Impediments to transforming the healthcare delivery system: shifting the paradigm from provider centric to patient centric.

Introduction: Stated aims for digital healthcare transformation frequently cite goals for better coordinated patient-centric systems. However, despite advances in medical science, digital technologies, health policies, and billions of dollars invested over the past 25 years, most healthcare providers are far from fully realizing the demonstrated benefits of today's digital technologies for improving patient care. Sharing information across healthcare systems remains challenging. Problems with fragmentation, quality, inequities, and rising costs of care delivery persist. A recent study of 1,026 U.S. hospital systems found that only 15.8 percent achieved a digital maturity level needed to provide digitally enabled healthcare services to better coordinate patient care. More importantly, hospital systems that were most successful in digitally transforming demonstrated significantly superior patient outcomes. From a system engineering framework, we pose the problem as: How do we transform a system as complex as U.S. healthcare delivery from today's costly, fragmented provider-centric system to a better coordinated patient-centric system with improved quality, access, affordability, and patient and provider experience. Methods: This mixed methods, cross disciplinary research employs an integrative approach, synthesizing diverse sources of evidence to explore challenges and issues associated with healthcare digital transformation. Data extraction was performed by studying the full text of over 100 articles, case studies, and other sources, which were then analyzed thematically employing a "framework synthesis" methodology, which uses a deductive approach rather than the more common inductive synthesis approaches. Results: Research points to multiple factors impeding progress, not the least of which is the sheer complexity of the problem. Healthcare systems that achieved significantly superior results reported different approaches to digital transformation in ways that may not necessarily be apparent on the surface, primarily because it is not just about what they did but, more importantly, about how they did it. A growing body of knowledge indicates that achieving digital transformation requires substantially different systemic approaches to the problem that intersect across clinical, technical, behavioral, and organizational domains. In other words, systemic problems cannot be solved with siloed solutions. Discussion: This research explores these differences with the aim of determining how approaches differ, why the differences matter, and implications for achieving better results. Conceptualizing the healthcare delivery system as distinct from the practice of healthcare (medical practice) makes an important contribution to the evolving science of healthcare delivery - working