1

DIGITAL TRANSFORMATION IN THE HEALTHCARE INDUSTRY

Name

Course

Professor
 2

Digital Transformation in the Healthcare Industry

Digital transformation is the strategic adoption of digital technology in various fields. It

has helped digitize services and operations within systems. One of the fields that have primarily

benefitted from digital transformation is the healthcare industry. A lot has been achieved through

digital transformation, thus, fulfilling the original intent of the initiative. The positive aspects,

however, have not been completed as smoothly as people can tend to think. There have been

many hurdles, and they are still there even now. This literature review seeks to bring out detailed

information about digital transformation in the healthcare industry in terms of its history and

initiation, adoption, implementation, benefits, and the challenges it faces in the current digital

society.

History and Initiation of Digital Transformation in the Healthcare Industry

When referring to the future, one thing always comes to mind, and that is the word

technology. Technology is the father of the current digital space. There is a need to keep up with

the ever-changing world, which means that industries such as healthcare have had to come along.

Before the digitization of the healthcare systems, traditional methods were being used

(Palfreyman, and Morton, 2022). Their efficiency was questionable, but nothing much could

have been done then. Things have taken a turn since the introduction of the digital space.

The digitization of the healthcare industry dates back to 1897, when it started as

telemedicine. Telemedicine is a subfield of healthcare that uses electronic forms for

communications, such as mobile forms, to perform medical diagnosis (Jandoo, 2020). Health

care could be accessed remotely, thus minimizing the severity of an illness and reducing

mortality rates.
 3

Initially, telemedicine was only used for Antarctica expeditions and, as time went by, for

space missions (Fagherazzi, Goetzinger, Rashid, Aguayo, and Huiart, 2020). Regular people

were not in a position to also benefit from telemedicine as it was expensive to access. In 1887,

telemedicine was first performed on a child with croup illness (Murray, Hekler, Andersson,

Collins, Doherty, Hollis, Rivera, West, and Wyatt, 2016). A healthcare official diagnosed the

disease via phone call with the child’s parents. Even after the incident, telemedicine was still not

implemented almost nine decades later. After the decades had passed, telemedicine started

becoming famous bit by bit until it was accepted as a standard way of medical diagnosis

delivery.

The growth of digital transformation in the healthcare industry started being noticed in

the 20th century between 1950 and 1999. Around this time, various technological advancements

began happening. Ultrasound imaging techniques were developed, which involved using high-

frequency waves generated through technology to see the inside of the body. Other developments

in this era included the creation of artificial organs and DNA sequencing (Jayaraman, Forkan,

Morshed, Haghighi, and Kang, 2020). These developments made healthcare delivery by

healthcare personnel efficient and effective. The results above were vital in the pavement of way

for the modern digital health that is currently in use.

Telemedicine was no longer the only digitized healthcare practice since many

other digital health forms were invented as time went by. The golden era of digital

transformation was experienced between the end of the 80s and the beginning of the 90s.

Multiple healthcare professional associations came together in the United States and worldwide

to improve healthcare delivery through digital communication (Lyles, Wachter, and Sarkar,
 4

2021). These organizations impacted healthcare transformation from traditional health methods

to advanced digital techniques.

The years between 2000 and 2015 were the years of maturation of digital transformation

in the healthcare industry. There was a higher appetite to digitize healthcare compared to the past

year. This was made possible by the ever-growing digital innovations such as the world-wide-

web, which is user-friendly. Digital innovations made it easier for healthcare workers to connect

with their patients from all over the world. The patients also communicated with their healthcare

personnel without traveling long distances for illnesses that could have been solved from where

they were.

In this era of digital maturity in healthcare, there was the birth of digital therapeutics

which utilized the use of online means to help diagnose, treat and prevent psychological

disorders such as anxiety and depression (Smith and Magnani, 2019). One of the early

companies that digitized therapeutics was the WellDoc Company. This company used

technology to link patients with psychiatrists to manage psychological disorders easily. During

this period of digital maturation in healthcare, new terms such as eHealth, mHealth, and

personalized health emerged to describe digital health services.

