title: A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review.
abstract: BACKGROUND
  Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways.
  
  
  OBJECTIVE
  The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways.
  
  
  METHODS
  We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework.
  
  
  RESULTS
  We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway.
  
  
  CONCLUSIONS
  The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system.
  
  
  BACKGROUND
  N/A.
authors.affiliation: Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom. k.flott14@imperial.ac.uk.
authors.forename: Kelsey
authors.identifier: http://orcid.org/0000-0002-7835-4322
authors.initials: K
authors.lastname: Flott
authors.forename: Ryan
authors.identifier: http://orcid.org/0000-0002-0710-6436
authors.initials: R
authors.lastname: Callahan
authors.forename: Ara
authors.identifier: http://orcid.org/0000-0001-7815-7989
authors.initials: A
authors.lastname: Darzi
authors.forename: Erik
authors.identifier: http://orcid.org/0000-0002-5509-4580
authors.initials: E
authors.lastname: Mayer
mesh_terms: D006296:Health Services; D006801:Humans; D007256:Information Systems / Q000458:organization & administration / Q000706:statistics & numerical data*; D018511:Systems Integration
keywords: digital maturity; evaluation; health information exchange; patient-centered care