Digitalization of Hospitals — What Level of Maturity Is Required?

Why always digitalization?

Before anything else, the most important question should be clarified: Are digitalization measures even necessary for a hospital, and, if so, which ones?

We cannot give a general answer at this point that would apply to a specific hospital. But a look at the comparisons with other sectors shows that hospitals in particular still have a lot of catching up to do. Moreover, the implementation of these measures can save a lot of money. Estimates range from 6.5 percent to 10 percent of total expenditures.

On first reading, this sounds highly promising. There is a catch, however. After all, the arguments above are far from demonstrating what digital projects are expedient for any given hospital. Digitalizing certain areas of a hospital’s operations may result in tremendous benefits for one while having little or no impact on another. The many different methods and services for determining the level of digital maturity are an indication of this issue.

Methods for determining digital maturity in hospitals

One of the best-known methods for measuring digital maturity is rarely found in the GAS region: the determination of the level of digitalization using the American EMRAM (Electronic Medical Records Adoption Model from HIMSS Analytics). This rating scale has been applied in several thousand hospitals worldwide. The model rates hospitals on a scale from 0 to 7. Level Zero (no online output of lab, radiology, pharmacy data by external service providers) is the lowest score and Level Seven (completely paperless EMR environment) is the highest.

For example, there is currently only one hospital in Germany with the second-highest rating of 6 (Medius Klinik Nürtingen; HIMSS). We must bear in mind, however, that very few hospitals have been assessed and ranked on the basis of the EMRAM model. The assessment based on the EMRAM logic is controversial, in part because of the structure of the score; there are fixed criteria that must be fulfilled for each level and an EMRAM score is assigned at each step. Hospital operations may be highly digitalized in general, but if they fail to satisfy only one of the requirements of Level Four, the institution will not be assessed any higher than Level Three on the rating scale. This feature severely limits the validity of the EMRAM assessment.

Typical weak points in digitalization

Certain areas in hospitals are typically inadequately digitalized, and digitalization here leads to a significant increase in efficiency. Some examples from our experience:

Patient admissions:

• Online or mobile appointment bookings and the timely cancellation of appointments or rescheduling of appointments and
• Digitalization of referrals and waiting times create a completely different patient journey, which has a positive impact on the hospital. Simultaneously, efficiency increases and resources can be used more effectively.

Paper-based documentation:

There are times when paper-based documentation offers advantages, but a digital version can often optimize processes and reduce costs.

Administration:

Inefficient processes and interfaces that fail to function properly for internal referrals cause the time and effort required for administrative duties to rise enormously.

Culture:

The health care system is often characterized by strict hierarchies while at the same time there is a lack of feedback opportunities and of a shared vision, giving rise to discontent among the staff. Yet a hospital’s culture is a decisive factor for its performance when there is a shortage of skilled personnel and may even pose a risk when implementing digitalization projects.

Interoperability:

The interconnection of separate systems, especially to the hospital information system (HIS), is often inadequate. There are multiple media breaks and parallel processes.

Networks:

New generations of networks such as 5G as well as even current technologies such as Bluetooth and Wi-Fi are not used efficiently for the most part and would simplify processes (e.g., tracking of equipment or beds).

Data security:

Various data breaches have proved that hospital data are not adequately protected. Communication via media such as fax presents critical vulnerabilities and can be disastrous in the event of a cyberattack.

What method for the measurement of the level of digital maturity will help me?

A recommendation for any particular digital maturity measurement would be inappropriate at this point. There is a long list of providers, and every measurement method has its advantages and disadvantages. Nevertheless, our experience with our own “Maturity Check” for hospitals allows us to make some basic recommendations.

• Every hospital is unique in its requirements, so a measurement of maturity must not be too restricted if it is to be truly meaningful. It must be possible to adjust to specific situations and focus on the key points of the locality.
• Strictly technical measurements of the level of maturity forget an important factor — people, the hospital’s own employees — its most important capital. A good measurement process should also include the opinions and needs of staff, patients, and perhaps even affiliated community health centers or physicians in private practice. These people are ultimately affected by all digital projects, changes, and innovations. The perspective of the management and/or the IT department alone is not adequate for an honest representation.
• A good measurement of digital maturity does not end with a figure stating how well the hospital is digitalized; it uses the results to determine concrete areas of action and weaknesses that can be used for better planning and the sustainable realization of projects. Our experience has demonstrated that the acceptance of projects among the staff is far better if the project objectives have been sufficiently communicated and, above all, if opinions have been sought beforehand. A measurement of digital maturity is the first, important communication for successful projects.

Have you had any experience with measurements of maturity levels in hospitals? Click here to read our follow-up article in which we discuss the “Digital Patient Journey.”