In 2007, the Fitbit Company invented the wireless fitness devices that patients now use to

monitor their health conditions without medical personnel. This invention was an essential step

towards digitizing health. Initially, such services were only available for expensive and

adventurous space missions since it was risky journey. Since Fitbit’s developments, digital

therapeutics have become accessible to everyone from the comfort of their homes.
 5

The period from 2015 onwards, the current decade, is the bright future era whereby

digital health is widely accepted and used worldwide. The digital growth in this field has been

tremendous and motivating. A significant milestone in the current decade is the development of

the digital health unit by the United States Food and Drug Administration. The main goal of the

digital health unit is to help expand the digital health opportunities to be absorbed into general

healthcare.

When it comes to investments, according to (Alwashmi, 2020), it has increased from 4.1

billion dollars in 2014 to 9.4 billion dollars in 2020. This indicates that digital health is becoming

more utilized by the general public compared to earlier years. Digital health has evolved into a

standalone entity of innovation in this digital era, and therefore, it is giving hope for the future

achievement of more sustainable healthcare.

Currently, United States citizens and people from across the world can comfortably

access health care from the comfort of their homes. Patients do not have to travel far and wide to

meet their healthcare workers to get medical assistance. Each improvement in the digitization of

the healthcare industry is making it better than before the various innovations.

Adoption of Digital Transformation in the Healthcare Industry

Digital transformation in the healthcare industry has not been sudden as it seems. The

conversion has been done through several stages: assessment, evaluation, analysis, and critique.

When proposals were made to digitize healthcare, some associations disagreed. It has, therefore,

not been a smooth transformation. A lot is still going on behind the scenes regarding the

effective ways of completely digitizing some aspects of healthcare.

 6

The digital transformation process in the healthcare industry has not been seamless

despite a digital transformation in the current era no longer being debatable (Benis, Tamburis,

Chronaki, and Moen, 2021). The realization is strange, given the benefits of digitization across

other industries. People are now living in an era of unprecedented digital transformation, and

there is an assumption that that is what is expected in all areas of life. Logically speaking, there

is no reason why adopting technological innovations aimed at making things better is becoming

harder to achieve in the current generation than expected.

There has been exceptional end-user resistance to digital innovations in healthcare. Some

stakeholders are not yet at par with implementing technology in solving or making some

problems easier (Benis, Tamburis, Chronaki, and Moen, 2021). It is not easy to adopt a particular

development as much as it seems genuine. This is also being promoted by fear of change.

The healthcare industry is susceptible and delicate since it deals with human health. Life

is likely lost if a small mistake is made during the innovation or implementation stages. To

counter such incidences, it is essential to be keen on what to implement and its consequences to

people’s well-being.

While attempting to decode the reason for digital transformation in healthcare resistance,

COVID-19 made the puzzle even more challenging (Benis, Tamburis, Chronaki, and Moen,

2021). The occurrence of pandemic restricted movement across the globe. It was even more

difficult in the healthcare industry since that is where patients were to find treatment. Given that

activities were limited; it was only practical to offer healthcare remotely rather than in congested

healthcare centers (Benis, Tamburis, Chronaki, and Moen, 2021). Healthcare stakeholders were

conflicted on the complete adoption of digital transformation, others being covert and others

overt. As the pandemic proceeded, however, telemedicine was needed since people were not
 7

allowed to socialize to prevent contamination. During this period, there was more remarkable

improvement in digital transformation adoption compared to regular periods.

However, the adoption of digital transformation in the healthcare industry has grown over

time (Benis, Tamburis, Chronaki, and Moen, 2021). Trust has been established by how some of

the already implemented innovations work. It is challenging to convince patients that acquiring

medical attention through online means is safe. To resolve such fears and doubts, qualified health

workers must create awareness to make the patients feel comfortable trusting such options.

