevent your healthcare organization from acquiring new patients and retaining existing ones.

"[Digitalizing the patient journey] entails holistically re-examining how every component of the health care experience, from the digital tools to visit interactions, synchronizes to address the full continuum of patient needs throughout the journey," reports a research piece in the Journal of Digital Health . "By doing this, care shifts away from one-size-fits-all, fragmented strings of visits, toward seamless experiences that adapt to patients’ needs in real-time while integrating within their daily lives."

Stages of the Patient Journey

We’ve already discussed the digital front door as it pertains to the patient journey, but where does the patient experience travel from that point?

Firstly, we have the awareness stage where someone realizes they or someone they care for needs help. They will already have absorbed some information by a kind of digital osmosis at this stage and will have some idea of the options which are available to them.

They will then progress to the searching stage of the journey. This is where a person is actively seeking healthcare providers who can help with their condition or general advice online. Predictive modelling is one digital tool you can use at this stage to better target your marketing to intercept patients at this stage.

At the pre-care stage, the patient has chosen a provider and has begun initial consultation. This is a very tenuous stage of the process as patients are likely to seek second – or more – opinions and the potential for them to switch providers is high. CRM technology can be deployed here to better personalize care and reduce the chances of this happening.

Point of care is where tests and referrals are ongoing. Keeping referrals within your healthcare network and removing roadblocks from care coordination processes will provide you with the greatest chance of retaining patients at this stage.

Post-care refers to the point where treatment has concluded, or ongoing care has been settled into. Quality outcomes and patient retention is the focus here which closes the loop on the patient journey and ensures your healthcare network is the first one they turn to for future problems.

As you can see, the stages of the patient journey share a lot of DNA with the customer journey of a retail interaction. Many of the same factors are in play and many of the same strategies can be deployed for acquisition and retention. The stakes are obviously much higher in healthcare, but patients just want to feel cared for and appreciated throughout the experience.

Final Thoughts

Digitalization during the patient journey can help healthcare organizations reach patients at the earliest possible stage of their condition and keep them engaged throughout the process – increasing the chances of retaining those patients for years to come and for whatever life might throw at them.

Digitalization of the patient journey is set to be part of the conversation at NGPX 2022 , taking place in December at the Hyatt Regency Indian Wells, CA.

Download the agenda today for more information and insights.

Driving Patient Experience in Underserved Communities

Next Generation Measurement and Reporting in Patient Experience

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How to effectively digitize the patient journey—Insights from HCA Healthcare and Podium

Digital transformation has impacted every industry, encouraging more convenience for every customer and in turn, increasing consumer expectations. And healthcare is no different. Patients are ready and searching for the same digital conveniences offered by banks, online retailers, and curbside restaurant pick up.

Today’s healthcare decisions are met with endless choices and options. And when patients aren’t satisfied with their digital experience, a simple Google search can connect them to a new provider within a few seconds.

In our most recent webinar hosted by Becker's Hospital Review and sponsored by Podium, industry experts Felicia Williams, Digital Marketing Manager at HCA Healthcare, and Craig Daly, Podium General Manager of Healthcare at Podium, gathered to discuss best practices for healthcare and digital transformation for the patient journey.

Here are five key takeaways from the discussion:

1. Mirror your digital presence with your in-person patient experience.

Healthcare organizations tend to place most of their focus on the in-person care delivery that occurs once patients are in office, but there are critical touch points in the journey leading up to the actual appointment. Reflecting the quality and great service you’re delivering in person adds value to your digital front door. Online reviews and your website experience (think web chat, FAQs, office hours, etc.) can impact your digital presence and upleveling each of those can reflect the quality of care you offer in person.

2. Humanize all possible digital interactions for your patients.

There are countless opportunities to digitize different aspects of the patient journey, but it’s critical to maintain authenticity in every response. It’s a key challenge many organizations face as they advance their digital presence—finding the balance between being human while increasing efficiency with digital solutions.

Patient feedback is an important area to incorporate a real-time human element in digital interactions. Responding to reviews, incorporating web chat, and even opening additional digital channels (e.g. texting) can help healthcare organizations accomplish this task. By implementing a strategy to humanize all possible digital interactions, negative feedback becomes a real-time opportunity to turn a potentially lost patient into a supporter.

3. Inform digital transformation initiatives and reduce call volume with patient inquiry data.

Taking note of commonly asked questions—such as questions about your telehealth options—presents a critical opportunity to provide more information online. Patient inquiry data can help you clearly identify exactly what patients and potential patients are searching for in their Google searches, on your website, and in reviews. Checking in regularly on search traffic and Google Analytics can help identify high-demand information gaps within an organization’s digital presence.

4. Utilize COVID-19 digital processes long term.

COVID-19 has accelerated digital growth in the healthcare industry, and many of the procedures implemented in the wake of the global pandemic are worth continuing. To eliminate exposure risk, for example, many healthcare organizations added a texting channel to communicate appointment start times and to allow pre-visit forms to be completed virtually. With these changes, patients have more convenience and more control throughout their patient journey.

5. Be proactive and communicate aspects of the patient journey that can't be optimized.

While Amazon is a model for the type of convenience and speed consumers expect, some elements of the patient journey simply can't be optimized. And while the healthcare industry has more compliance and privacy concerns, in terms of patient data, compared to the retail industry, certain digital adoptions that work for a business like Amazon are infeasible. In those cases, it’s important to proactively set expectations.

To watch the full webinar and hear more about effectively digitizing the patient journey, click here.

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Integrating the experience: Principles for digital transformation across the patient journey

Affiliations.

1 Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
2 Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA.
PMID: 35392253
PMCID: PMC8980412
DOI: 10.1177/20552076221089100

As medical science advances and the population ages, the prevalence of chronic conditions has also grown. The traditional model of care, with its focus on acute and episodic issues within the office visit, is not designed to meaningfully address long-term patient needs. With COVID-19 has come unprecedented digital adoption, bringing health care delivery to a critical juncture. While digital tools and technologies present vast opportunities for democratizing and decentralizing care experiences, their piecemeal application to the existing "sick care" model and its information technology infrastructure will not only limit their value, but will inevitably add cost, inefficiency, and burden to care teams. In order to build upon this momentum and reap the full benefits of practice digitization, care model transformation must occur. This entails holistically reexamining how every component of the health care experience, from the digital tools to visit interactions, synchronizes to address the full continuum of patient needs throughout the journey. By doing this, care shifts away from one-size-fits-all, fragmented strings of visits, toward seamless experiences that adapt to patients' needs in real-time while integrating within their daily lives. Rather than acting as a substitute for care, technology instead is vital to promoting and amplifying the impact of all those involved. To achieve this, this paper outlines 10 principles for restructuring care to incorporate digital health capabilities. Each describes how all care model components work as a system that aligns with patient needs. By doing this, technology is now an integral in supporting relationships across the full continuum of care.

Keywords: connected care; digital health; ehealth; personalized medicine; technology; telehealth; telemedicine.

Patient Hub

Transformation of the patient journey in the digital age

Last Updated : December 11, 2023

We are all aware of how quickly the internet is evolving and changing contemporary lifestyles. But can patients use the internet to find better solutions?

Former vice president for Google Health, David Feinberg, reported that 7% of Google's daily searches are health related. According to The Telegraph , that's equivalent to 70,000 health-related searches every minute. This data emphasizes the willingness of patients to embrace the increasing shift toward digitization in the healthcare industry.

Patients are transitioning from followers to influencers

Imagine you are planning to visit a dental clinic in your area. First, you decide to learn more about their services from a neighbor who recently visited that clinic. The feedback you receive is positive, and the neighbor even mentions several friends who visited the clinic and were pleased with the service. Now, the main question is: Will the recommendation of others influence you to use that local dental clinic? Odds are, the positive experiences of your neighbor and her friends will help you proceed with the clinic confidently.

This example shows why it has become necessary to collect feedback and obtain insights that help identify areas where you can improve the patient experience. Happy patients become advocates for your services, while those who are dissatisfied may dissuade future patients from moving forward. Clinicians can address any issues and ensure top-quality patient services by listening and responding to feedback and suggestions.

Applications such as Zoho Survey can simplify the process of collecting feedback from patients. The trust and confidence patients place in your health care services often increase when they see positive feedback. Positive feedback can also help attract first-time patients to your medical practice.

Telehealth is continuing to gain traction

Gone are the days when patients had to stand in line and wait for an appointment to visit the doctor for a consultation. In this age of digitization, patients don't want to spend hours in a waiting room or fill out a lengthy intake form. They want to book appointments online from the comfort of their homes. Now, they even have the option to receive medical advice without leaving home, thanks to telehealth services. With applications like Zoho Meeting , it's easy to move regular medical counseling and follow-ups online.

The use of telehealth will likely continue to expand in the future, giving it the potential to become a mainstay of the hospital system. According to Fortune Business Insights, the telehealth market projects growth from $90.74 billion USD in 2021 to $636.38 billion USD in 2028.

QR codes expedite and enhance patient experiences

QR codes can improve efficiency, communication, and an organization's ability to provide high-quality care to patients. According to QRTIGER's database , 2022 QR code usage statistics showed a 443% scan increase since 2021, equaling 6,825,842 scans globally.

QR codes can be automatically embedded in a medical record, a digital health card, or a mobile application. Everything from lab tests to e-pharmacy and hospitalization information can be made readily available with a scan. This type of data is encrypted for better privacy and a more secured platform.

QR codes can increase patient engagement too, by providing access to educational materials and allowing patients to communicate with their health care providers. Overall, the use of QR codes can improve the efficiency, accuracy, and accessibility of patient care.

Organizations are embracing AR and VR opportunities

Augmented and virtual reality provide a viable solution as well as numerous diverse opportunities. AR and VR implementations are typically used for general diagnostic and medical training. Even medical students and doctors can now treat patients with a lowered risk of surgical mistakes. VR technology can perform high-precision operations through robotic surgery . Physical therapy with VR helps patients overcome high pain levels by providing distractions for the brain.

Digitization is the way forward

Due to the evolution of health care, the industry is looking for new ways to understand patients and their clinical needs. Many hospitals and clinics are still hesitant to implement new technology in their systems due to privacy and security concerns. However, quality software empowers you to restrict data access through strong password policies, regular security updates, staff training on best security practices, and encryption for securing data.

Digitization has helped transform the way health services are delivered to patients, and improved the quality and efficiency of patient care. Crucially, it has also enabled the analysis of large amounts of health data to better inform treatments and improve outcomes.

The never-ending patient journey of chronically ill patients: A qualitative case study on touchpoints in relation to patient-centered care

Roles Conceptualization, Visualization, Writing – original draft, Writing – review & editing

Affiliation Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, Noord-Brabant, the Netherlands

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing

Affiliation Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, the Netherlands

Roles Conceptualization, Formal analysis, Methodology, Validation, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, Noord-Brabant, the Netherlands, Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, the Netherlands

Roles Supervision, Validation, Writing – review & editing

Affiliations Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, the Netherlands, Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, the Netherlands

Roles Resources, Supervision, Validation, Writing – review & editing

Vera K. Maas,
Frederik H. Dibbets,
Vincent J. T. Peters,
Bert R. Meijboom,
Daniëlle van Bijnen

Published: May 17, 2023
https://doi.org/10.1371/journal.pone.0285872
Peer Review
Reader Comments

Healthcare professionals caring for chronically ill patients increasingly want to provide patient-centered care (PCC). By understanding each individual patient journey, they can significantly improve the quality of PCC. A patient journey consists of patient interactions, so-called touchpoints, with healthcare professionals distributed over three periods: pre-service, service, and post-service period. The aim of this study was to ascertain chronically ill patients’ needs for digital alternatives for touchpoints. Specifically, we aimed to explore which digital alternatives patients would like to see implemented into their patient journey to help healthcare professionals providing PCC.

Eight semi-structured interviews were conducted either face-to-face or via Zoom. Participants were included if they had visited the department of internal medicine and had received treatment for either arteriosclerosis, diabetes, HIV, or kidney failure. The interviews were analyzed utilizing a thematic analysis approach.

The results suggest that the patient journey of chronically ill patients is a continuous cycle. Furthermore, the results showed that chronically ill patients would like to see digital alternatives for touchpoints implemented into their patient journey. These digital alternatives consisted of video calls, digitally checking in before a physical appointment, digitally self-monitoring one’s medical condition and personally uploading monitoring results into the patient portal, and viewing their own medical status in a digital format. Particularly, patients who were familiar with their healthcare professional(s) and were in a stable condition mostly opted for digital alternatives.

In the cyclical patient journey, digitalization can help put the wishes and needs of the chronically ill patients at the center of care. It is recommended that healthcare professionals implement digital alternatives for touchpoints. Most chronically ill patients consider digital alternatives to lead to more efficient interactions with their healthcare professionals. Furthermore, digital alternatives support patients to be better informed about the progress of their chronical illness.

Citation: Maas VK, Dibbets FH, Peters VJT, Meijboom BR, van Bijnen D (2023) The never-ending patient journey of chronically ill patients: A qualitative case study on touchpoints in relation to patient-centered care. PLoS ONE 18(5): e0285872. https://doi.org/10.1371/journal.pone.0285872

Editor: Edward Nicol, South African Medical Research Council (SAMRC) / Stellenbosch University (SU), SOUTH AFRICA

Received: July 28, 2022; Accepted: May 3, 2023; Published: May 17, 2023

Copyright: © 2023 Maas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: We have uploaded our minimal underlying dataset to Tilburg University’s data repository, TiU Dataverse. This repository has been certified with the CoreTrustSeal. You can access the repository via https://doi.org/10.34894/P8FWAL .

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Healthcare professionals caring for chronically ill patients increasingly want to provide patient-centered care (PCC), given that patients are demanding to have more influence and control on the treatment they receive. PCC has been a focus in healthcare research for a significant amount of time to make care more focused on the patient and thereby improve safety, efficacy, public health, and patient satisfaction [ 1 ]. PCC focuses on the patient’s healthcare needs and has the goal to empower patients to become active participants in their care [ 1 ]. PCC could possibly replace the current physician-centered system with one that revolves around the patient [ 2 ]. This is important because each patient is unique and requires treatments that suit their situation in a patient-centered way. This implies that due to continuously changing patient needs and wishes, healthcare professionals are required to innovate and change the way they deliver care regularly. Also from a societal perspective, it is important that healthcare services become more responsive to the complex needs and requirements of chronically ill patients [ 3 ]. Additionally, hospitals should keep up with the ever-increasing amount of diagnostic and treatment options, specifically including digital opportunities. Gerteis et al. [ 4 ] introduced seven dimensions that affect PCC: 1) Respect for patients’ values, preferences, and expressed needs, 2) Coordination of care, 3) Communication between patient and providers, 4) Physical care, 5) Emotional support, 6) Involvement of family and friends, and 7) Transition and continuity of care. These dimensions provide insights in how healthcare professionals can become more involved in patient-centered quality efforts, and how patient-centered quality can be integrated into health care policy, standards, and regulations. By bringing the patient’s perspective to the design and delivery of health services, providers can improve their ability to meet patient’s needs and enhance the quality of care [ 4 ].

Hospitals can also significantly improve the quality of the service provided by exploring and understanding the individual patient journey [ 5 ]. The patient journey principle stems from the customer journey principle, an often studied topic within service and marketing research [ 6 ]. The customer journey is defined as “the customer’s personal interpretation of the service process and their interaction and involvement with it during their journey or flow through a series of touchpoints” [ 6 ]. In the context of healthcare, the patient journey represents patient interactions, i.e., touchpoints, with multiple healthcare professionals distributed over space and time [ 7 ].

Touchpoints are present in every patient journey and are widely discussed in service research [ 6 ]. A touchpoint is considered as a moment of contact between a firm or service provider and a customer at distinct points in the customer journey [ 8 ]. Touchpoints differ from each other in the way the contact between the patient and the healthcare professional is established. In this study, the focus will be on two categories of touchpoints. The first category of touchpoints is described as healthcare encounters [ 9 ]. These encounters could be hospital admissions, urgent care, and primary care provider visits. For these types of touchpoints, the patient is usually required to visit the healthcare institution or healthcare professional. Some of these healthcare encounters that are currently taking place physically at the hospital could also be performed by the patient. For example, the self-monitoring of blood glucose for diabetes patients which has been around for years now has positively impacted the self-management of this illness [ 10 ].

