Managing Demand for Digital Health Investments in a Multi-Hospital System: A Mixed-Methods Multiple-Case Series

OBJECTIVES: Hospitals face increasing demand from internal stakeholders to develop or procure new digital solutions intended to improve patient outcomes and system efficiency. This trend is unlikely to diminish with ongoing proliferation of artificial-intelligence-based solutions. The objective of this investigation was to illustrate and explore practical consideration when applying a recently developed novel multi-criteria decision analysis (MCDA) approach for managing digital investment requests.

METHODS: A MCDA approach was recently developed using experience-based co-design to aide in management of hospital stakeholder requests for investment in new digital health initiatives. This mixed-methods case series applying the MCDA was nested in a large multi-hospital healthcare system (high level of digital maturity) serving a population of ~1.2 million. Contributing stakeholders included hospital administrators, policy decision makers, digital system administrators, clinicians, information technologists, and other digital health and informatics content experts. Mixed-methods analyses (concurrent triangulation) of qualitative (conventional content analysis from observation of stakeholder team meetings, individual and group interviews, document reviews) and quantitative data (costing estimates, MCDA ratings) derived from a series of potential investment case analyses were used to summarise practical considerations.

RESULTS: Stakeholder perspectives of value, likely procurement or implementation risks and expected benefits varied greatly depending on professional background, prior experience and organisational role. Stakeholders reported the MCDA approach provided a pragmatic platform to integrate and harmonise different perspectives, clarify points of agreement or disagreement, and enhance collective understanding of key considerations. This included general (healthcare provider costs, anticipated clinical effects) and digital-specific considerations (lifecycle costs; technology dependencies; cybersecurity; clinical and non-clinical workforce impacts; external regulation and legislation).

CONCLUSIONS: Conventional health economic perspectives alone (society, healthcare provider) may not be well suited for local digital health investment decisions where success is dependent on local multi-stakeholder cooperation. MCDA incorporating multi-stakeholder perspectives can facilitate cooperation in real-world hospital system digital investment decisions.