The adoption process has been gradual but sure (Benis, Tamburis, Chronaki, and Moen,

2021). Despite the challenges encountered on the way, it has been effective regardless.

Individual differences are still being experienced, and talks are ongoing to help come to a

common ground regarding the seamless adoption of digital health.

Implementation of Digital Transformation in the Healthcare Industry

The implementation of digital health is the final step that needs to be achieved to

ascertain its success (Alauddin, Baharuddin, and Mohd Ghazali, 2021). Digital health is

increasing, something that is slowing down its implementation. The need for digitized health

care is high, making it difficult for the existing metrics and indicators to keep up. According to

the World Health Organization (WHO), the measurement of governance and reuse of health data

across healthcare systems are becoming challenging priorities (Alauddin, Baharuddin, and Mohd

Ghazali, 2021). Challenges such as the one mentioned above are the ones that are making

implementation difficult.

The majority of digital health innovations, however, have been successfully implemented

and working. Their outcomes have already been determined to be okay, giving hope for future
 8

and ongoing implementations. The effectiveness of implementing innovation is affected by

several factors. The availability of these factors determines whether the process runs smoothly.

In our contemporary society, there is evidence of successful and incomplete digital health

implementation (Alauddin, Baharuddin, and Mohd Ghazali, 2021). Some healthcare facilities,

for instance, can offer their services remotely, and some require patients to visit their facilities

for medical treatment. Some nurses and doctors are flexible regarding service delivery, and

others prefer one-on-one encounters to attend to the patient well. All these are signs of the extent

to which technology implementation is being utilized in the healthcare sector.

For a smooth implementation, there is a need for collaboration between healthcare

facilities and healthcare workers. The cohesion within these two groups will catapult the

performance of digital transformation in the healthcare industry. Otherwise, the process is going

to be slower.

Countries like the United States and European countries are ahead in implementing

digital transformation in the healthcare industry (Alauddin, Baharuddin, and Mohd Ghazali,

2021). They are ahead because of the strict policies that have been put in place to allow the

implementation of digital innovations to take place. Currently, citizens of these countries are

used to digitized health, thus making the changes versatile.

Globally, there is a need to create more awareness of the importance of digitalizing health

care so that it can make it easier for its adoption and implementation (Alauddin, Baharuddin, and

Mohd Ghazali, 2021). There is a need to have strict policies by different governments. Different

healthcare stakeholders need to come together to agree on the effective way through which there

can be smooth digital transformations in the healthcare industry.

 9

Various strategies can be used to ensure a systematic intervention process in adopting

technological-based healthcare practices into usual care (Alauddin, Baharuddin, and Mohd

Ghazali, 2021). One of these strategies is engaging the intended end users of digital innovation.

End users include healthcare personnel such as nurses, doctors, clinicians, psychologists,

psychiatrists, and society representatives.

More strategies that can be used to implement digital transformation in the healthcare

industry include changing infrastructure to suit the new methods brought about by digitization

(Meskó, Drobni, Bényei, Gergely, and Győrffy, 2017). Old infrastructure is not able to

accommodate recent changes. For instance, if telemedicine is implemented, there is a need to

have effective communication devices to ensure the effective delivery and receipt of messages.

Implementation can also be achieved by weighing its penetration and sustainability

(Meskó, Drobni, Bényei, Gergely, and Győrffy, 2017). Penetration means the extent to which the

adoption of digitization can go, and sustainability means its duration. Innovation has to be

sustainable enough to bring change and be used long-term. For this to happen, a lot of thought

has to be put behind it, and the innovation has to pass through health experts for it to be termed

effective.

Before the actual implementation, it is essential for the relevant personnel to first define

and understand the problem at hand (Alauddin, Baharuddin, and Mohd Ghazali, 2021). The pros

and cons of the issue have to be weighed to ascertain whether an innovation is necessary. Not all

healthcare aspects need to be digitalized; some require traditional working methods to function

effectively. Digitalizing such elements is going to bring more harm than good.
 10

There is a need to identify ways to bring change and how to deliver change mechanisms

(). This includes being aware of the change needed and what it entails to bring it to serve the

intended purpose. Before implementing an innovation to the entire system, it must undergo

testing on a small scale. A sample is chosen from which effectiveness and quality are established

before formal introduction.