The second category of touchpoints are described as device touchpoints and are considered technological solutions that are utilized by patients and healthcare professionals [ 9 ]. These touchpoints involve, for example, online meetings with healthcare providers, administrative tasks such as planning appointments, and informational actions like reviewing one’s medical records. This category of touchpoints provides tremendous opportunities to improve patient experiences and possibly also improve the efficiency of care [ 11 ]. For example, the use of video calls was found to have the potential to improve the patient experience especially if these patients otherwise must travel long distances [ 12 ].

The patient journey can be divided into three specific periods: pre-service, service, and post-service [ 13 ]. A basic patient journey of chronically ill patients usually begins during the pre-service period with the registration of the patient at the outpatient clinic. Following, an intake consult takes place between the patient and the healthcare professional to establish a first relationship and discuss the expectations for the treatment. In numerous hospitals the physical check-in at the desk before an appointment has been replaced by digital registration screens, which is found to be more efficient and less expensive compared to having several staff members at the desk. Furthermore, it improves the general patient satisfaction [ 14 ].

In the service period of the patient journey, the focus is on the regular checkup-meetings patients with chronic illnesses tend to have. Typically, chronically ill patients have a low chance of being cured. Therefore, the main meetings they have are with their healthcare professional to check their health status and to discuss the results of previous blood tests. However, extensive physical examination is usually not needed. Due to the Covid-19 pandemic physical meetings with healthcare professionals have increasingly been rescheduled to an online format. Ramaswamy et al. [ 15 ] showed that video appointments had been increased by 8729% during the pandemic compared to the year before. They also found that patient satisfaction with video appointments is very high and is not a barrier to shift from physical visits at the outpatient clinic to online video visits. In addition, research shows that most patients have the required knowledge and technology to participate in online checkup meetings [ 16 ].

The post-service period of the patient journey is dominated by administrative actions. These involve the planning of new appointments and other administrative tasks, as well as reviewing one’s medical records. A study on patient access to medical records has found modest benefits and showed moderate improvements in doctor-patient communication, adherence, patient empowerment, and patient education [ 17 ]. Though, it was also found that some patients experienced slight confusion while reading their own records and could not understand everything that was in their file. Currently various applications of digital solutions in hospital care have been integrated into so-called online patient portals. Research has indicated that the use of these portals can lead to improvements in clinical outcomes, patient behavior, and experiences [ 18 ].

Previous analysis of the patient journey has revealed three important needs for PCC, especially for patients with chronic conditions [ 19 ]. First, the patient and the healthcare professional should develop a visible health goal. Second, they should establish clear and transparent shared decision-making. Third, they should have a closed-loop communication process [ 19 ]. More factors, for example the implementation of digital innovations, can be identified in order to create a better setting for PCC [ 20 ]. Digital developments can help improve healthcare service by improving connectivity between the patient and the healthcare professional [ 21 ]. Currently, little is known about the perspective of chronically ill patients on the implementation of digital opportunities of their patient journey to improve the delivery of PCC. Although we acknowledge the eHealth Enhanced Chronic Care Model, as proposed by Gee et al. [ 22 ], which places chronic care in the context of the community where the person will receive care, we are convinced that the work by Gerteis et al. [ 4 ] provides a more comprehensive view on how digitalization can improve dimensions of PCC.

The main aim of the present study is to ascertain the chronically ill patients’ needs for digital alternatives for touchpoints between them and their healthcare professionals. Specifically, we aim to explore which digital alternatives the patients would like to see implemented into their patient journey to help healthcare professionals providing PCC. The potential digital alternatives for the touchpoints are allocated to the three periods of the patient journey: pre-service, service, and post-service period. Each period has its own characteristic touchpoints and potential digital alternatives. The digital alternatives that chronically ill patients like to see implemented can lead to higher levels of patient satisfaction as it responds to the patient’s own needs and preferences, and thus we assume that these alternatives can improve the delivery of PCC.

Study design

A qualitative, exploratory case study design was used to identify the touchpoints between chronically ill patients and healthcare professionals during the patient journey and to explore opportunities for digital alternatives for these touchpoints to make the patient journey more patient-centered. Because the topic of this study is in its formative stage, we conducted qualitative research in the form of a case study. Case study research designs have different purposes, namely exploratory, explanatory, and descriptive, or a combination of those purposes [ 23 ]. The design of the current study can be defined as exploratory, as it explores the patient journey of chronically ill patients, their attitudes towards that journey, and the possible digital alternatives provided by these patients for the encountered touchpoints during their journey. We used a case study approach to generate an in-depth understanding of a complex issue in its real-life context, which lends itself well to capture information on ‘how’, ‘what’, and ‘why’ questions [ 24 ]. An advantage of conducting research in this manner is that it provides the opportunity to study a topic in its real-life context; this can contribute to understanding whether digital alternatives for touchpoints make the patient journey of chronically ill patients more patient-centered. The consolidated criteria for reporting qualitative research (COREQ) [ 25 ] were used as guidelines for the study design and the data analysis ( S1 File ).

We took the healthcare provision for chronically ill patients characterized by continuous, monitoring episodes, provided at the department of internal medicine of a hospital in the south of the Netherlands, as our case. The department consists of outpatient clinics for patients who suffer from (chronic) illnesses such as infectious diseases, kidney diseases, metabolic diseases, and vascular diseases. The case sampling of the participants focused on typical cases of care for chronically ill patients characterized by continuous, monitoring episodes at this department. In the fall of 2021, using e-mail and telephone, the study team approached three internists at the department of internal medicine to help us select and contact potential participants. Potential participants were considered for inclusion if they visited the department of internal medicine and are treated for either arteriosclerosis, diabetes, HIV, or kidney failure.

Participants

Chronically ill patients who received treatment and are monitored at the department of internal medicine were asked to participate. First, convenience sampling logic was used to identify potential participants [ 26 ]. Second, purposive sampling was used to target specific chronic illnesses to capture a wide variety of experiences of patients who are being treated at the department of internal medicine, with a focus on patients who suffered from infectious disease (HIV), kidney disease (kidney failure), metabolic diseases (diabetes), and vascular diseases (arteriosclerosis). Table 1 provides an overview of the demographic profile of ages of these four patient groups. Potential participants were given two weeks to consider whether they wished to participate and, in the case of a positive decision, were asked to reply to the internist and give consent for their contact details to be disclosed to the study team. The participants who gave consent were then contacted by telephone to schedule the interview. The sample size aim was to include at least three patients of each patient group, so that we would conduct twelve interviews in total. This number of interviews was based on previous research that proves that data saturation, meaning new interviews do not yield new data on the interview topics, can be achieved with 9 to 17 interviews [ 27 , 28 ]. Eight patients agreed to participate in this study, despite our continued efforts to include more patients. Although the number of participants is relatively small, a limited number of interviews can be sufficient in the case of exploratory studies to get a reliable sense of thematic exhaustion and variability of the data [ 27 , 28 ]. In addition, research has indicated that sample size should not be considered alone but be embedded in the more encompassing examination of data adequacy [ 29 ]. This implies that sample size numbers in qualitative research are not unimportant but should be extended to terms of adequate amounts of evidence, adequate variety in kinds of evidence, and adequate interpretive status of evidence. Given our comprehensive data collection, consisting of semi-structured interviews and document analysis, we are convinced that, despite our relatively small number of interviews, we were able to present adequate variety and interpretation of our evidence. By combining the information from the interviews and document analysis with the theoretical framework, we were able to draw a comprehensive image of the patient journey for the patient groups included in our study. For instance, when an interviewee mentioned a specific touchpoint, we verified this touchpoint with our collected documents and interview transcripts to ensure that this touchpoint was in accordance with the baseline patient journey we developed. This approach strengthened us in our belief that we were able to present convincing evidence. This conviction also arose during the data analysis when we observed that data saturation happened after seven interviews, as no new themes emerged from the data gathered between interview seven and interview eight. This is in accordance with previous research that demonstrated that saturation can be achieved in a narrow range of interviews [ 27 ].

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https://doi.org/10.1371/journal.pone.0285872.t001

Data collection

The study team approached twelve chronically ill patients of the department of internal medicine. Eight of them agreed to participate in the present study, none of them were from the cardiovascular patient group. Reasons for not participating that were given were no interest in participation or not having sufficient time for the interview. Table 2 provides an overview of the participant characteristics. Three of the participants were male and five of them were female. The youngest participant was 38 years old and the oldest was 78 years old ( M = 50.00 years; SD = 13.09). On average, participants were living with their chronic illness for 18 years at the time of the interviews ( M = 18.00 years; SD = 11.26). The interviews lasted from 20 to 55 minutes.

https://doi.org/10.1371/journal.pone.0285872.t002

We conducted eight semi-structured interviews which allowed us to make sure that important topics were covered, while leaving room for the participants to provide their story regarding their patient journey [ 30 ]. Given the qualitative and exploratory nature of our case study, the focus was primarily on understanding the experiences, perceptions, and attitudes of chronically ill patients during their patient journey. The semi-structured interview approach is relevant for exploratory research, as it is an effective way to gather rich data and it allows for the creation of new insights into the case under study [ 23 ]. As a consequence of Covid-19 restrictions in the Netherlands in 2021, five interviews were conducted via Zoom [ 31 ] instead of face-to face. We also collected patient characteristics such as age, gender, type of disease, and how long the participants were living with their chronic illness.

The interview questions were grouped in advance according to the three phases of the patient journey: pre-service period, service period, and post-service period [ 13 ]. In each interview the same questions were asked, but not in a fixed order ( Table 3 ). The semi-structured approach was used to obtain insights in the touchpoints in the patient journey during different periods. In addition, we collected participants’ needs, preferences, and suggestions for digital alternatives for the touchpoints per period of the patient journey. The interviews were audio recorded and transcribed verbatim.

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We also collected relevant documentation that was open to the public (e.g. information leaflets, invitation letters), and internal documentation of the department of internal medicine (e.g. planning schemes, medical protocols). These collected documents provided valuable information in terms of touchpoints encountered by chronically ill patients during their patient journey.

Data analysis

The data were analyzed using the three steps method for thematic analysis as described by Miles et al. [ 32 ]: 1) data reduction, 2) data display, and 3) drawing conclusions. This is a systematic data reduction process building on, among others, the reading of transcripts, document summaries, codification of text segments, generation of themes and categories, and identification of relationships [ 32 ]. We employed this deductive, thematic analysis approach since we used a coding framework for analysis that was based on concepts and definitions derived from the literature [ 4 , 6 , 13 , 19 ]. While exploratory case studies probe into and shed light on what is essentially unknown, they should be guided by a specific purpose that frames the research [ 23 ]. The deductive codes were useful in both the segmentation and coding phase of the data analysis. Three main categories were created to store the coded data: touchpoints, patient-centered care, and digital solutions. The definitions of these categories and their subcategories can be found in Table 4 . These (sub)categories were later used to label the data with the relevant codes. The coding framework was continuously discussed and tested during the coding of the interviews, which is in alignment with the main principle that Miles et al. [ 32 ] endorse and entails that codes should ‘have some conceptual and structural unity. Codes should relate to one another in coherent, study-important ways; they should be part of a unified structure’ [ 32 ].

https://doi.org/10.1371/journal.pone.0285872.t004

We started with developing a baseline patient journey, which is common practice in patient journey research [ 33 ], based on the data commonalities that were obtained from the interviews ( S1 Fig ). Next, as our guiding principle, we used the touchpoint definition in customer journeys of Lemon & Verhoef [ 6 ] to identify touchpoints in the patient journey: a moment of contact between a firm or service provider and a customer at distinct points in the customer journey (p. 71). It was then discussed within the research team whether these touchpoints could be described as healthcare encounters or device touchpoints. To obtain more detailed information about the touchpoints and about the moments at which they occurred in the patient journey, the touchpoints were grouped together according to the three periods of the patient journey, as identified by Rosenbaum et al. [ 13 ]. After the coding process, we systematically analyzed the touchpoints to explore whether digital alternatives that were provided by the participants could be used in the patient journey and how this could improve PCC, using the dimensions identified by Gerteis et al. [ 4 ].

Validity and reliability

To establish validity and reliability of our data, several measures were taken [ 34 ]. To improve the internal validity, the interviewed patients were initially contacted by their healthcare professionals to ask whether they would take part in this research. The study and its purpose were explained. To further increase reliability, the interviews have been conducted in Dutch, the native language of the participants, so that no language barriers existed. Additionally, the member checking method was applied. This method entails to check that the transcription was correctly done by returning the transcripts of the interview to the participants [ 35 ]. The transcripts were returned to all participants and they were given one week to review and return their transcript. A reminder was sent after one week. We received no comments and corrections, all participants agreed on their transcript.

Ethical considerations

The Ethics Review Board of Catharina Hospital Eindhoven thoroughly evaluated and approved our study design (nWMO-2021.055). We informed the participants about the study and their rights as a participant in scientific research. All participants provided oral and written informed consent.

The interview results will be presented according to the three periods of a patient journey: pre-service, service, and post-service period. The touchpoints that are experienced during these periods will be illustrated. Additionally, we show whether the participants are interested in digital alternatives and which digital alternatives they would like to see implemented to improve the delivery of PCC.

Pre-service period

Finding the way in and around the hospital..

The interviews provided insights into touchpoints that were not directly related to the patient journey within the hospital. It was mentioned by participants that parking around the hospital can be tremendously inconvenient and time-consuming. Furthermore, finding the way around the hospital was perceived to be difficult too, especially when one must move through the hospital in areas that have not been visited before. To reduce the unnecessary stress that participants experienced about finding the way in and around the hospital, participants would have liked to see digital developments implemented.

“I believe that one of the areas where the hospital can be improved is the logistics . I think it would be great to be able to check in with your car license plate or pay the parking fee online” – Participant 6 “Recently , I had to walk a route in the hospital that I didn’t know , so I struggled to find the fastest route . It would have been useful to have some navigation through an app for example . ” – Participant 7

Intake consult with the healthcare professional.

In general, participants stated that they appreciated physical consults, especially when they did not yet had a strong relationship with their healthcare professional. In the intake consult, the first contact between the patient and the healthcare professional took place, a treatment plan was made together with the patient, and their treatment-related expectations were discussed. Participants indicated that they appreciated this approach.

“I would like to see someone if I meet them for the first time . I think it truly matters whether you already have a relationship with the doctor . ” – Participant 8

The participants mentioned that they usually received several information documents, such as information leaflets, before the intake consult took place. Some participants pointed out that digital alternatives could have helped them in order to be better prepared for the intake consult.

“Now you get an entire library of documents to read , which I did not manage to read . I think some informative clips could work better . ” – Participant 4 “I am a huge fan of short videos . I like to watch them way more than I like to read a folder , which I usually lose soon after I got it . ” – Participant 5

A good preparation before the intake consult took place was important in order to ask the healthcare professional better questions related to the treatment for their chronic illness.

“It is important to be well-informed before you meet the doctor . Otherwise , it might be unclear where the difficulties are and what things are important to take into consideration . ” – Participant 4

In contrast, another participant stated that she did not prepare the intake consult at all. She specified that she trusts the healthcare professional’s judgment and did not want to interfere. This participant mentioned that she accepted the treatment proposals without extensive consideration.

“I let the doctor decide everything , as he knows best . I would not know how things work . ” – Participant 3

Check-in at the desk.

Most participants indicated that they did not consider the physical check-in at the desk as a value-added activity. However, one participant did mention that this touchpoint was value-adding.

“The people at the desk know me well , so I am able to have some small talk with them . ” – Participant 3

All other participants saw no or little added value of the physical check-in at the desk and addressed their interest for a digital alternative for this touchpoint.

“I think checking in at the desk is not necessary , digitally would be preferable for me , for example through an app on my telephone . ” – Participant 6

Service period

Blood tests and checkup meetings in the hospital..

In this period of the patient journey, most of the touchpoints can be considered healthcare encounters. Each chronically ill patient was required to undergo periodical blood tests, which were followed up by the healthcare professionals in a checkup meeting. The regularity of these tests varied from every two months to every six months. The appointments for these blood tests could already be made digitally by the patients themselves and could usually still be scheduled on the same day. However, it was possible to have blood tested without an appointment from 8 a.m. to 7.30 p.m. on weekdays. Participants mentioned that it was reported by the physician’s assistants that the waiting line at the blood test center could go up to over an hour when no digital appointment was made.