Lastly, there has to be sufficient evidence drawn from the test sample to justify the

implementation of technological innovation. This will help build trust from other stakeholders

and end users. Most of the questionable digital transformation implementations result from

insufficient evidence (Long, Shen, Tan, Gerrard, Clarke, and Jiang, 2022). Innovations can be

done for various reasons. Some creations are geared towards improving the business side of

health care while ignoring the well-being of patients. In as much as healthcare is aimed at

delivering quality services, some healthcare centers have taken advantage of people’s

vulnerability to improve their business side of healthcare at the expense of patient’s well-being.

The implementation stage, therefore, is volatile and needs to be handled cautiously to

avoid deadly risks (Burton-Jones, Akhlaghpour, Ayre, Barde, Staib, and Sullivan, 2020). When

implementing innovation in the healthcare sector, there has to be a consideration of the business

side, patients’ side, and healthcare workers’ side (Alauddin, Baharuddin, and Mohd Ghazali,

2021). These are very important because they work hand in hand with delivering quality health

care. Before significant decisions such as implementing an innovation, for instance, it is right to

consult all the participating parties to get their view on what they think should be done and what

should not. The collective responsibility will help successfully implement digital transformation

in the healthcare industry.

Benefits of Digital Transformation in the Healthcare Industry

 11

When speaking or thinking of digital transformations, what comes into our minds is

things made more accessible and more straightforward. In short, only the benefits go into the

mind. Healthcare is a fast-growing industry, with health spending constantly increasing

(Schueller, Hunter, Figueroa, and Aguilera, 2019). Usually, there has to be a valuable thing

where much money is spent. Digital transformation in healthcare has brought about many

benefits that it was anticipated (Burton-Jones, Akhlaghpour, Ayre, Barde, Staib, and Sullivan,

2020). These benefits are experienced in business, patient outcomes, and health workers’ sectors.

As observed, health facilities and organizations that have adopted the digital way of

working have been ahead of the rest (Chen, Wu, Tomasino, Lattie, and Mohr, 2019). Such

organizations are competitive and are always preferred. In as much as the digital growth in

healthcare has not yet been streamlined, it is safe to say that things are not badly off compared to

previous years. As time passes, more positive changes are experienced in the healthcare industry.

A lot of benefits are being experienced in the healthcare industry due to digital

transformations (El Khatib, Hamidi, Al Ameeri, Al Zaabi, and Al Marqab, 2022). One of the

benefits is the creation of employment. One of the goals of digital transformation was to create

jobs. With the new additions due to digitization, the healthcare industry has added to its list of

new employment opportunities (Huckvale, Nicholas, Torous, and Larsen, 2020). The new roles

are technology-based, which means that even non-medical staff have been considered in the

employment sector.

Another benefit is the creation of new models of service delivery. New healthcare service

delivery models such as telemedicine have benefited the healthcare industry (Colombo,

Oderkirk, and Slawomirski, 2020). Telemedicine involves using electronic devices such as

mobile phones and computers to deliver and receive health services. In so doing, it has enhanced
 12

long-distance patient and clinician contact. Patients can now connect with their clinicians,

nurses, or doctors from wherever location they are worldwide.

Developing new service delivery models makes it easier to conduct health-related

education, intervention, and monitoring (Henson, Wisniewski, Hollis, Keshavan, and Torous,

2019). Telemedicine is a widely accepted form of digital transformation in the healthcare

industry. Even though it has its challenges, it has brought about a great deal of positive impact.

Improved efficiency in healthcare is another benefit of digital transformation in the

healthcare industry. Service delivery has been efficient with the aid of technological

advancement (Dionisio, Paula, and de Souza Junior, 2020). Communication has been made more

accessible, availability of resources has been made cheaper and easily accessible. Patients are

being provided with quality care, thus improving patient outcomes.