“I have to say that the people in the hospital really said that you should make an appointment , otherwise you could be waiting for over an hour . ” – Participant 7 “At this point , you can make a digital appointment yourself , which I think is really convenient . I can book an appointment 45 minutes from now , it is really easy to plan it yourself . ” – Participant 8

One participant mentioned that when her blood sample was taken, she had to wait for up to 1.5 hours before the results were in, which were then discussed with the healthcare professional during the physical checkup meeting. The participant indicated that she preferred a digital alternative.

“Most of the time I have to wait for 1 to 1 . 5 hours for my blood results . If possible , I would prefer to go home and get the results digitally . ” – Participant 1

Another participant stated that he usually had to wait for more than two weeks to receive all the blood results. When he received these results, he usually had to come back to the hospital once again to discuss them physically with the healthcare professional.

Due to Covid-19 restrictions in the Netherlands almost all checkup meetings were conducted via telephone only, to limit the number of people that were visiting the hospital. This was perceived as more convenient by most of the participants because they did not had to wait in the hospital for the results.

“During Covid-19 I had my blood tested at the hospital . But then they just called me and asked me how I was doing . I liked it , that they called me . ” Participant 3

The digital alternative for the checkup meetings via telephone was also discussed during the interviews. Several participants indicated that they would have liked to have a video call with their healthcare professional.

“Especially if you know most of the routine appointments , it would be nice for me if things like that could be done online . ” – Participant 5

One participant indicated that she had two separate checkup meetings in the hospital, one appointment with her doctor and one appointment with the nurse. When the possibility of combining these two meetings via a video call was suggested, she responded very positive.

“Yes , that would be great because then I can plan and combine these meetings in time” . – Participant 1

Multiple participants elaborated on why a video call would be a good alternative for the physical checkup meeting.

“Seeing my healthcare provider makes a conversation more personal I think . And I really appreciate that . ” – Participant 1 “The advantage for me would be that I can see my healthcare professional , which does provide some extra value for me . ” – Participant 7

To better understand the patient journey of the participants, it was discussed how they were usually notified about the telephone appointment for the checkup meeting. Many stated that the details of the telephone appointment were accessible in the patient portal or in a letter that has been sent to the patient. Several participants mentioned that a timeframe was provided in which the healthcare professional would call them to discuss the blood test results, but that this was not particularly convenient for them.

“Next Monday , I have an appointment by telephone again and the time period for the call is between 11 : 00h and 13 : 30h , which is quite inconvenient . ” – Participant 6

Some of the participants said that they would have liked to see improvements on the (telephone) checkup meetings to tailor it more to their needs and wishes. An example that was given was recording the telephone call and video calls with the healthcare professional. In this way, a participant could later listen or look back at the conversation, even with their relatives.

“Thing like that are really important in my experience , especially if you are going to suffer from dementia for example . ” – Participant 5 “Yes that will work for me . If people are emotional and have to hear a story that has a lot of impact , I can imagine that not everything comes across . ” – Participant 7

Another suggestion that was made to help healthcare professionals in the delivery of PCC through digitalization.

“What I have seen in another hospital is that the doctor had two screens . One for himself and one for the patient to look at , and I thought that was a very good bit of openness . Then you literally see what is being written and then the doctor does not have to turn their screen . ” – Participant 8

Furthermore, it was also discussed whether it was more convenient for the participants if there were broader timeslots to have an appointment in the hospital, for example after 5 p.m. Some participants stated that this could have been of added value for them.

“I think a lot of people would benefit from being able to come after 5 p . m .. When you are able to include the patient’s preferences , you really put a patient central . ” – Participant 4

Self-monitoring.

Self-monitoring of one’s medical condition was only applicable for patients with diabetes at the department of internal medicine. These patients could measure their own blood values and upload them digitally into the patient portal. After the values were inserted into the patient portal, patients were called by their healthcare professional who would provide advice on, for example, how much insulin to take. Participants suffering from other illnesses, like HIV and kidney failure, pointed out that self-monitoring was appealing for them as well.

“I think this could surely be possible , especially taking my own blood pressure , weight , or something like that . I could definitely share that myself online” – Participant 6

One participant even proposed a more digitalized solution where the digital system provided an advice instead of the healthcare professional.

“At the moment the nurse has to check my blood values and give an advice , but I think this could also be done by a system to make it somewhat faster . ” – Participant 1

Post-service period

Reviewing medical records..

In the patient portal, patients were able to review appointments, find general medical information about the medications they are taking, and make and change appointments. Not all participants made use of the possibilities of the patient’s portal. It was specified that this occurred either because they were unaware of the possibilities or because they preferred other methods.

“I know I can log in with my DigID , and I could probably see some things in there . But I actually have not really used it so far . ” - Participant 2 “ I have not come that far , but I know I can see my appointments in there . And that my general practitioner has a similar system . ” – Participant 5

All participants mentioned that they were aware that they could investigate their medical records online. However, a lack of clarity was experienced about the sharing of medical records on the patient portal and the ability of what could be seen in these digital medical records.

“I checked my results twice on the patient portal when I was pregnant , but sometimes I could not see them . ” – Participant 1 “I would like to have a better overview of every picture or scan that was once taken from me , but most of the time you can never see them after the conversation with the doctor . ” – Participant 8

e-Consults.

One participant mentioned the use of an e-Consult via the patient portal. This entailed asking a question through the portal, which was then first reviewed at the front desk and, if the assistants could not answer the question, they would send it to the doctor.

“I do not always like calling as the person I need is not always there . I can have an e-Consult , which works very well . I send a question and it will get answered by either the front desk or the doctor . This way I do not have to wait . ” – Participant 8

Online health platforms.

The participants were asked whether they used online health platforms, like websites or Facebook pages of patient associations, for information about their chronic illness. Not all the participants made use of these platforms. Others indicated that they did look for information about the newest healthcare technologies and about other patient’s experiences, but not always online.

“I do not necessarily look into these platforms on the internet , but also in magazines . I feel that you get a lot of information from the doctor in terms of results and checks . But you have to look for the newest technologies that could improve your life for yourself . I feel that the doctors expect that . ” – Participant 5 “I am a member of the patient association and sometimes I look into their Facebook page . There I see what other people experience , which is sometimes serious . Then I worry a bit which is not always helpful . ” – Participant 4

Table 5 presents an overview of the touchpoints that were identified in each period of the patient journey, the suggested digital alternative for each touchpoint, and which dimension(s) of PCC this digital alternative would improve, based on the dimensions identified by Gerteis et al. [ 4 ].

https://doi.org/10.1371/journal.pone.0285872.t005

The main aim of the present study was to ascertain the chronically ill patients’ needs for digital alternatives for touchpoints between them and their healthcare professionals. Specifically, we aimed to explore which digital alternatives the patients like to see implemented into their own patient journey to help healthcare professionals providing PCC. We will now discuss in more detail the findings of the current study that were listed in Table 5 with the findings from the literature.

The patient journey of chronically ill patients

The patient journey in a hospital can be described as a three-stage process in which three different service periods are defined [ 13 ]. Though, for chronically ill patients these different periods are often not entirely applicable. The three patient groups that were included in this study are likely to be treated for their illness for the rest of their lives. Most research on the topic of patient journeys has been performed on patients that have the prospect of being cured and, therefore, leave the patient journey [ 36 ]. This implies a linear journey with a clear beginning and end. Our findings suggest that the patient journey of chronically ill patients is not a linear journey, but a continuous cycle instead ( Fig 1 ). For chronically ill patients it is common that a series of touchpoints happens again and again in a somewhat similar and logical sequence. In this continuous cycle, the pre-service, service, and post-service periods feed into each other. For example, a patient could perform the post-service activity of looking into the results of his blood test and use this information to ask more relevant and informed questions in a checkup meeting with the healthcare professional during the service period. This way, the journey of chronically ill patients is a continuous loop of healthcare encounters and device touchpoints.

https://doi.org/10.1371/journal.pone.0285872.g001

Touchpoints, digital alternatives, and PCC

Our findings show that the patient journey starts when a patient is referred to the hospital in accordance with previous studies [ 5 , 19 , 36 ]. Commonly this happens through a referral of a general practitioner or a transfer from another hospital. This start of the patient journey is usually the same for each patient, irrespective of their illness.

The check-in process in medical settings is occasionally already done through a digital interface at a screen in the waiting area to improve patient experience and to potentially reduce patient waiting time [ 37 ]. In this way, the check-in process can be perceived as more efficient and made significantly faster when implementing this digital alternative. When adjusting the physical check-in into a digital check-in before an appointment it is no longer a healthcare encounter, but it can be considered a device touchpoint. This device touchpoint is in accordance with the majority of the patients’ expressed needs and relates to a different coordination of care. Furthermore, most patients addressed their interest in a digital alternative for the information documents they receive before the intake consult takes place. By providing this information digitally, in the form of short video clips, healthcare professionals meet the majority of the patients’ needs and wishes and thus provide PCC.

Regarding the service period, the most important findings were that most of the patients prefer digital check-up meetings and the option of digitally self-monitoring one’s condition. During the Covid-19 pandemic, the physical check-up meetings mostly have been replaced by telephone calls. Patients perceived this as more convenient because they did not have to wait in the hospital for the results of their blood sample. Our findings suggest that a digital alternative for telephone calls, for example video calls, could also be implemented in the patient journey in order to make it more patient-centered. This is in line with the findings of a previous study [ 38 ] that found that most patients are satisfied with video calls and prefer them as an alternative to physical meetings. Patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment [ 38 ]. So, instead of calling patients, the check-up meeting could be done through a video call. Patients valued the option of being able to see their healthcare professional and believe that it is also valuable for the healthcare professional to see the patient. Furthermore, patients are positive about the option of recording the video call. This would make it possible for a patient to listen or look back at the conversation, even with relatives, at a convenient moment. According to the findings of this study, another digital alternative for a touchpoint in the service period that could be implemented is to make it possible for patients to monitor their own medical status. This involves that the patient uploads medical values in a digital system, which are checked by the healthcare professional who can then provide medical advice based on these values. This finding is in accordance with the eHealth Enhanced Chronic Care Model of Gee et al. [ 22 ] who propose that access to and control over personal health data due to policy changes is needed to provide the consumer more autonomy. Some health care organizations have had positive experiences with open access for consumers, including the provider notes [ 25 ].

Currently, self-monitoring is being implemented in the treatment of diabetes patients. Self-monitoring of one’s medical status is a form of telemonitoring. A previous study [ 39 ] found that patients comply with telemonitoring programs and the use of technologies. Therefore, home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions. With technology moving at a rapid pace, non-diabetic patient groups may also benefit from self-monitoring practices in the future as well. Digitally self-monitoring was found to be very appealing for the patients, which shows their willingness to take control over their own medical process.

Concerning the post-service period, the most important finding was that most of the chronically ill patients experienced a lack of clarity about the sharing of medical records on the patient portal and the ability of what can(not) be seen in these digital files. Therefore, patients do not often use the patient portal. This finding is similar to a previous study [ 40 ] that presents that knowledge barriers on how and when to use patient portals is one of the many perceived barriers by patients to use these portals. Considering that there is a need for more knowledge and awareness about possibilities patient portals offer, it could be of added value when the healthcare professional demonstrates the possibilities and benefits of the patient portal. Digitally providing information is also in alignment with the findings of Gee et al. [ 22 ], who argue that the role of the community to provide support for patient engagement or activation and for self-management should be expanded to include online community and health-related social networks. Moreover, healthcare professionals could also raise more awareness about e-Consults. e-Consults can be an addition to the communication channels that the hospital already makes use of, such as e-mail and telephone, which would allow the hospital to be more varied in their contact options. Additionally, it could be made possible that the healthcare professional has the option to video call the patient following the question that was asked in the e-Consult. A video call is generally perceived as a more personal way of communicating compared to a regular phone call [ 38 ]. An additional advantage of the use of e-consults is that it can reduce the waiting time for the patients that contact the hospital by phone. Patients are increasingly looking for information about their disease on their own. They are not only searching on sites supported by healthcare professionals, but also across the internet and social media like Facebook and Twitter. One of the areas where they are looking for information is on platforms where patients with the same chronic illness share their experiences. Sometimes these platforms are unregulated, but some are controlled by patient associations. The use of online health platforms could be managed by the hospital to make sure that the patient obtains reliable medical information.

Limitations, recommendations, and future research

Clearly, there are limitations of the present study. The primary limitation of this study is the transferability of the results. Transferability entails the extent to which it can be applied in other contexts and studies [ 35 ]. Morse [ 35 ] elaborates that in qualitative research the application of the findings to another situation or population is achieved through de-contextualization and abstraction of emerging concepts and theory which should be the prerogative of the original investigator. However, in our study the findings can hardly be interpreted separate from its context. Moreover, caution must be applied with results based on a small sample size. In this study we used a qualitative, exploratory study design to develop an initial understanding of the patient journey of chronically ill patients and possible digital improvements of the touchpoints in this patient journey. We acknowledge that our sample size is smaller than recommended by the findings of multiple studies [ 27 , 28 ]. The aim was to include multiple patients from four distinct patient groups: cardiovascular diseases, diabetes, HIV, and kidney failure. However, it proved to be very hard to find patients suffering from cardiovascular diseases who were willing to participate. Additionally, mainly middle-aged patients, between 35–60 years, were included and the sample size lacked patients younger than 35 years old. This could make the results of this study biased towards the middle-age group. However, previous research found that patients younger than age 65 are more likely to participate in clinical studies compared to patients 65 or older [ 41 ]. Hutchins et al. endorse this finding, as they conclude that the most consistent and largest disparity in study participation pertains to age [ 42 ]. Our findings are based on mostly middle-aged participant, but younger and older patients could potentially provide other interesting insights and suggestions of digitalization and the patient journey. Besides, according to our findings chronically ill patients have an essentially different patient journey compared to non-chronically ill patients. Our findings suggest a continuous cycle, rather than a linear patient journey, for chronically ill patients. Therefore, the results may not be entirely generalizable towards other (non-chronically ill) patient groups.

Our recommendations apply to different levels: the patient level, the healthcare professional level, and the hospital management level. On the patient level, it is advisable to keep communicating with the patients that are experiencing the touchpoints firsthand. Their feedback is extremely valuable and often generalizable to a larger part of the patient population, as chronically ill patients often have similar wishes and needs. Additionally, there is a noteworthy number of patients that have stable conditions that would like to assess their medical status. For example, take their weight, measure blood pressure, or even blood values if possible. Improved technology could make this possible for more patients in the future, as now only diabetes patients actively perform self-monitoring activities. However, for most patients, it is not clear what digital possibilities are already available for them through the patient portal. Therefore, there is a challenge for hospitals to communicate and educate about the existing digital possibilities.

On the level of healthcare professionals, it is also important that they are aware of the existing digital possibilities. Furthermore, as is the case for patients, healthcare professionals need to be trained to use the digital platform in a consistent way. It is not preferable to have some healthcare professionals using the platform very extensively, while others are rarely making use of it.

On the hospital management level, it would be advisable to install digital check-in screens, as most of the patients do not see the added value of checking in at the desk but do so of asking questions. Consequently, employees at the desk will have more time to answer questions that patients may have. For the hospital management, this transition to digital check-in screens would also be beneficial, when keeping the increasing shortage of medical personnel in mind.

In terms of PCC, it would be desirable to perform a more extensive study of the current experiences that patients have with digitalization. Common patterns and experiences could be identified, and possible future digital applications could be based on the current experiences of the patients and their actual needs and preferences. Ideally, this would be done across the entire hospital to be able to obtain different insights from various perspectives. The concept of visualization of each interactive touchpoint that the patient experiences as they navigate the care continuum, e.g., patient journey mapping, is a relatively novel practice [ 36 ] and therefore there is no fixed or widely accepted method of establishing the patient journey. This might also be a cause for the lack of adoption of patient journey mapping in the healthcare industry [ 43 ]. Therefore, it might be interesting to capture the patient journey using a different approach, for example through questionnaires or observations or a method that solely focuses on the digital side of the patient journey. In addition, future research could build on our identified touchpoints and measure their effectiveness in relation to PCC provision [ 44 ].

Literature showed that a patient journey can be divided into three distinct periods: pre-service period, service period, and post-service period. However, the empirical data showed that these periods are cyclical instead of a linear process for chronically ill patients. In this cyclical patient journey, digitalization can help put the wishes and needs of the patients at the center of care. Digital alternatives to all kinds of touchpoints within the patient journey can make the journey less of a burden and increase the level of communication between the patient and the healthcare professional. Ultimately, digitalization can help support the delivery of PCC, as it helps patients to flow more efficiently through their patient journey while establishing higher levels of communication with their healthcare professionals.

Supporting information

S1 fig. visualization of a baseline patient journey..

https://doi.org/10.1371/journal.pone.0285872.s001

S1 File. A 32-item checklist for reporting qualitative studies (COREQ).

https://doi.org/10.1371/journal.pone.0285872.s002

Acknowledgments

The authors would like to thank all patients for their kind participation in the study.

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Jun 08, 2021

Healthcare’s digitization: Achieving true connected care

Estimated reading time: 4-6 minutes

Addressing the next phase of healthcare’s digital transformation at HIMSS21 & Health 2.0

The COVID-19 pandemic sparked a global sense of urgency to pivot and adapt, causing the industry to rapidly increase the adoption of interoperable tools to support innovations in care management, virtual health, and remote patient monitoring. Within the last year, the healthcare industry has witnessed an acceleration in its digitization journey and truly demonstrated the value of digital health and shifted how patients received care. At the virtual HIMSS21 & Health 2.0 European Health Conference , held from June 7-9, Philips is addressing the ongoing challenges faced by a global healthcare industry that seeks to build on this momentum and create a longstanding digital framework. By adopting connected, secure and scalable informatics solutions across clinical and operational departments, healthcare organizations have an opportunity to unify care across care settings to help clinicians and health system leaders improve health outcomes, enhance patient and staff experiences and reduce the cost of care. As healthcare continues to evolve, organizations must take a holistic view of the end-to-end patient journey when considering how to adapt and lead the future of care delivery. Even in a post-pandemic future, patients will continue to access care from different settings, encouraging healthcare organizations to meet patients where they are – with personalized services that are informed by centralized sources of information.

The rapid escalation of virtual care tools presents health and service providers with an opportunity to fundamentally transform the way people interact with healthcare. Now is the time to break down the remaining barriers between health analytics, care management, operations, and patient engagement. This will truly enable connected care and collaboration.

Chief Business Leader Connected Care, Philips

“The rapid escalation of virtual care tools presents health and service providers with an opportunity to fundamentally transform the way people interact with healthcare,” said Roy Jakobs, Chief Business Leader Connected Care, Philips. “Now is the time to break down the remaining barriers between health analytics, care management, operations, and patient engagement. This will truly enable connected care and collaboration.”

Expanding care beyond the hospital walls

The landscape of care delivery has been rapidly evolving. With more care being managed outside the hospital, data intake continues to grow. However, some IT infrastructures are not designed to keep pace with this influx of information. Many health systems today have a myriad of niche systems, modalities, and devices with associated software that make managing this data challenging. Fragmented IT systems can create unique difficulties related to the delivery of care, particularly for clinical staff. In this new environment where care is not always managed within the hospital, the integration and standardization of patient information become crucial to being able to make confident, well-informed clinical decisions. As patients continue to embrace virtual care, providers will continue to offer services that were previously done in the hospital in the home, such as post-discharge patient monitoring. This means that data needs to be accessible. Patients expect transparency of information and protection of their privacy, but care teams and staff also need easy and secure access to patient information at different points in the care continuum. In Philips’ 2021 Future Health Index (FHI) report, feedback from healthcare leaders – including executive officers, financial officers, technology and information officers, operations officers and more – explores the challenges they have faced since the onset of the pandemic, and where their current and future priorities lie. With a focus on patient-centered healthcare enabled by smart technology, their vision is shaped by a fresh emphasis on partnerships, sustainability and new models of care delivery, both inside and outside the hospital. When it comes to telehealth, nearly 64% of healthcare leaders around the world reported they would continue to prioritize telehealth when it comes to digital health technology investments. And the interest in adopting innovative healthcare technologies to drive more efficient and effective patient care doesn’t stop there. More than half (52%) of FHI surveyed informatics leaders say that, three years from now, their hospital or healthcare facility will need to invest in implementing predictive healthcare technologies to be prepared for the future and make them more agile. But such evolution does not come without challenges. Leaders cite difficulties with data management (53%) and lack of interoperability and data standards (45%) as the biggest barriers to digital health technology within their facility. Healthcare organizations can make the most of complicated and overwhelming data streams by having a common, cloud-based IT infrastructure, where data can be easily accessible, anywhere – an essential requirement for new models of care delivery, where patient information must be visible in care settings that include the home, outpatient clinics, and traditional hospital environments.

Improving efficiencies to support financial sustainability

More than ever before, healthcare organizations are also being challenged to do more with less, maximizing operational and financial efficiencies. Last year, the American Hospital Association , reported that hospitals were projected to lose an estimated $323 billion due to COVID-19 related expenses and losses, leaving nearly half of America’s hospitals and health systems with negative operating margins by the end of the year. These financial pressures require healthcare organizations to find effective solutions to help them maximize existing resources and minimize costs. IT solutions that are nimble and allow for scalability as organizations grow can allow them to gain a more holistic view of their operations and of the patient journey. Predictive solutions can provide intelligent insights, which inform actionable outcomes inside and outside the hospital. For example, AI-enabled tools facilitate smart scheduling to help ensure exam appropriateness, reduce no-shows and late arrivals, and assist with workforce efficiency. Solutions can also help track patient flow and bed utilization, empowering clinicians and administrators to ensure patients receive the right level of care and can be discharged or stepped down safely and efficiently. At the same time, cloud platforms provide health systems with flexibility that allows leaders to invest in new technology and prioritize key areas of improvement, while also providing a more predictable cost model. This kind of common infrastructure also means that the processes of administering the data are the same from solution to solution – which reduces strain on internal IT resources and means clinicians can spend less time learning how to enter data, and more time using it to guide their clinical decisions.

Accelerating the digital transformation

In order to adapt to an increasingly virtual and expansive care environment, and work towards achieving the quadruple aim, healthcare organizations need to be supported by flexible, connected health platforms and tools that help them meet these market demands. The pandemic has demonstrated that individual point solutions aren’t enough as the industry continues its digital transformation, solutions such as cloud technology, telehealth, virtual tools, and interoperability are critical. As demand for care is rising and access to care is limited or restricted, health systems are seeking ways to support retention and support clinical productivity management. New technologies can transform and enable fast innovation. Analytics, machine learning, and AI allow the identification of patterns and correlations, to provide actionable information for decision support. Providers need to be able to link clinical workflows inside the hospital with the patient’s health journey in ambulatory care and at home in a cost-effective way. To make meaningful progress in the digitization journey, solutions have to connect care across care settings and provide a single, secure, unified experience for patients and healthcare professionals alike. For more information about Philips’ presence at HIMSS21 European Health Conference, including the solutions that will be highlighted and speaking engagements, please visit Philips.com/himss .

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Digitalization from the Patients’ Perspective

First Online: 14 March 2021

Cite this chapter

Julia Plugmann 4 &
Philipp Plugmann 4

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Digitalization in health care is often discussed from the professionals’ point of view (e.g. physicians, dentists, nurses), but what about the patients’ perspective? Patients face new challenges: They are a cost factor, which has to be monitored. This requires access to all their health care data plus additional information. Patients’ behavior may well be measured in the future—mandatory genetic testing could be on the horizon, and in times of coronavirus the question of compulsory vaccinations arises once again. There is more: Should every German citizen automatically become an organ donor by law? Should opting out mean having to make a written declaration? And should the system punish people who opt out, e.g. by putting them last on the waiting list if they need an organ transplant? Is this environment really conducive to creating high acceptance of digitalization from the patients’ point of view? We conducted the following three studies, which will help to understand patients’ needs and perspectives in the age of digitalization in health care, especially in the hospital environment. Ultimately, patients’ acceptance of innovation and digitalization is crucial to the success of implementing new technologies in health care. To achieve higher acceptance, policymakers should promote public campaigns to communicate the advantages of these technologies for all patients in the health care system.

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Plugmann, J., Plugmann, P. (2021). Digitalization from the Patients’ Perspective. In: Glauner, P., Plugmann, P., Lerzynski, G. (eds) Digitalization in Healthcare. Future of Business and Finance. Springer, Cham. https://doi.org/10.1007/978-3-030-65896-0_4

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Driving digital transformation in healthcare: An interview with Dr. Pius S. Hornstein, Country Chair Sanofi Greater China

Digital technology is driving rapid, fundamental change in almost every aspect of our daily lives. For younger generations, and the young at heart, mobile digital experiences are an integral part of consumer services, from banking and insurance, to entertainment, retail, and travel.

Healthcare is no exception. Patients, healthcare providers, and other industry stakeholders are moving to a fully digitalized offline-to-online patient journey, opening new opportunities in the research and development of medicines and delivery of healthcare services, while resolving barriers to treatment and improving patient outcomes.

Under CEO Paul Hudson, French-European pharmaceutical company Sanofi is seeking to shape this transition; pursuing global leadership in scientific innovation, and the use of digital technology and data to transform the practice of medicine.

In China, Sanofi’s second-largest market, those goals are being realized in the form of new institutions dedicated to driving digital innovation in healthcare: In early 2019, Sanofi established an Innovation Hub in Shanghai to deepen and expand its relationships with China’s dynamic digital players, before opening the Sanofi Institute for Biomedical Research in Suzhou last year.

This new global institute integrates Sanofi’s early research capabilities with China’s drug discovery ecosystem, aiming to accelerate the development of best-in-class and first-in-class medicines. It also seeks to pioneer virtual healthcare services like Amulet Health Technologies (AHT), a Sanofi subsidiary launched in 2021 to provide integrated online-to-offline care for chronic disease patients.

Borne from a partnership with the Shanghai Pudong Software Park, AHT embodies Sanofi’s collaborative approach to digital innovation, which spans partnerships with technology giants Jing Dong Health, Ping An Health, and Tencent, as well as an array of China-based start-ups.

AHT’s open-handed evolution is also characteristic of Dr. Pius S. Hornstein, Country Chair Sanofi Greater China, a company veteran who has presided over Sanofi’s China business since early 2019.

Hornstein recently spoke with Franck Le Deu, leader of McKinsey’s Asia Life Sciences practice, and Serina Tang, an associate partner in McKinsey’s Shanghai office, about the challenges of leading digital transformation across a vast pharmaceutical company.

Their conversation highlights the importance of staying relentlessly focused on milestones while measuring return on investment (ROI), the secret to attracting and retaining digital talent, and how technological advances are changing healthcare delivery in the world’s second-largest economy.

McKinsey: How did you arrive at your current role in Sanofi China?

Pius Hornstein: This journey started in Brazil in 2015, where I first experienced a digital ecosystem that was in some aspects more advanced than the U.S. or Europe in areas such as banking and healthcare. I considered how we might integrate a digital, patient-focused experience into the healthcare system, and went on to study what digital disruption means for business at the Singularity University in California. China, with its renowned digital ecosystem, was the natural place to come and apply the things I’d learned.

McKinsey: What makes China’s digital healthcare ecosystem different from other markets?

Hornstein: China’s 1 billion mobile internet users, who are incredibly attuned to convenient mobile digital experiences, and vast healthcare system present a huge opportunity for digital to improve patients’ lives. China’s vibrant technology ecosystem is another point of difference; we leverage Tencent’s WeChat mini-programs to improve patient interactions, and WeCom, the enterprise version of WeChat, to liaise directly with advanced clinical practitioners (ACPs). Finally, an ultra-rapid development and iteration cycle, in which it can take as little as three months to deliver a MVP (Minimum Viable Product), makes the China market truly unique.

McKinsey: How will digital transformation affect the way Sanofi China operates five years from now?

Dr. Pius S. Hornstein

Holds a master’s degree in pharmacy and earned his PhD in medical research, graduating magna cum laude from the University of Basel, Switzerland. He is also an alumnus of INSEAD and Singularity University.

Leads over 8,000 associates as Sanofi China General Manager and Country Lead, driving the introduction of innovative medicines, the adoption of best-in-class digital transformation, and the nurturing of leading talent in Sanofi’s second-largest market.

Serves as Board Member of the RDPAC (R&D-based Pharmaceutical Association Committee) of China.

Acts as Vice Chair of the European Union Chamber of Commerce in China’s Shanghai chapter.

Led Sanofi Group Brazil as Country Chair and General Manager Pharma in São Paulo from 2015 to 2019, where he oversaw Sanofi Genzyme, Medley, Specialty Care, Diabetes, and established Care, and served as Chairman of the Board of Sanofi unit Medley Indústria Farmacêutica.

Headed Sanofi’s Turkey and Middle East operations with P&L responsibility for PharmaOps.

Held multiple roles with P&L responsibility for Sanofi’s leading global brands in Europe.

Is a recipient of the Magnolia Silver Award from the City of Shanghai for his contribution to innovation and the advancement of healthcare.

As a leading healthcare company, Sanofi needs to understand where and how it can contribute to that ecosystem to offer the best standard of care. How do we interact with physicians, or help patients to find the right information, and assist both parties with adhering to clinical guidance? Meanwhile, we want to have a real understanding of patient needs, use their feedback to upgrade, and help them to improve their treatment outcomes.

From the business perspective, scalable operational efficiencies are allowing us to truly understand the 40-50,000 healthcare practitioner (HCP) interactions we handle each day. We can measure HCP satisfaction via NPS (Net Promoter Score) surveys, leverage them to design meaningful interactions and initiatives, and better equip our staff. On the recruitment front for example, we transformed an almost entirely offline recruitment process for the roughly 3,500 people we hire each year into one where onboarding is more than 90 percent digital. Our HR teams and the candidates saved thousands of hours, and we now focus on adding value elsewhere. As a result, the average NPS among people applying to Sanofi is now 72. That great digital experience immediately positions us as an innovative company, and has a positive impact on ROI.

McKinsey: The scope of your digital transformation is now very broad, but what were your first steps?

Hornstein: We started with a three-year high level vision and roadmap that was fully aligned with our global ambition. By 2020, we transitioned from our legacy and highly fragmented ITS (IT Services) organization, with dozens of reporting lines out of the country across different hardware and software systems, to one of the first in China to have a consolidated digital organization—technology infrastructure, data, digital, and innovation—all under one roof. It was a big move that united people around a common ambition, and helped us gain significant velocity and traction.

McKinsey: How did you go about measuring progress on the digital journey?

Hornstein: At the start of the journey, we discovered we had more than 150 projects, not all of which were well defined or had clear success metrics. That is a classic mistake, but one that led us to understand that we need to ruthlessly prioritize and be laser-focused on creating value for patients and the company. We looked closely at delivering incremental ROI, either by improving patient care or increasing revenues or operational efficiency. Then we benchmarked ourselves against other pharmaceutical companies and non-pharma digital leaders. We quickly established our WeCom platform for HCP interaction, as well as our data lake and application hosting environment on Tencent Cloud. We benefited from that decision during the first months of the COVID-19 pandemic, when we increased or sustained our performance despite almost no in-person interactions with HCPs. According to McKinsey’s Digital Quotient Index, we have risen in digital maturity from below average in mid-2019 to among the top 10 percent of pharma companies globally, and among the top 10 percent of companies across all industries surveyed in China by the end of 2021.

McKinsey: Last year, you launched Amulet Health Technology. What was the idea behind that, and how does it resonate with plans for digital health to drive new revenue streams?

Hornstein: All the great medicines in the world are meaningless if patients are not diagnosed. More than half of patients with diabetes go undiagnosed in China. Of those who are diagnosed, more than half do not receive the appropriate therapy, and many of those who receive therapy discontinue prematurely. Creating digital tools that appropriately facilitate and improve physician-patient or nurse- patient interactions is a challenge. Amulet Health Technology, a virtual approach to managing patients with chronic disease that integrates software tools and professional care, is part of a possible response.

Ultimately, we want to develop a digital patient journey solution that can be reimbursed by the healthcare system. Digital Therapeutics (DTx) products are already making inroads in the U.S., and German authorities have taken a bold step to reimburse some services. We expect that China’s regulators will follow suit, and reward appropriately— there is definitely a patient need and positive impact on treatment outcomes.

McKinsey: What was the thinking behind organizing the 2021 Dream and Go summit, which attracted almost 7,000 participants from China’s healthcare ecosystem?