Digital transformation in healthcare has enhanced and improved collaboration between

healthcare practitioners (Fosso Wamba, and Queiroz, 2021). Healthcare practitioners can now

consult quickly and help create effective interventions for patients. Health care is enhanced when

healthcare professionals work together. In so doing, there is a realization of increased patient

outcomes.

Digitization of health care has improved collaboration by enabling departments to

collaborate efficiently (Klinker, Wiesche, and Krcmar, 2020). Initially, departments used to work

solely. Currently, departments in healthcare facilities, for instance, work hand in hand to ensure

that medical services are provided conclusively.

On the business side, digital transformation has benefited healthcare stakeholders by

making their businesses stand out in the market. A health facility that employs the new service
 13

delivery models is more likely to attract customers than one that still uses traditional methods

(Gopal, Suter-Crazzolara, Toldo, and Eberhardt, 2019). People have become aware that engaging

in digital health care results in higher patient outcomes.

Reduced costs are another benefit of digital transformation in health care. With the

development of eHealth, for instance, patients do not have to spend a lot of cash traveling to

meet their health practitioners. When it comes to minor illnesses, patients can receive treatment

or guidance on what to do remotely instead of visiting a health facility in person (Torous,

Andersson, Bertagnoli, Christensen, Cuijpers, Firth, Haim, Hsin, Hollis, Lewis, and Mohr,

2019). EHealth is also an advantage to health practitioners because they do not have to move

from one place to another to offer their services. As long as they are licensed, they can offer their

services from the comfort of their home offices.

Through the digitization of healthcare, it is easy to monitor and communicate with

patients through wearable devices or mobile apps (Torous, Stern, and Bourgeois, 2022).

Technology has made it easier to create applications that help offer basic medical help. These

apps contain vital information that patients can use to improve their general health. Healthcare

practitioners can conduct their monitoring of patients through such applications. With the

advancement of technology in healthcare, health-related information is now easily accessible,

thus, preventing and managing most illnesses.

Digital transformation has also helped personalize patients’ data making it simpler to

create interventions for patients. A patient’s health history is stored electronically and retrieved

whenever to help a clinician better understand the patient’s condition (Kraus, Schiavone,

Pluzhnikova, and Invernizzi, 2021). This improves treatment and also helps generate predictions.
 14

Challenges Faced in Digital Transformation in Healthcare

There are a lot of challenges faced in the digital transformation in healthcare. These

challenges are why the transformation has been slow in healthcare compared to other industries.

Mitigating these challenges has not been worthwhile since they keep reoccurring. Strategies are,

however, being put in place to help eradicate such challenges.

One of the challenges faced is a data breach. With the advancement of technology, data is

collected and stored for future reference (Rieke, Hancox, Li, Milletari, Roth, Albarqouni, Bakas,

Galtier, Landman, Maier-Hein, and Ourselin, 2020). While this makes work more manageable,

this data is prone to breach. Due to the collaborative nature brought about by digital

transformation, patients’ private information is likely to be exposed without their consent. This is

a complex case because, on the one hand, medical professionals must access patients’ data to

help make better medical decisions (Shaw, Agarwal, Desveaux, Palma, Stamenova,

Jamieson,Yang, Bhatia, and Bhattacharyya, 2018). On the other hand, patients’ data has to be

protected and secured to prevent breaching. With these two scenarios in between, data can be

leaked either intentionally or unintentionally.

To prevent data breaches, there must be proper data privacy control to ensure that

patient’s data is secure to avoid compromised patient care (Brewer, Fortuna, Jones, Walker,

Hayes, Patten, and Cooper, 2020). Some institutions have already set regulations on how data

can be collected and transferred without the possibilities of getting leaked or compromised.

Cybersecurity is another challenge faced by digital transformation in healthcare.