Hornstein: We want to leverage innovations no matter where they come from. We partner with start-ups and tech companies through our Innovation Hub, and aim to continue working openly with the ecosystem. Since 2019, Dream and Go—our annual, mainly online, event—has enabled us to meet tech companies with the potential to help us co-create and resolve pain points. We also invite venture capital and other investment firms, who introduce us to entrepreneurs with whom we can cooperate or invest. For example, we collaborated with a company that develops devices to measure tremors and other indicators in Parkinson’s patients, gathering real-world evidence on how they react to therapies over time. These efforts have elevated Sanofi’s reputation as a digital and innovation leader in the healthcare sector, making it easier to attract talent.

McKinsey: What are the key factors behind the success of Sanofi China’s digital transformation?

Hornstein: Being very clear about what you want to achieve. You really want to have a strong global company strategy that is fully aligned with large markets. The enemy of any go-to-market digital transformation is fragmentation, especially in a company of Sanofi’s size. As I mentioned, you need to ruthlessly prioritize, and recognize that six months down the road, new shiny objects could creep in to dilute your initial objectives, and slow down your ability to create big wins.

Today, we invest less in aggregate than we did three years ago, yet for the chosen priority projects, we devote more resources. Our iterative agile build cycles go faster and involve users in the development process, resulting in solutions that are much more relevant and impactful.

A second obstacle to success is us, the leadership, the management team. Everybody likes to have their sphere of business power, which in the past was linked to a specific, often siloed, P&L. The digital future is not like that. You need to be more open, able to empower, delegate, and collaborate. Nurturing digital capability is another factor. We had to train up a critical mass of people who could understand digital in order to attract and retain digital talent. Previously, we didn’t move fast enough and rejected innovative ways of working introduced by the new talent, which led to frustration and rapid churn.

McKinsey: Are the majority of Sanofi employees following agile principles at this point?

Hornstein: Our first priority was to instill an agile mindset and ways of working within the digital organization. As most were from our legacy ITS organization, with waterfall-like, project-based principles, this was no easy task. We paired digital teams with business teams to co-build key products. Then, we refocused on commercial operations, and especially medical and marketing, because we wanted to make a more positive impact on patients. That meant recruiting more agile coaches, driving agile awareness, rolling out training, and adapting our office space to support agile pod work.

We have certified Scrum Masters and Product Owners, and are training up the next generation of agile coaches. The agile mindset is also about learning by doing; it’s a continuous learning journey for our employees. I’d say we are halfway along that process. Over the next two years, we aspire to achieve agile at-scale. However, we don’t intend to work agile everywhere; there are still areas where it is better to work in the classic waterfall method. Finding the right balance is key.

McKinsey: What are the major barriers to scaling up agile and digital ways of working?

Hornstein: The first step is to ensure your technology and data foundation is fit for purpose. Having systems which are not fragmented, and data in one cloud, is essential if you want to move at scale. Sanofi’s heritage of mergers and acquisitions made this an acute challenge. For Sanofi China, we resolved two-and-a-half years ago that we would have a one-cloud data approach. We also decided our front-end for customers and employees would be on mobile first, leveraging WeCom. Then we started to tackle the bigger issue of agile-digital knowledge. We have already rolled out agile and digital capability training to much of our corporate workforce, but much still needs to be done to upgrade the mindset and culture—although we are also making good progress here, too.

McKinsey: How do you go about attracting and retaining digital talent?

Hornstein: China’s healthcare market has an average attrition rate of 25-30 percent; every year, 30 out of 100 employees decide to move on. Digital talent is clearly in high demand. Our response was to move from a focus on retention to being permanently attractive for existing and prospective staff. We try to empower the people we hire, create interesting career growth opportunities, including across functions and potentially to global roles, and do our best to recognize achievements.

We also encourage our talent, who have an average age of 28, to pursue the ambitions they have in their private lives. The digital transformation helped raise employee satisfaction. As a result, our attrition rate is falling slightly even as China’s economic recovery is pushing the market level higher, especially in healthcare. Also, Sanofi is the only pharma company ever to rank as China’s leading employer, an accolade we achieved two years running in 2020 and 2021.

McKinsey: People often say that while China has a vast supply of data, much of it is poor quality. Can you improve data quality and make it more reliable?

Hornstein: Saying that China’s data is unreliable is too often used as an excuse not to look at the data. That is a profound mistake. Look at your data, whatever the quality, as it helps you benchmark customer behavior and derive insights. Simply by looking, standardizing, and curating data, the quality will improve rapidly. Then install a proper data governance process with accountable data owners, and give them digital monitoring tools to keep incoming data high quality. Creating digital touchpoints, for example using WeCom to interact with healthcare professionals (HCPs), also allows us to generate our own data, and improve quickly by measuring customer satisfaction and other variables.

McKinsey: What role does advanced analytics play in digital transformation?

Hornstein: While it has become a bit of a buzzword, like artificial intelligence, advanced analytics is fundamental as it facilitates a data-driven approach to our decision making across the board, rather than relying on subjectivity. For instance, we already have a smart engine that analyzes data from 50,000 touchpoints a day, allowing us to map correlations and then tailor improved customer interactions. This in turn yields higher efficiency and productivity for our field force and marketers. Eventually, we want to connect interactions—physical and digital—and medication delivery together for the best patient experience. This will require advanced analytics.

McKinsey: Three years from now, looking back at what the digital transformation has achieved, how would you define success?

Hornstein: We aim to be the leader in China’s healthcare medical education ecosystem. We want to be recognized by patients and the healthcare community for how we improve patients’ lives, not only in terms of our best-in-class drug portfolio, but also how we interact with them and address their needs. We will contribute to a patient journey that is largely digitalized, be meaningfully embedded in the digital healthcare ecosystem, and generate new revenues by doing so. We will also have transformed into the most efficient company possible—operating lean, agile, and with an extremely high innovation index.

Franck Le Deu is a senior partner in McKinsey & Company’s Hong Kong office; Serina Tang is an associate partner in Shanghai.

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Digitizing Healthcare: Understanding the Key Trends, Benefits and Challenges of Digital Health

July 1, 2022

Mother and daughter doing a teleconsultation with a doctor

Digital health solutions have radically changed the way patients interact with healthcare professionals and receive treatment. They’ve also reshaped the way patients consume and share medical information and data.

By digitizing healthcare, medical providers can enjoy more streamlined processes and a wider range of options with regard to the prevention, diagnosis and management of diseases. Patients can also make better and more informed decisions about their health and treatment options.

This global shift in the healthcare industry has brought about a wide range of innovative technologies including telemedicine, electronic health records (EHRs), robotic nurse assistants, 3D-printed organs and tissues and portable connected medical devices.

In this article, we cover the key trends, benefits and challenges of digitizing healthcare. We also share about some digital health solutions that are being adopted around the world!

Improves accuracy of diagnosis

Improves quality of healthcare, improves access to healthcare, reduces cost of healthcare, increases efficiency.

Electronic health records

Telemedicine

Wearable devices, regulations and legislations, reimbursement, interoperability, digital literacy, data security and privacy, willingness to adopt technology, 1. on-demand healthcare, 2. artificial intelligence (ai), 3. big data and predictive analytics, 4. blockchain technology.

5. Virtual reality (VR)

Leverage and connect data

Empower and engage patients, showcase the value of digital healthcare, benefits of digitizing healthcare.

Healthcare digitization brings about many benefits to both patients and healthcare professionals throughout different stages in the patient journey.

In general, a patient’s treatment journey consists of the following stages: Diagnosis, making a treatment decision, receiving treatment and monitoring.

Doctor reviewing x-ray of patient's chest

Stage of patient journey: Diagnosis

The use of digital health technologies has enabled industry professionals to diagnose patients’ conditions remotely. Patient information such as their treatment history and list of medications can also be stored, accessed and shared between healthcare professionals in real-time.

This helps to present a clearer and more accurate profile of the patient, thus improving the accuracy of diagnoses and facilitating clinical decisions.

Stage of patient journey: Monitoring

The rise of digital health platforms has made it easier for patients to access medical data and healthcare services. It has also enabled them to monitor and track their conditions remotely, promoting a greater emphasis on self-care and giving them more control over their treatment.

Through digital health platforms, healthcare providers can also offer care in a wide range of applications including therapeutics and acute and chronic diseases. They can detect changes in patients’ condition earlier, allowing for a quicker response in the case of an emergency.

Stage of patient journey: Across all stages

In Asia, almost 80% of the population resides in rural areas with little to no access to healthcare services . For patients living in these areas, traveling to the city to receive medical care and treatment can be challenging and costly.

Additionally, elderly patients or those with mobility issues may face difficulties accessing healthcare services.

Yoann Sapanel, from Yong Loo Lin School of Medicine (NUS), shared during APACMed’s webcast and podcast series – Doses of Healthcare , that digital technologies have pushed the boundaries of healthcare beyond the walls of the hospital.

Patients who once faced challenges accessing medical services can now do so from their homes or communities. For example, diagnosis and patient monitoring can be carried out remotely or outside clinical settings.

According to the World Health Organization, approximately half of the world’s population lack access to essential health services due to the costs involved. This includes medical treatment, rehabilitation and prevention.

With the help of digital health technologies such as telemedicine, patients can better understand and monitor their health conditions remotely. This reduces unnecessary and often costly visits to emergency rooms, and even helps them save on transportation costs.

As such, the cost of healthcare for patients and service providers can be reduced. This allows more patients, especially those in low- to middle-income countries, to receive both primary and specialty care services at more affordable prices.

The World Health Organization estimates that the world will experience a shortage of 18 million skilled healthcare professionals by 2030 . As such, the need for more efficient medical services is essential in easing the burden on existing healthcare providers.

By allowing these professionals full access to patients’ medical data and history, they can improve medical outcomes and provide quicker treatment. Moreover, giving patients greater control over their health can reduce the strain on providers and increase treatment efficiency.

Healthcare Digitization around the World

Many countries around the world have begun adopting digital healthcare solutions and technologies to improve the quality of healthcare for patients. This includes Electronic Health Records (EHRs), telemedicine and wearable devices.

Note: This list illustrates some of the examples of healthcare digitalization and is not exhaustive.

Electronic Health Records

Example of an Electronic Medical Record (EMR)

EHRs are digital copies of patients’ medical data, history and charts. They also include their personal data such as their addresses and financial information.

These records can be shared among healthcare providers to ensure equal access to data and promote more accurate clinical actions.

EHRs in Australia

Australia is one of the countries in the world that have implemented a nationwide EHR system – My Health Record. It’s available to anyone with an Individual Healthcare Identifier (IHI) or Medicare card.

This secure EHR system contains patients’ health records that are shared across healthcare providers in the country. This gives them access to a more comprehensive view of each patient’s medical history, allowing them to provide safer and more personalized treatment.

Telemedicine is a digital technology that allows medical care to be delivered remotely. For example, a healthcare professional working in the city can provide consultations and treatment to a patient living in the countryside.

Telemedicine in India

In India, the healthcare industry faces numerous challenges with a shortage of medical workers and 70% of the population living in rural areas with limited income . As such, delivering healthcare services has been a challenge.

Through the implementation of telemedicine in the Barielly and Madhubani districts, villagers in the rural areas are able to consult healthcare professionals in the urban area without physically traveling there. Medical records can also be shared between providers.

Patients who require physical care can be referred for a physical appointment with the appropriate specialist in town, ensuring that they receive the right treatment promptly.

Close up of man's hand wearing a smartwatch

Many wearable devices on the market come with health monitoring functions such as heart rate monitors and activity trackers.

As this technology evolves, the possibility that these devices could be used for other health monitoring activities such as the measurement of glucose levels for diabetes grows as well.

Wearable devices for biomedical research in Singapore

Sleep studies often use questionnaires to gather data from respondents. However, some may be unable to provide precise answers, causing the results to be inaccurate.

To address this challenge, a week-long study was conducted with 480 volunteers in Singapore using sleep data gathered from a Fitbit activity tracker.

This information, coupled with other health and lifestyle data such as blood pressure, blood glucose and cholesterol, was used to identify the link between chronic sleep deprivation and an increase in a marker of biological aging.

Challenges in Digitizing Healthcare

Despite the many benefits of digital health technology, such products often face challenges with regard to their launch and adoption.

One of the key challenges faced by the Medical Technology (MedTech) industry is the complex and fragmented regulatory and legislative landscape.

Instead of a single legislation, many regions use multiple schemes and regulations to address digital health technologies. However, they’re often insufficient to address the unique features of such solutions, impeding the creation, launch and adoption of many innovative products.

To address this challenge, APACMed has been working with various stakeholders in the ASEAN region to

establish and support a strong workforce to address the industry’s regulatory needs and challenges, and
promote the adoption of common regulatory frameworks among industry stakeholders.

Even after their launch, many digital health solutions face challenges due to unclear, complex and inconsistent reimbursement pathways. This is especially apparent in public healthcare systems around the world.

For patients, these difficulties with reimbursement can limit the adoption of such technology, reducing access to patients’ data. In turn, this makes it challenging for innovators to prove the value of such technologies against the investment required.

In the Asia-Pacific (APAC) region, APACMed has been making efforts to address this challenge. Their efforts include sharing best practices and creating unique frameworks targeted at the digital health landscape in the APAC region.

Due to the lack of harmonized regulations and differences in storage and coding of data, data interoperability has been an ongoing challenge for many solution providers and healthcare professionals even after product adoption.

Large amounts of data remain unused and healthcare providers are unable to leverage this information to improve the standard of healthcare for patients.

As such, it’s paramount that the relevant industry stakeholders establish regulatory convergence to maximize the value of such data. For example, APACMed has proposed a set of interoperability standards for medical devices in hopes of addressing this challenge.

Digital literacy refers to the ability to find, understand and share information via online platforms.

Due to low digital literacy among patients and healthcare professionals, the chances of product adoption may be reduced as many may experience inertia in learning how to use these new technologies.

Even after adopting these technologies, stakeholders may be unable to reap the full benefits of the product as they struggle with their usage and functionality. Moreover, privacy and security issues could surface due to the lack of knowledge with regard to using these products.

To address this challenge, both public and private institutions could work together to provide education to the relevant stakeholders such as patients and healthcare providers. This could come in the form of online courses, training sessions and even product demonstrations.

For digital health, data security and privacy are critical challenges that must be overcome. A data breach could result in the loss of personal information, loss of trust, scams and disruption of care.

As such, it’s crucial that loopholes in digital healthcare systems are addressed and users are educated on the right preventive measures to safeguard their data. Furthermore, it’s essential that a consistent policy framework to tackle data security and privacy is established.

At APACMed, the Digital Health Functional Committee strives to advocate for policies in a wide range of areas including data security to promote the adoption of digital health solutions across the region.

Willingness to adopt digital health technologies can be affected by various factors including ease of use, cost and privacy concerns. The perceived value of a digital health solution can also play a big role in the adoption of such technology.

To address this challenge, it’s crucial to establish new frameworks that can help to demonstrate the value of digital health products to the relevant stakeholders in the industry.

Key Trends in Healthcare Digitization

As digital health solutions continue to evolve, understanding the key trends that have been shaping the industry landscape can be useful in helping solution providers find ways to address a wider range of healthcare needs and challenges.

On-demand healthcare refers to the real-time usage of healthcare services via online platforms. This includes booking appointments, receiving test results and even remote consultations.

In the APAC region, it’s estimated that the digital healthcare market will see a compound annual growth rate (CAGR) of 21.2% from 2021 to 2027 . This is likely to be fuelled by the COVID-19 pandemic and the growing number of telemedicine options available.

As the industry continues to experience a boom, the demand for such healthcare services in real-time is only expected to increase.

Person using a chatbot on their smartphone

By 2025, the global AI-powered healthcare market is expected to exceed US$34 billion . This can be seen by the growing adoption of AI-powered technologies such as chatbots, virtual health assistants and even robot nurses.

This technology has also provided great value to healthcare providers in fields such as genomics, precision medicine, drug research and medical imaging. In the future, AI could evolve to provide other services such as population health analytics and the formation of clinical diagnoses and treatment plans .

Big data collects information from various online sources such as social media and e-commerce platforms to identify patterns about a particular subject.

In healthcare, this technology can be used to

reduce the rate of medical errors such as in the prescription of drugs,
improve manpower planning and reduce patients’ waiting time, and
reduce the number of repeat visits to emergency rooms by encouraging preventive care.

As this technology evolves, big data can potentially help in predicting the types of sicknesses and diseases that may pose a major challenge in the future. This can allow healthcare professionals and patients to take preventive measures to guard against these conditions.