Cyberattacks are rampant in the healthcare industry (Kadakia, Patel, and Shah, 2020). For

obvious reasons, this is the most targeted industry by cybercriminals. Due to the growing use of
 15

digital devices to share and store data, it has become easier for cybercriminals to access private

data. In response, if medical data is stolen, patients will have to sue the health facility, and they

will no longer have trust in it moving forward.

Challenges are also experienced due to poor data management. In some cases, it is

impossible to manage the large amount of data collected in various health facilities. It is,

therefore, difficult for healthcare professionals to provide personalized care. Collecting and

synchronizing data is a very challenging aspect.

Conclusion

In conclusion, Digital transformation in the healthcare industry has been one of the

innovations that have resulted in a positive shift in healthcare. A lot of improvements have been

experienced over time because of the transformation. The trajectory of the continued use of

technology in the healthcare sector is promising as time goes by. Digital transformation in

healthcare has got both its benefits and challenges. This, however, does not mean that it should

be done with. As the world keeps evolving, more technological enhancements are needed.

Digitalization in all fields has made human life more bearable compared to when only traditional

methods used to be employed.

 16

Reference List

Alauddin, M.S., Baharuddin, A.S. and Mohd Ghazali, M.I., 2021, January. The modern and

digital transformation of oral health care: A mini review. In Healthcare (Vol. 9, No. 2, p.

118). MDPI.

Alwashmi, M.F., 2020. The use of digital health in the detection and management of COVID-19.

International Journal of Environmental Research and Public Health, 17(8), p.2906.

Benis, A., Tamburis, O., Chronaki, C. and Moen, A., 2021. One digital health: a unified

framework for future health ecosystems. Journal of Medical Internet Research, 23(2),

p.e22189.

Brewer, L.C., Fortuna, K.L., Jones, C., Walker, R., Hayes, S.N., Patten, C.A. and Cooper, L.A.,

2020. Back to the future: achieving health equity through health informatics and digital

health. JMIR mHealth and uHealth, 8(1), p.e14512.

Burton-Jones, A., Akhlaghpour, S., Ayre, S., Barde, P., Staib, A. and Sullivan, C., 2020.

Changing the conversation on evaluating digital transformation in healthcare: Insights

from an institutional analysis. Information and Organization, 30(1), p.100255.

Chen, A.T., Wu, S., Tomasino, K.N., Lattie, E.G. and Mohr, D.C., 2019. A multi-faceted

approach to characterizing user behavior and experience in a digital mental health

intervention. Journal of biomedical informatics, 94, p.103187.

Colombo, F., Oderkirk, J. and Slawomirski, L., 2020. Health information systems, electronic

medical records, and big data in global healthcare: Progress and challenges in OECD

countries. Handbook of Global Health, pp.1-31.

 17

Dionisio, M., Paula, F. and de Souza Junior, S.J., (2020). Innovation and digital transformation

in Healthcare: A systematic review.

El Khatib, M., Hamidi, S., Al Ameeri, I., Al Zaabi, H. and Al Marqab, R., 2022. Digital

Disruption and Big Data in Healthcare-Opportunities and Challenges. ClinicoEconomics

and Outcomes Research, pp.563-574.

Fagherazzi, G., Goetzinger, C., Rashid, M.A., Aguayo, G.A. and Huiart, L., 2020. Digital health

strategies to fight COVID-19 worldwide: challenges, recommendations, and a call for

papers. Journal of Medical Internet Research, 22(6), p. e19284.

Fosso Wamba, S. and Queiroz, M.M., 2021. Responsible artificial intelligence as a secret

ingredient for digital health: Bibliometric analysis, insights, and research directions.

Information Systems Frontiers, pp.1-16.

Gopal, G., Suter-Crazzolara, C., Toldo, L. and Eberhardt, W., 2019. Digital transformation in

healthcare–architectures of present and future information technologies. Clinical

Chemistry and Laboratory Medicine (CCLM), 57(3), pp.328-335.

Henson, P., Wisniewski, H., Hollis, C., Keshavan, M. and Torous, J., 2019. Digital mental health

apps and the therapeutic alliance: initial review. Psych open, 5(1).

Huckvale, K., Nicholas, J., Torous, J. and Larsen, M.E., 2020. Smartphone apps for the treatment

of mental health conditions: status and considerations. Current opinion in psychology, 36,

pp.65-70.

Jandoo, T., 2020. WHO guidance for digital health: what it means for researchers. Digital health,

6, p.2055207619898984.
 18

Jayaraman, P.P., Forkan, A.R.M., Morshed, A., Haghighi, P.D. and Kang, Y.B., 2020.

Healthcare 4.0: A review of frontiers in digital health. Wiley Interdisciplinary Reviews:

Data Mining and Knowledge Discovery, 10(2), p. e1350.

Kadakia, K., Patel, B. and Shah, A., 2020. Advancing digital health: FDA innovation during

COVID-19. Npj Digital Medicine, 3(1), pp.1-3.

Klinker, K., Wiesche, M. and Krcmar, H., 2020. Digital transformation in health care:

Augmented reality for hands-free service innovation. Information Systems Frontiers,

22(6), pp.1419-1431.

Kraus, S., Schiavone, F., Pluzhnikova, A. and Invernizzi, A.C., 2021. Digital transformation in

healthcare: Analyzing the current state-of-research. Journal of Business Research, 123,

pp.557-567.

Long, G., Shen, T., Tan, Y., Gerrard, L., Clarke, A. and Jiang, J., 2022. Federated learning for

privacy-preserving open innovation future on digital health. In Humanity Driven AI (pp.

113-133). Springer, Cham.

Lyles, C.R., Wachter, R.M. and Sarkar, U., 2021. Focusing on digital health equity. JAMA,

326(18), pp.1795-1796.

Meskó, B., Drobni, Z., Bényei, É., Gergely, B. and Győrffy, Z., 2017. Digital health is a cultural

transformation of traditional healthcare. Mhealth, 3.

Murray, E., Hekler, E.B., Andersson, G., Collins, L.M., Doherty, A., Hollis, C., Rivera, D.E.,

West, R. and Wyatt, J.C., 2016. Evaluating digital health interventions: key questions and

approaches. American journal of preventive medicine, 51(5), pp.843-851.

 19

Palfreyman, J. and Morton, J., 2022. The benefits of agile digital transformation to innovation

processes. Journal of Strategic Contracting and Negotiation, 6(1), pp.26-36.

Rieke, N., Hancox, J., Li, W., Milletari, F., Roth, H.R., Albarqouni, S., Bakas, S., Galtier, M.N.,

Landman, B.A., Maier-Hein, K. and Ourselin, S., 2020. The future of digital health with

federated learning. NPJ digital medicine, 3(1), pp.1-7.

Schueller, S.M., Hunter, J.F., Figueroa, C. and Aguilera, A., 2019. Use of digital mental health

for marginalized and underserved populations. Current Treatment Options in Psychiatry,

6(3), pp.243-255.

Shaw, J., Agarwal, P., Desveaux, L., Palma, D.C., Stamenova, V., Jamieson, T., Yang, R.,

Bhatia, R.S. and Bhattacharyya, O., 2018. Beyond “implementation”: digital health

innovation and service design. NPJ digital medicine, 1(1), pp.1-5.

Smith, B. and Magnani, J.W., 2019. New technologies, new disparities: the intersection of

electronic health and digital health literacy. International journal of cardiology, 292,

pp.280-282.

Torous, J., Andersson, G., Bertagnoli, A., Christensen, H., Cuijpers, P., Firth, J., Haim, A., Hsin,

H., Hollis, C., Lewis, S. and Mohr, D.C., 2019. Towards a consensus around standards

for smartphone apps and digital mental health. World Psychiatry, 18(1), p.97.

Torous, J., Stern, A.D. and Bourgeois, F.T., 2022. Regulatory considerations to keep pace with

innovation in digital health products. npj Digital Medicine, 5(1), pp.1-4.