Blockchain is a secure digital ledger that allows parties to exchange information without the need for a third party. In healthcare, this technology is used to facilitate the transfer of patients’ medical records between service providers, prevent data breaches and reduce costs.

The application of blockchain technology to healthcare is expected to continue in the coming years. In fact, the APAC blockchain in healthcare market is estimated to observe a CAGR of 54.99% from 2019 to 2028 .

5. Virtual Reality (VR)

Woman wearing a virtual reality headgear

While VR is typically associated with gaming, this technology has brought much value-add to the healthcare industry. It has been used to treat pain, stroke and various mental health issues such as anxiety. It’s also used by healthcare professionals to practice their medical and surgical skills.

As research into this technology continues, VR could potentially be used for a range of other treatments such as recovery from brain injury and management of Asperger’s syndrome.

Tips for Driving Healthcare Digitization

As digitization in the healthcare industry continues, here are some tips on how to drive the movement forward.

Data is crucial in digital healthcare, and being able to manage, interpret and leverage these data requires the right tools and frameworks in place. Education is also crucial in enabling those with access to these data to use them in a safe and effective manner.

Thus, stakeholders in the industry should seek to push for the right regulatory frameworks and provide the necessary educational resources for patients and medical providers.

In the past, decision-making for treatment plans has been left to medical professionals. However, as digital technology becomes more prevalent around the world, patients have taken a more active role in this process.

The role of medical professionals has, therefore, expanded to include patient education to allow them to make more informed decisions. Through this, patients can be empowered to use and share medical data in a safe and effective manner, reducing the risks of data breaches.

Furthermore, in the Doses of Healthcare podcast, Sapanel encourages healthcare professionals to engage patients in the design of new digital health technologies. This enables the creation of more patient-centric solutions that are able to address relevant problems.

Showcasing the benefits of digital healthcare to both patients and medical professionals is key in encouraging the adoption of such technologies. These benefits can come in the form of improving patients’ health and well-being, increasing the efficiency of healthcare operations and more.

By highlighting the value and encouraging the adoption of such digital healthcare solutions, more data can be collected and used to improve existing technologies.

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J Med Internet Res
v.24(8); 2022 Aug

Digital Patient Experience: Umbrella Systematic Review

Tingting wang.

1 Industrial Design Engineering, Delft University of Technology, Delft, Netherlands

Guido Giunti

2 Digital Health Design and Development, University of Oulu, Oulu, Finland

Marijke Melles

Richard goossens, associated data.

Study characteristics and digital health intervention characteristics of included reviews.

Influencing factors on digital patient experience (double-edged factors imply diverse impact, positive factors imply positive impact, and negative factors imply negative impact).

Detailed information on themes of influencing factors of the digital patient experience.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

The adoption and use of technology have significantly changed health care delivery. Patient experience has become a significant factor in the entire spectrum of patient-centered health care delivery. Digital health facilitates further improvement and empowerment of patient experiences. Therefore, the design of digital health is served by insights into the barriers to and facilitators of digital patient experience (PEx).

This study aimed to systematically review the influencing factors and design considerations of PEx in digital health from the literature and generate design guidelines for further improvement of PEx in digital health.

We performed an umbrella systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched Scopus, PubMed, and Web of Science databases. Two rounds of small random sampling (20%) were independently reviewed by 2 reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed using the Fleiss-Cohen coefficient ( k 1=0.88 and k 2=0.80). Thematic analysis was applied to analyze the extracted data based on a small set of a priori categories.

The search yielded 173 records, of which 45 (26%) were selected for data analysis. Findings and conclusions showed a great diversity; most studies presented a set of themes (19/45, 42%) or descriptive information only (16/45, 36%). The digital PEx–related influencing factors were classified into 9 categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. These can have three types of impacts: positive, negative, or double edged. We captured 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (human-centered or user-centered design, co-design or participatory design, and inclusive design) as design considerations.

Conclusions

We propose the following definition for digital PEx: “Digital patient experience is the sum of all interactions affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health.” In this study, we constructed a design and evaluation framework that contains 4 phases—define design, define evaluation, design ideation, and design evaluation—and 9 design guidelines to help digital health designers and developers address digital PEx throughout the entire design process. Finally, our review suggests 6 directions for future digital PEx–related research.

Introduction

Recently, there has been a significant increase in the use of digital health technologies. In addition, many countries currently use digital health technologies to support health care service delivery to overcome the disruptions caused by the COVID-19 pandemic. These include web-based patient consultations and requesting pharmacy and medication refills [ 1 ]. Digital health offers care without the risk of exposure to the virus, especially for vulnerable patients such as older adults and patients with chronic diseases [ 2 ]. Before the COVID-19 pandemic, there was increasing recognition of the potential of digital health to improve the accessibility of health care in different clinical settings (eg, ambulatory care, acute care, and inpatient care) [ 3 ]. Digital health provides an opportunity to both reduce the costs of care and improve patient affordability [ 4 , 5 ], and previous research suggests that digital health has the potential to provide health prevention, consultation, treatment, and management [ 5 - 10 ]. With digital health solutions continuing to grow in both number and functionality, patient interest in digital health has rapidly increased, leading to an expanding reliance on digital health technologies [ 11 ].

As digital health has become a more familiar term, it has generated many definitions, and the concept has been expanded to encompass a much broader set of scientific concepts and technologies [ 12 ]. These include digital health applications, ecosystems and platforms [ 13 ], patient portals [ 14 ], mobile health apps [ 15 ], eHealth records, and appointment scheduling applications [ 16 ]. For the purposes of this study, we will use eHealth, mobile health, telemedicine, telehealth, virtual health, remote health, electronic consultations, and health information systems (HISs) as interchangeable terms for digital health.

Patient Experience in Digital Health

Digital health has the potential to improve patients’ overall health care experience [ 17 - 19 ]. However, there is currently no common concept for describing patient experience (PEx) in digital health. Neither the general PEx nor user experience (UX) adequately reflects the experience of a patient using a digital service. For example, in a hospital setting, the environment’s cleanliness, background noise, and even food provision could affect PEx [ 20 ]; however, these factors would not be expected to influence the experience of a patient using a digital service. Similarly, the fact that the system passes usability heuristics does not necessarily mean that the overall experience of a patient using digital health services is positive [ 21 ]. Therefore, it is vital to understand the experiences of individuals using digital health and how the design of new technologies can affect them [ 17 , 22 , 23 ].

The concept of (nondigital) PEx has many definitions in general health care practice and research. The Beryl Institute defines PEx as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions, across the continuum of care” [ 24 ]. Other definitions and studies note that the core elements of optimized PEx include access to appropriate care, patients’ active participation in care, a good patient-physician relationship, reliable evidence-based care, comprehensible information, physical comfort, emotional support, involvement of family and friends, individualized approaches, responsiveness of services, and continuity of care [ 19 , 25 - 27 ]. These core elements of PEx help to recognize patients’ priorities when receiving care and in providing patient-centered care. However, patients’ priorities may differ for digital health, in which traditional face-to-face interaction is replaced by human to digital interface interaction. Therefore, to address patient priorities in digital health, it is essential to consider UX in the design of digital health [ 28 ]. In this study, we define UX as a person’s perceptions and responses that result from the use or anticipated use of a product, system, or service [ 18 , 29 ]. Usable, useful, findable, accessible, credible, valuable, and desirable products are more likely to succeed in delivering a positive UX [ 30 ]. However, the full impact of digital health technologies on PEx or UX still remains unclear [ 31 ]; some products even result in negative effects such as increased patient anxiety [ 32 ]. Therefore, more insights into the barriers to and facilitators of individuals’ experiences with digital health are required [ 33 ].

The objectives of this paper were to systematically review (1) the factors that influence PEx in digital health and (2) the design considerations of PEx that are in digital health. The overall aim was to generate a design framework and guidelines for further improving PEx in digital health.

We performed an umbrella systematic review compiling evidence from multiple systematic reviews [ 34 ] on PEx and UX in digital health. This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, which is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses [ 35 ].

Digital PEx Working Definition

Throughout this study, we use the term digital PEx as a working definition to describe people’s experiences in various digital health contexts. As the study progressed, the definition underwent several revisions, which resulted in a more inclusive final definition.

Search Strategy

We searched Scopus, PubMed, and Web of Science for studies published between January 1, 2000, and December 16, 2020. The search time window was limited to 2000 as the term digital health was first introduced by Frank [ 36 ] in 2000. To be inclusive, we used broad interchangeable search terms with varying combinations of digital health, PEx, and UX:

Category 1: “patient experience” OR “health experience” OR “user experience” OR “customer experience” OR “client experience”
Category 2: “ehealth” OR “e-health” OR “mhealth” OR “m-health” OR “telehealth” OR “tele-health” OR “digital health” OR “virtual health” OR “remote health” OR “telemedicine” OR “telemonitoring” OR “teleconsultation”
Category 3: “patient digital experience” OR “patient experience in digital health” OR “e-patient experience” OR “epatient experience” OR “online patient experience”

After combining categories 1, 2, and 3, limits were set to restrict studies to English-language literature reviews published in journals after 2000. The final search strategy was ([category 1 AND category 2] OR category 3) AND (DOCTYPE [review]) AND (PUBYEAR>2000) AND (LIMIT-TO [SRCTYPE, “journal”]) AND (LIMIT-TO [LANGUAGE, “English”]). Google Scholar was used as an additional database to manually search for additional related references based on the snowballing method during the review process.

Selection Criteria

Eligibility criteria were developed for title and abstract screening and refined for full-text screening. The following inclusion criteria were proposed by TW and GG and adjusted by MM and RG:

No duplicated articles
Full text available
English language
Only completed peer-reviewed journal articles
Only review articles
Related to digital health (ie, use of information and communication technology in health) and PEx, UX, or health care experience

Screening Process

The collected articles were included in the final analysis if they met all the inclusion criteria after a 2-stage screening process: first, a title and abstract review, followed by a full-text review. In the screening process, 2-round, small random samples (20%) were independently reviewed by 2 reviewers (TW and GG) who evaluated the eligibility of the articles against the selection criteria. The interrater reliability and clarity of the selection criteria were assessed using the Fleiss-Cohen coefficient until it reached the required strength (≥0.60). Uncertainties around paper inclusion and exclusion were resolved by discussions with the research team (TW, GG, MM, and RG) when necessary.

Data Extraction and Thematic Analysis

Articles meeting the eligibility criteria were imported into ATLAS.ti (Scientific Software Development GmbH; version 9.0.7; 1857) for data extraction. Data were extracted for the following aspects: (1) study characteristics, including authors, year of publication, research aims, review methods, target users, and digital health intervention (DHI) characteristics; (2) the overall impression of digital PEx (eg, the foci or types of findings regarding digital PEx); (3) influencing factors of digital PEx; and (4) design considerations for improving digital PEx.

We used the Braun and Clarke 6-phase thematic analysis method [ 37 ] to analyze the extracted data; these include (1) familiarization with the data, (2) generation of initial codes, (3) searching for themes among codes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the final report (analytical themes). A total of 4 researchers participated in the review process. After data familiarization, a set of a priori categories was defined by TW and refined by all the coauthors ( Table 1 ). The coding was based on the Performance of Routine Information System Management (PRISM) framework [ 38 ], which states that routine HIS performance is affected by the system’s inputs (ie, technical, behavioral [ 39 ], and organizational determinants) and progress. Please note that other elements of the framework (outputs, outcomes, and impact) are discussed in another study addressing the evaluation of digital PEx (work in progress).

A priori categories of influencing factors of digital patient experience based on the Performance of Routine Information System Management framework [ 38 ].

Group discussions among the authors were used to reach an agreement on the produced a priori categories. TW quoted the relevant data across the included reviews, generated initial codes based on a priori categories, and then searched for themes among codes. Frequently used terms in the included reviews were used as inspiration to generate subsequent codes and themes. The latter process was independently and randomly validated by GG, MM, and RG.

Figure 1 shows the flow diagram of the systematic search. A total of 173 records were generated after the computer search; 58 (33.5%) duplicates were removed, and the titles and abstracts of 115 (66.5%) articles were reviewed. Subsequently, 53.9% (62/115) of full-text articles (including 4 additional records collected through snowballing) were reviewed for inclusion. Ultimately, 45 studies were included in the review for data extraction.

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Study flow diagram. ICT: information and communications technology.

Study Characteristics

Embase, MEDLINE, PubMed, PsycINFO, CINAHL, and the Cochrane Library were the most common databases for the included reviews. Of these, 62% (28/45) were systematic review articles. The remainder included scoping reviews (6/45, 13%), literature reviews (3/45, 7%), integrative reviews (3/45, 7%), narrative reviews (2/45, 4%), comprehensive overviews (1/45, 2%), review of systematic reviews (1/45, 2%), and umbrella reviews (1/45, 2%). More than half of the included reviews (24/45, 53%) conducted quality assessments. The reviews included >1400 studies, which mainly or partially reported qualitative and quantitative analyses of PEx in digital health. The data analysis methods varied and included thematic analysis (8/45, 18%), meta-synthesis (5/45, 11%), meta-ethnography synthesis (2/45, 4%), taxonomy (1/45, 2%), hermeneutic synthesis (1/45, 2%), qualitative evidence synthesis (1/45, 2%), and state-of-the-art survey analysis (1/45, 2%).

Among the included reviews, some focused on specific populations, such as children (3/45, 7%), college students (1/45, 2%), younger people (1/45, 2%), adults (7/45, 16%), or older adults (4/45, 9%). Others either focused on the general population or did not mention the target population. The most common health issues across the included articles were chronic diseases (17/45, 38%), including chronic obstructive pulmonary disease, heart failure, cardiovascular disease, cancer, diabetes, and hypertension. Mental health problems (7/45, 16%), including depression, anxiety, psychological well-being, psychotic disorders, and schizophrenia, were the second most common health issues. The remainder either focused on other issues (8/45, 18%), including audiology, asthma, reproductive health, maternal health, newborn health, child health, adolescent health, surgery, postpartum, somatic diseases, or palliative care, or did not mention any specific health issues (14/45, 31%). Some papers (8/45, 18%) also provided multistakeholder perspectives, including health care professionals, providers, surgeons, clinicians, staff and organizations, implementers (such as health policy makers, clinicians, and researchers), and the participation of information technology.

The degree of detail provided about the interventions varied greatly across the studies. Phone-based apps, websites, handheld sensing devices, and ambient assisted living health care systems were common digital health deliveries. Interaction techniques included synchronous, asynchronous, and hybrid models. Diverse intervention platforms, systems, or functions were used to deliver various health care services, including supporting disease management (14/45, 31%); patient-to-physician communication or consultation (9/45, 20%); symptom monitoring (9/45, 20%); information transmission (4/45, 9%); health promotion activities (3/45, 7%); screening, diagnosis, or self-assessment (2/45, 4%); behavior changes (2/45, 4%); self-education (1/45, 2%); and decision-making (1/45, 2%). Multimedia Appendix 1 [ 28 , 40 - 83 ] provides detailed information regarding the characteristics of the included studies.

Overall Impression of Digital PEx

Our study revealed great diversity in the perspectives and definitions describing patients’ experiences and characteristics when using digital health, presenting a variety of influencing factors and design considerations for digital PEx. The included studies showed different foci regarding digital PEx, including influencing factors (21/45, 47%) [ 28 , 40 - 59 ], digital health performance (19/45, 42%) [ 40 - 43 , 46 , 48 , 49 , 56 , 57 , 59 - 68 ], patient perceptions (9/45, 20%) [ 28 , 45 , 47 , 49 , 69 - 73 ], evaluation methods of digital health or digital PEx (8/45, 18%) [ 43 , 64 , 74 - 79 ], and design considerations (9/45, 20%) [ 48 - 50 , 53 , 54 , 59 , 80 - 82 ]. The findings and conclusions of the 45 reviews showed a great diversity. Most studies presented a set of themes (19/45, 42%) [ 28 , 44 , 45 , 48 , 49 , 51 , 54 - 57 , 59 , 62 , 69 - 73 , 76 , 79 ] or descriptions only (16/45, 36%) [ 40 - 42 , 46 , 47 , 58 , 60 , 61 , 63 - 67 , 74 , 75 , 83 ]. Other studies concluded with a theory-based description (5/45, 11%) [ 52 , 68 , 77 , 78 , 80 ], framework (4/45, 9%) [ 28 , 49 , 50 , 82 ], model (2/45, 4%) [ 53 , 69 ], method (2/45, 4%) [ 43 , 81 ], or checklist (1/45, 2%) [ 59 ]. Only a few studies transformed findings into design considerations (9/45, 20%) or visualized or structured their results into frameworks, models, checklists, or methods (9/45, 20%). Limited information was found on participant dropout reasons during the interventions [ 28 , 41 , 43 , 51 , 53 , 63 , 69 , 71 ]. The overall impression of the researchers on the DHIs was positive. In 51% (23/45) of reviews [ 41 - 44 , 48 , 49 , 52 - 54 , 57 , 59 , 61 - 63 , 65 - 69 , 72 , 73 , 77 , 80 ], the DHIs either showed promising results or at least results comparable with face-to-face health care services. Only 4% (2/45) of reviews [ 47 , 60 ] reported concrete evidence of the negative impact of current DHIs on digital PEx. In general, digital PEx was addressed because of the interactions between the DHIs and the patients involved and how the service was organized and carried out.

Influencing Factors of Digital PEx

An influencing factor is an aspect of the existing situation that influences other aspects of the situation, and it is formulated as an attribute of an element that is considered relevant and can be observed, measured, or assessed [ 84 ]. In this study, influencing factors refer to specific factors that lead to a positive or negative experience (digital PEx). Some factors have either positive or negative consistent and concrete impacts, whereas others have double-edged impacts; that is, impacts that are different per individual or change over time. Among the included papers, a common understanding of the potential influencing factors was captured from 3 aspects—behavioral, technical, and organizational determinants—following the categorization of the PRISM framework. These determinants were each classified into 3 categories, resulting in nine categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. Multimedia Appendix 2 [ 28 , 40 - 83 ] presents an overview of the themes identified for each category, the influencing factors per theme (positive, negative, and double-edged), and references. Most factors appear to be related to technical determinants, followed by behavioral and organizational determinants. For technical determinants , we summarized 3 categories with 13 themes, containing 58 positive, 35 negative, and 13 double-edged factors. For example, DHIs with multiple behavioral change techniques appeared to be more effective [ 42 , 56 , 80 ] and reported higher patient satisfaction [ 54 , 57 ]. Behavioral determinants included 3 categories with 9 themes containing 11 positive, 21 negative, and 5 double-edged factors. For instance, some studies mentioned a lack of confidence in patients’ own ability to use the technology [ 43 , 45 , 47 , 48 , 71 , 81 ], leading to a negative digital PEx. Organizational determinants were classified into 3 categories with 5 themes, including 13 positive and 23 negative factors. For example, unrealistic financial reimbursement and higher costs related to the internet or equipment were practical challenges of using digital health [ 47 , 48 , 51 , 55 , 56 ]. For the behavioral and organizational determinants, we collected more negative factors than positive factors. This is in contrast to the technical determinants, in which more positive factors were identified. Double-edged factors were less than both positive and negative factors for all the 3 determinants. Multimedia Appendix 3 [ 28 , 40 - 61 , 63 - 67 , 69 - 73 , 75 - 78 , 80 - 83 ] provides detailed information and examples.

Design Considerations of Digital PEx

Table 2 provides an overview of the identified themes for each design construct or method, related considerations, and references. To address the abovementioned influencing factors, several the included articles referred to design constructs (personalization, information, navigation, and visualization) [ 48 , 49 , 53 , 54 , 59 , 80 ] and design methods (ie, human-centered design [HCD] or user-centered design [UCD], co-design or participatory design, and inclusive design) [ 48 - 50 , 54 , 80 - 82 ], either as recommendations or implications for improving digital PEx from a design perspective. Notably, there was an overlap between design considerations and influencing factors. The former focuses on concluding possible design suggestions, recommendations, and implications proposed by the reviewed articles. The latter involves mapping the impacts of interaction design on digital PEx in different contexts; therefore, they refer to different themes and references. Generally, the personalization construct identifies patient profiles and tailors digital health according to patients’ needs and preferences. The information construct addresses the source, language, presentation, content, and architecture of delivered health information. The navigation construct considers the interactive, delivered, and instructional elements of digital health to guide users to different areas of content within digital health. The visualization construct focuses on the aesthetics, attractiveness, visibility, and consistency of digital health appearance and interface. Furthermore, co-design and UCD or HCD were recommended as the most common methods for designing digital health, which involve multi-stakeholders and multi-disciplinaries in the design process to facilitate the designers’ work, as designers need to understand end user needs and be aware of potential barriers to engaging in DHIs. Finally, inclusive design provides flexible design and is usable for a broader population. Notably, the design considerations identified in the included papers are not meant to be applied to every project; the implementation depends on the project’s focus. Designers always need to balance project requirements (such as profits), user needs (such as privacy concerns), and policy regulations (such as data security). For example, peer-to-peer patient communication may not be appropriate for more sensitive health issues.

Design considerations of digital patient experience.

a DHI: digital health intervention.

Design Implications

On the basis of our findings regarding influencing factors and design considerations for digital PEx, in this section, we define digital PEx and present design guidelines for the implementation of improving PEx in digital services.

Definition of Digital PEx

Our review reveals the absence of a commonly used concept for PEx in digital health. An increasing number of studies have been conducted on surveying PEx, satisfaction with, and expectations in varied digital health. With the growing academic interest in this topic and increasing efforts to address PEx in digital health design practice, a common concept with a concise definition will strengthen and align efforts overall. After reviewing the alignment of widely accepted concepts of PEx, UX, and DHIs with our generated influencing factors, we observed that many of our findings are included in the PEx definition offered by The Beryl Institute. Therefore, by including the sum of all interactions shaped by an organization’s culture, which influence patient perceptions across the continuum of care [ 33 ] along with the constructs of UX (people’s perceptions and responses [ 18 , 29 ]), DHIs (digital health technologies [ 13 ]), and the determinants (ie, technical, behavioral, and organizational determinants) identified in this review, we propose a concise, practical definition of digital PEx to guide the future design of digital health: “Digital patient experience is the sum of all interactions, affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health.” Compared with the original definition of general PEx, this new definition underlines the digital part of health care delivery and includes 2 new determinants (technical and behavioral) that go beyond the organization’s culture to clarify what can influence patient perceptions while traveling along a digital care pathway.

Design Guidelines for Improving Digital PEx

We developed a design and evaluation framework to help digital health designers or developers improve digital PEx in the design process ( Figure 2 ). This framework was based on the findings of this umbrella review and was inspired by the double diamond model [ 85 , 86 ]. Our framework shows four phases: define design, define evaluation, design ideation, and design evaluation . The first and third phases focus on the design itself, and the second and fourth phases focus on design evaluation. In this study, we focus on explaining the first and third phases. In the first phase, designers must define the design goals by considering the factors that affect digital PEx. In this phase, we provided 3 determinants referring to 9 categories of influencing factors that have 3 types of impact on digital PEx (positive, negative, and double-edged) for designers to discover and explore. Designers can frame their design goals based on the intervention purposes and the selection of influencing factors. For example, if the purpose of the intervention is to improve patient eHealth literacy, designers need to pay more attention to patient capability and frame a design goal to develop suitable intervention functionality for improving patient capability. After defining the design goals, designers can move to the second phase, which is the define evaluation phase. In this phase, designers need to consider evaluation indicators (patient emotional, behavioral, and health outcomes) and evaluation methods (surveys and interviews) that are used to assess digital PEx. Detailed information regarding this phase will be discussed in a parallel study. Following this, we provide 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (ie, HCD or UCD, co-design, and inclusive design) for the design ideation phase. Personalization [ 41 , 54 , 56 , 57 , 59 , 69 , 81 , 87 ] refers to ascertaining user needs with design goals. It encompasses the design of intervention technology and functionality needs that meet the patients’ ability, opportunity, and motivation to trigger behavior changes and promote health outcomes. UCD/HCD and inclusive design are valuable at this stage for the inclusion of patient perspectives. Driven by user needs and intervention goals, information includes content, communication, and functionality [ 54 , 59 , 81 ], and navigation comprises forms of delivery, user flows, instructions, and tutorials [ 54 , 59 , 80 , 81 ]. This relates to how relevant content presented in multimedia with a clear information architecture can attract patient attention and help them understand and complete tasks efficiently [ 88 ]. Co-design and participatory design are multidisciplinary collaborations that are necessary at these 2 stages. Finally, designers need to consider visualization [ 54 , 57 , 59 , 80 , 81 ], which determines the product look. The digital health interface can affect patients’ first impressions when using DHIs. An attention-grabbing, simple, and consistent interface [ 59 ], layout (colors and images) [ 80 ], and message presentation [ 59 ] can all lead to positive UX. The design guidelines ( Textbox 1 ) can be used at this stage to produce design concepts. In addition, this phase contains the digital health design workflow, challenges, and tips from a design practice perspective (which will be presented in an ongoing interview study). Finally, we ended up with this framework by introducing the design evaluation phase, in which designers need to develop tests (based on evaluation metrics) to evaluate design concepts. If the evaluation outcomes do not meet the evaluation standards, designers can return to the design ideation phase to adjust the design concepts or return to the first phase to reconsider the design goals.

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Digital patient experience design and evaluation framework. HCD: human-centered design; UCD: user-centered design.

Design guidelines for improving digital patient experience.

Categories and design guidelines

Identify patients’ knowledge and skill levels by understanding their technology, language, and health literacy; consider their previous experience and current confidence level in using digital health; improve their actual literacy and correct their perceived inability; tailor design to their ability
Profile patients’ identity (eg, age, gender, economic status, and daily routines) and health status (eg, illness complexity, severity, and stability); consider patients’ accessibility and affordance to digital health; tailor design to their individual opportunity
Recognize patients’ mindset and perceived advantages and disadvantages; inform them of the potential benefits of using digital health; address their concerns and worries; understand their expectations and needs; tailor design to their preferences to trigger their motivation
Increase technical usability; ensure ease of use, ready to use, and timely feedback on digital health; select technical features (eg, data accessibility) and delivery media or devices (eg, device ownership) to meet patients’ preferences and needs
Strengthen theory-based interventions (eg, behavior change techniques and evidence-based interventions); improve intervention quality, considering privacy, security, and accuracy issues; provide regular and continuous social support combining both remote communication and real human contact; tailor health promotion and intervention structure to patients’ needs and preferences
Provide personalized and consistent information, clear tutorials or technical support, and visualized data; allow patients to choose personalized interactive elements; follow human or user-centered design, co-design, and inclusive design methods; involve multi-stakeholders and multi-disciplines in the design process
Reduce equipment or service cost and time; improve health care providers’ professional ability, communication skills, and service attitudes across the use of digital health; increase workflow transparency and clarify accountability; improve system integration and compatibility
Provide a familiar, warm, and comfortable environment rather than cold and unfamiliar settings; reduce environmental distractions (eg, background noise or lighting)
Provide adequate support policies and legislation; develop plausible business cases

Compared with the original double diamond model, our framework separates the evaluation part from the design part. This aligns with the design research methodology framework [ 84 ], which suggests generating success criteria after clarifying design research goals and before producing design support, formulating criteria for success is essential to be able to determine whether the results help achieve this aim. Therefore, we paid equal attention to design and evaluation. In addition, our framework provides detailed reference materials (such as 3 determinants) for each phase to provide designers with more practical support. Notably, in our framework, we retain some typical features of the double diamond model: the first 2 phases are research related, the last 2 phases are practice related, and each phase starts from divergence and ends at convergence.

On the basis of our findings on influencing factors and design considerations, we mapped the combinations of design constructs and design methods into 9 design guidelines to address different influencing factors ( Textbox 1 ), which can be used to guide the design ideation process. Some of the design guidelines uncovered in this study have already been implemented, resulting in a positive digital PEx, such as the digital platform PatientsLikeMe, which aims to empower patients to navigate their health journeys together through peer support, personalized health insights, tailored digital health services, and patient-friendly clinical education [ 89 ]. One of the studies pointed out that patients can greatly benefit from using this platform as it improves patient health literacy, and its condition-specific customization may still further improve PEx [ 90 ], which aligns with our design guidelines on improving “patient capability” and providing “personalized information.”

Principal Findings

We systematically reviewed review articles on factors that influence digital PEx and considerations regarding how best to design digital PEx. The reviews varied greatly in type, including studies and data analysis methods, as well as in HIS, health issues, target patient groups, intervention content, and structure. Of the selected reviews, 62% (28/45) were systematic reviews, the rest were other types. These included qualitative, quantitative, and mixed methods studies. Thematic analysis and meta-analysis were the most common data analysis methods used in the reviews. We note that the studies described in the selected reviews were extremely heterogeneous, and information about interventions and digital PEx were often mixed and complex, making comparison difficult.

Our results are in line with the findings reported by previous authors [ 25 , 30 , 38 ] on the factors that affect PEx, UX, or the implementation of digital health. On the basis of the identified influencing factors and design considerations, we developed 9 design guidelines for improving digital PEx. Our findings reveal that among the selected reviews, only a few formulated design strategies or guidelines. This lack of design knowledge transformation makes it difficult for designers or developers to apply the findings directly. This aligns with the studies by Sakaguchi-Tang et al [ 48 ] and Søgaard Neilsen and Wilson [ 80 ]; the former indicated that the absence of specific design recommendations impairs the design of digital health, with the latter suggesting that there was a lack of understanding of the most beneficial design aspects for some specific digital health and how design principles can best be applied. Moreover, the use of UCD has been recommended in many studies to address UX-relevant issues in digital health [ 3 , 80 , 91 ], which also supports our findings.

Digital PEx Versus General PEx and UX

We found a lack of a common term to describe PEx in digital health; UX (25/45, 56%) and PEx (17/45, 38%) were the most commonly used terms. Patient UX, patient perceptions, client experiences, patient empowerment, and user engagement were also used to describe similar concepts. Many reviews indicated that there was limited information about UX or PEx in varied digital health and underlined the need for a more holistic view of patient needs and priorities to better shape digital health design strategies and provide tailored digital health [ 28 , 40 , 42 , 45 , 60 , 74 ].

Influencing Factors Are More Complex Than Facilitators and Barriers

The information provided about digital PEx–influencing factors was complex and heterogeneous. Digital health is often treated as a whole, whereas digital PEx is affected by the additive effect of varying digital health factors. A single change in a factor may affect everything else. We found that without a concrete interaction context, factors could be regarded concurrently with facilitators or barriers. For example, regular contact with health care providers (HCPs) could be perceived to increase a sense of reassurance or perceived as a burden to patients’ daily lives [ 28 ]; some patients experienced digital health as time consuming or an additional burden, whereas others experienced it as time saving or convenient [ 69 ]. Some influencing factors may have a soft or indirect influence on digital PEx [ 44 , 76 ]. For instance, users who are completely unaware of privacy or security risks may have excellent experience with digital health that fails to meet privacy or security requirements [ 76 ]. A lack of concrete solutions to address these barriers was mentioned [ 48 ]. It is likely that digital health cannot serve all populations equally well [ 71 ], which aligns with the results of a scoping review that investigated the inequities caused by the adoption of digital health technologies [ 92 ]. Some researchers indicated that older adults can also experience benefits by using digital health [ 53 ], whereas others suggested that telehealth is, at best, a partial solution for younger and fitter subpopulations [ 47 , 71 ]. Again, although some mentioned that patients preferred using personal devices [ 49 , 55 , 61 , 64 ], others noted the opposite [ 64 ].

Unclear Benefit From the Different Elements in Digital Health

It is likely that some patient groups benefit more than others from specific DHIs. For example, one of the reviews suggested that in telemedicine treatment for type 2 diabetes, behavioral change and continuous management were the keys to success [ 43 ]. However, it was unclear precisely which elements of digital health resulted in patients’ satisfaction or dissatisfaction and how they could be addressed [ 83 ]. Moreover, we found limited data and even contradictory results on which factors affect digital PEx the most, which elements should be considered first when developing DHIs, and who benefits more from them. The latter is commonly mentioned [ 48 , 53 , 70 ], with some authors suggesting that patients with unstable chronic diseases might benefit the most [ 47 , 93 ]. However, another review indicated that even if patients are provided with the latest state-of-the-art technology at home, the intervention will not be beneficial if it remains unused [ 43 ]. Patients who are less activated are likely to have less positive experiences than those who are highly engaged [ 74 ].

Lack of Multiple Perspectives During the Design of Digital PEx

Clear communication between experts, designers, and patients regarding their understanding of digital PEx is required. Some reviews acknowledged the need for a multistakeholder perspective on digital PEx [ 55 , 69 ]. However, we found circumstances in which this was not possible. For example, in some cases, UCD for DHIs was conducted on nonpatient users either because of ethical reasons or relevant regulations [ 43 ], and in others, apps that are not specifically designed for patients with cancer were being used for this patient group [ 64 ]. HCPs are often isolated from the decision-making process to incorporate digital health into their current service provision [ 28 ]. Moreover, a lack of clinician perceptions of digital health use was also reported [ 40 , 54 ]. Furthermore, no studies focused on exploring designers’ views, opinions, experiences, or values in addressing PEx or UX in the design of digital health. There was little information on whether experienced designers had worked with patients in their design process.

Over- or Underestimated Results

Some studies suggested that a lack of interest was the main reason for patients’ refusal of digital health and that reasons for patient withdrawal were patients not wanting to use equipment, deteriorating health, and technical problems [ 94 , 95 ]. We need to gain better insights into the reasons for patients choosing not to engage in or withdraw from digital health, as these will significantly inform future DHI development and design [ 43 , 53 , 69 ]. However, it is likely that most studies only included patients who had already agreed to or were using digital health technologies; those who refused to use, withdrew from, or had no accessibility were excluded [ 28 , 51 , 63 , 69 ]. One of the reviews suggested that this would result in over- or underestimated results of DHIs’ effects on digital PEx, as participants who completed the intervention may differ from those who did not [ 41 ]. Another review found that patients only reported positive themes associated with remote monitoring, which may indicate a selection bias [ 71 ].

Conflicts Between Benefits and Cost for Developing DHIs

The provision of digital health can reduce the treatment burden and better integrate care into patients’ daily routines [ 69 ], which is consistent with our findings; we found that most reviews had a positive perspective of DHIs. However, in one of the reviews, it was suggested that although there was agreement among most professionals that health information technology can have a positive impact on PEx, when weighing the benefits against the potential cost, demonstrating this will be challenging [ 44 , 47 ]. Moreover, unnecessary high-frequency monitoring could result in a waste of health resources and an increased workload for HCPs [ 52 ]. Compared with existing health care services, the application of new technology needs to demonstrate clinical evidence of improved health conditions [ 43 ]. However, there were discordant findings in terms of the benefits of using DHIs. For example, there was no concrete evidence that telemedicine consultations were quicker than face-to-face consultations [ 40 , 57 , 68 , 83 ]. In another case, the impact of DHIs on health care use was not examined [ 57 ]. In conclusion, only user-friendly and quality-certified DHIs should be provided to patients [ 64 ]; health care organizations should not shift their focus from the basic and inexpensive strategies that affect patient care. Care is needed: new technology should not overwhelm the patient or ignore patient needs [ 44 ].

Limitations

First, when undertaking a review of review articles, some important details included in the original studies may have been lost, which increases the possibility of reporting bias. We also noted differences in the interpretation of terms and methods between the reviews. There is a lack of consistency in the terminology used to describe the functions of DHIs, HISs, or digital PEx itself. For example, in some cases, “eHealth” and “mHealth” were used as interchangeable terms [ 75 ], “persuasive technology” and “behavior change techniques” were presented as having a similar meaning [ 43 ], and “patient engagement” and “patient activation” were also regarded as being the same [ 74 ]. This inconsistent use of terms may impede knowledge translation and dissemination [ 57 ]. To counter this, we summarized the varied factors with unified descriptions to build a common understanding of the digital PEx–influencing factors.

Second, the intervention types and patient groups varied widely among the reviews, limiting meaningful comparisons between different studies. In addition, the digital health landscape is rapidly evolving, and the technology infrastructure is constantly shifting [ 41 ], as are the continuous updates of the UX design area. It is important to keep the influencing factors updated or adapted as the technology develops. Possibly, relevant original studies may have been excluded because of our focus on review papers. However, our approach to conducting an overarching review provides readers with a quick overview of the relevant digital PEx studies and a basis for further research.

Third, our umbrella review did not account for the multimodal relationships between subthemes or the potential overlap between subthemes within different domains. For example, different subthemes, such as “personalized design” in “interventions’ interaction design” also interconnect with “interventions’ technology” and “interventions’ functionality.” Moreover, our review process did not aim to address the question of whether some influencing factors are more important than others or how different aspects of DHIs influence them. This warrants further investigation as we suspect that differences may exist between the influencing factors, as some elements in digital health are more likely to increase or inhibit a positive digital PEx.

Finally, as we used qualitative thematic analysis to synthesize the findings and generate themes, the generated themes could have been influenced by the authors’ previous research experiences and personal understanding. By asking other researchers to repeat the coding process, the resulting themes are likely to be different. However, to minimize the potential coding bias, the generation of categories was based on the PRISM framework; 4 researchers with different backgrounds, including design, medical, and human factors, were involved in the iterative coding process, group discussion, and independent and random validation, and existing theories were used.

Further Research

The goals of this umbrella review were to systematically review the influencing factors that affect digital PEx and the design considerations for improving digital PEx that are summarized in the existing literature. We must conclude that, currently, much remains unknown, and the topic of digital PEx is relatively new. We propose 6 directions that require further research. The first direction is to develop frameworks or models that translate digital PEx–related research findings into design practices or implications. For example, in this study, we used design guidelines and a design framework to summarize the findings. The second direction is to identify those who will benefit more from which elements in DHIs and which influencing factors could be addressed by combining design constructs and design methods. The third direction is to further examine how designers understand and address digital PEx in the digital health design process. To address this, we conducted a qualitative study on how designers address digital PEx in design practice. The fourth direction is to standardize evaluation indicators, methods, or tools for assessing digital PEx; we are currently evaluating digital PEx in a parallel study. The fifth direction is to quantify the balance between the benefits and costs of developing user-friendly and validated DHIs. The sixth direction is to identify participants’ reasons for dropping out and their impact on the reported digital PEx–related results.

To the best of our knowledge, this is the first study to propose the term “digital patient experience” as a common phrase to describe PEx in digital health and define digital PEx by synthesizing the reported PEx or UX of varied DHIs from multiple reviews. Multimedia Appendix 4 shows more details about the structure of this study. In this review, information on influencing factors was identified and summarized into 9 categories (ie, patient capability, opportunity, motivation, intervention technology, functionality, interaction design, organizational, physical environment, and social environment). These categories were classified into positive, negative, and double-edged factors based on their positive, negative, and diverse impacts on digital PEx. Our review uncovered 4 design constructs (personalized, information, navigation, and visual design) and 3 common design methods (UCD or HCD, co-design, and inclusive design) as design considerations for addressing digital PEx. Finally, we proposed a design and evaluation framework and design guidelines to help digital health designers and developers address digital PEx throughout the entire design process.

Acknowledgments

This work was supported by the China Scholarship Council under grant 201906790084.

Abbreviations

Multimedia appendix 1, multimedia appendix 2, multimedia appendix 3, multimedia appendix 4.

Authors' Contributions: TW conceived, designed, and led the overall study, conducted data collection, led the data analysis and interpretation, and drafted the manuscript. TW and GG performed the review selection and data interpretation. GG, MM, and RG participated in the overall study; contributed to the analysis and interpretation of the study data; and conceptualized, reviewed, and suggested modifications regarding the presentation of results. All authors have read and approved the final manuscript.

Conflicts of Interest: None declared.

Transformation in Patient Journey through Digital Revolution

Jul 5, 2019

Insights for Pharmaceutical Industry

The integration of digital technology is improving healthcare outcomes and reshaping the relationship between physicians, patients, and the healthcare system. By connecting patients and healthcare providers through mobile technology, treatment efficiency can be improved by increasing the accessibility of existing or real-time data. Quick availability of such information to healthcare providers helps them take immediate action if necessary. This will prevent conditions from worsening, and therefore, improve the quality of life of patients.

Patient expectations and needs toward the healthcare system are evolving over time. Digital access to treatment options, medical research, and provider reviews have created a new generation of empowered consumers. Patients want to remain informed, engaged, and connected to all stakeholders within the healthcare system to become an expert in their treatment pathway and remain at the center of their medical journey.

Greater access to knowledge, exposure to self-management programs, and new regulations for patient involvement have contributed to patient empowerment, and thus, redefined roles in relation to healthcare. Through these changing dynamics, the relationship between patients and care providers are transforming, wherein patients are becoming a partner of their care providers instead of simply being a care receiver. Therefore, healthcare service providers will need to focus on becoming more customer-driven through the implementation of proper patient acquisition and retention processes.

Understanding the Digital Patient Journey

The trend towards the use of digital solutions is increasingly gaining interest across all stakeholders in the healthcare value chain ranging from patients to healthcare organizations and payers. Primary reasons for this are qualitative treatment modules and improved patient care, which will further contribute to potential cost savings in the long run.

With the growing penetration of smartphones in the healthcare setting, patients extensively rely on digital sources for information and seek support at several points through digital means along their patient journey. Thus, the digital journey offers immense opportunities to learn about factors that influence patients’ behaviors and build stronger relationships. In healthcare, the way patients access and utilize information is somewhat similar to other industries. To connect with patients at the right time and in the right manner, it becomes important to build awareness regarding the distinct digital path they follow.

Consistently evaluating the digital journey and capturing patient-generated health data to gain insights and provide services are key factors that help pharmaceutical companies gain market access. These factors also play an important part in developing effective patient-centric medical and marketing strategies.

Patient Journey Mapping

Digital journeys toward a health solution are a surprisingly similar order of events from start to finish. The end result of mapping a digital patient journey is understanding their desires, hidden needs, and preferences, and mapping all these touchpoints (touchpoints are any interactions that the patient can experience at a specific stage in their journey) against what a service provider (pharmaceutical companies, healthcare organizations, etc.) can deliver, through which channels and timelines for service delivery to patients. The first crucial step in mapping the patient’s digital journey is to adopt a patient-centric mindset and understand needs, motivations, emotional states, and goals in terms of healthcare outcomes. The next step is to strategically lay out all touchpoints.

Marketing and communication efforts should be focused and customized per digital journey stage. Furthermore, producing and organizing quality content with SEO best practices is necessary to create brand awareness. Maintaining an easily navigable website with updated and compelling information is needed to provide excellent mobile experience to users, and hence, raise online brand awareness. New opportunities to reach patients can also be created by providing mobile applications to support patients and healthcare professionals. Apps may help in identifying triggers and providing the personalized or right treatment more quickly by enabling patient monitoring and driving treatment adherence. They may be equipped with advanced analytical or monitoring capabilities for informed decision making by healthcare providers.

How to build a patient journey map?

Patient journey mapping is a patient-centric data-driven approach to plan communications and marketing activities, and deliver exemplary healthcare experience. Involvement of several activities and patient behavior make patient journey mapping a much more complex, fragmented exercise for service providers and pharmaceutical companies.

Spreadsheets and the use of various software such as UX360 can be used to track patient journey.

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Transformation of Patient Journey in the Digital Age
Get instant access. In this paper, we will investigate how digitalization has transformed the patient journey and why mapping the digital patient journey in place of the traditional patient journey offers myriad of opportunities for pharma to understand, reach, and support patients, enhancing their experiences and outcomes. We will also explore ...
Integrating the experience: Principles for digital transformation
The patient journey must embody long-term goals for health: Under the current paradigm, care is delivered in an episodic format. Focusing on treatment and risk mitigation at the moment, episodic care undermines the patient's capability to cope, adapt, and thrive. ... With increasing digitalization, the care experience is moving beyond mere 1:1 ...
The Digitalization of the Patient Journey
The digital patient journey begins with what can be loosely defined as the digital front door. The digital front door is a group of digital touchpoints which represent a patient's first few steps along the healthcare journey. The digital front door can be made of everything from social media posts and adverts and your portal/website, to ...
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1. Mirror your digital presence with your in-person patient experience. Healthcare organizations tend to place most of their focus on the in-person care delivery that occurs once patients are in ...
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This ultimately contradicts any efforts to incorporate the above principles. By illumin-ating what to expect across the journey, patients now have a foothold for resuming greater control. 9. Change the role of the care team: For these models to ourish, all members of the care team must have the. fl.
(Digital) Patient Journey and Empowerment: Digital Twin
Abstract. New forms of interaction between doctors and patients are facilitated by a transformation of the patient journey. The advent of better data integration through digital twins allows for completely new forms of interaction, decision-making in unprecedented frequencies. The Digital Twins will also allow a more personalized data analysis ...
Integrating the experience: Principles for digital transformation
This entails holistically reexamining how every component of the health care experience, from the digital tools to visit interactions, synchronizes to address the full continuum of patient needs throughout the journey. By doing this, care shifts away from one-size-fits-all, fragmented strings of visits, toward seamless experiences that adapt to ...
Transformation of the patient journey in the digital age
QR codes expedite and enhance patient experiences. QR codes can improve efficiency, communication, and an organization's ability to provide high-quality care to patients. According to QRTIGER's database, 2022 QR code usage statistics showed a 443% scan increase since 2021, equaling 6,825,842 scans globally.
The never-ending patient journey of chronically ill patients: A ...
In the cyclical patient journey, digitalization can help put the wishes and needs of the chronically ill patients at the center of care. It is recommended that healthcare professionals implement digital alternatives for touchpoints. Most chronically ill patients consider digital alternatives to lead to more efficient interactions with their ...
Healthcare's digitization: Achieving true connected care
Within the last year, the healthcare industry has witnessed an acceleration in its digitization journey and truly demonstrated the value of digital health and shifted how patients received care. At the virtual HIMSS21 & Health 2.0 European Health Conference, held from June 7-9, Philips is addressing the ongoing challenges faced by a global ...
Digitalization from the Patients' Perspective
Digitalization in health care is often discussed from the professionals' point of view (e.g. physicians, dentists, nurses), but what about the patients' perspective? Patients face new challenges: They are a cost factor, which has to be monitored. This requires access to all their health care data plus additional information.
(PDF) Digitalizing the patient journey
Patient journey mapping in the healthcare indus try is a data-driven, patient-centric approach to planning marketi ng . activity, communications, and (to some degree) even . delivering care. It ...
Identified gamification opportunities for digital patient journey
Digitalization provides great potential for improving patient‐centred services in a cost‐effective way, ... A digital patient journey solution's ease of use could be addressed with the help of a simple and clear user interface and long‐lasting battery in sensors. A solution could visualize rehabilitation exercise results reported via ...
Driving digital transformation in healthcare: An interview with Dr
Ultimately, we want to develop a digital patient journey solution that can be reimbursed by the healthcare system. Digital Therapeutics (DTx) products are already making inroads in the U.S., and German authorities have taken a bold step to reimburse some services. We expect that China's regulators will follow suit, and reward appropriately ...
Digitizing Healthcare: Key Trends, Benefits and Challenges
Stage of patient journey: Across all stages. ... Note: This list illustrates some of the examples of healthcare digitalization and is not exhaustive. Electronic Health Records. EHRs are digital copies of patients' medical data, history and charts. They also include their personal data such as their addresses and financial information.
Digital Patient Experience: Umbrella Systematic Review
Objectives. The objectives of this paper were to systematically review (1) the factors that influence PEx in digital health and (2) the design considerations of PEx that are in digital health. The overall aim was to generate a design framework and guidelines for further improving PEx in digital health. Go to:
Transformation in Patient Journey through Digital Revolution
The first crucial step in mapping the patient's digital journey is to adopt a patient-centric mindset and understand needs, motivations, emotional states, and goals in terms of healthcare outcomes. The next step is to strategically lay out all touchpoints. Marketing and communication efforts should be focused and customized per digital ...

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The never-ending patient journey of chronically ill patients: A qualitative case study on touchpoints in relation to patient-centered care

Introduction

Study design

Participants

Data collection

Data analysis

Validity and reliability

Ethical considerations

Pre-service period

Intake consult with the healthcare professional.

Check-in at the desk.

Service period

Self-monitoring.

Post-service period

e-Consults.

Online health platforms.

The patient journey of chronically ill patients

Touchpoints, digital alternatives, and PCC

Limitations, recommendations, and future research

Supporting information

S1 File. A 32-item checklist for reporting qualitative studies (COREQ).

Acknowledgments

Addressing the next phase of healthcare’s digital transformation at HIMSS21 & Health 2.0

Expanding care beyond the hospital walls