Leadership Strategies in Improving Service Quality and Employees

Motivation in Hospitals: Review and Challenges

Divo Septian Zarwin1, Purwadhi Purwadhi2, Rian Andriani3

1,2,3
Master of Management, ARS University, Indonesia

*[email protected], [email protected], [email protected]

Abstract

Intorduction : Effective leadership in hospital organizations is critical to achieving optimal health

care goals. This abstract discusses the implementation of various leadership theories, such as
Transformational Leadership Theory, Situational Leadership Theory, and Servant Leadership
Theory, in the hospital context. Method : This research shows that the application of
transformational leadership can increase the motivation and performance of medical and non-
medical staff, through developing a shared vision and empowering employees. Meanwhile,
situational leadership theory emphasizes the importance of leader flexibility in adapting
leadership style according to the needs of the team and the situati on at hand. On the other
hand, servant leadership focuses on service to the team and patients, which contributes to
increased patient satisfaction and employee loyalty. Result : The results of this study indicate
that the combination of various leadership approaches can create a collaborative work
environment, improve the quality of care, and support innovation in medical practice. Thus,
hospital organizations are advised to adopt a holistic and adaptive leadership approach to
achieve long-term success in healthcare.

Keywords: Leadership, Hospital Organization, Service Quality, Employee Motivation.

1
International Conference on Economic Issues (ICONES)

INTRODUCTION
The COVID-19 pandemic has catalyzed a profound transformation in global healthcare
systems, emphasizing the urgent need for innovative solutions to enhance service delivery and
patient care. As traditional healthcare models faced unprecedented challenges, the adoption of
digital health technologies became not only a necessity but also a strategic imperative for
sustainable development. This literature review aims to explore the intersection of digital
health transformation and sustainable management practices in the context of post-pandemic
recovery. Digital health encompasses a broad spectrum of technologies, including telemedicine,
mobile health applications, artificial intelligence, and big da ta analytics. These innovations have
revolutionized the way healthcare services are delivered, facilitating remote consultations,
improving patient engagement, and enabling real-time data management (Yeung et al., 2023).
The World Health Organization (WHO) defines digital health as the integration of digital
technology into health systems to enhance health outcomes, thereby broadening the scope of
traditional eHealth initiatives to include advanced computing and connectivity solutions
(Abdolkhani et al., 2022).
In light of the Sustainable Development Goals (SDGs), particularly Goal 3 which aims to
ensure healthy lives and promote well-being for all at all ages, the role of digital health
technologies is increasingly recognized as pivotal. The pandemic has highlighted significant
disparities in healthcare access and delivery, particularly in low-resource settings. Therefore,
leveraging digital health can address these inequities by providing innovative solutions that
enhance accessibility and efficiency in healthcare delivery (Novillo-Ortiz et al., 2018).
Moreover, this review will discuss the implications of digital health transformation for
management strategies within healthcare organizations. Effective management practices are
essential for integrating these technologies into existing systems while ensuring that they align
with broader sustainability goals. The need for robust policy frameworks, regulatory
compliance, and workforce training emerges as critical components for successful
implementation.

LITERATURE REVIEW
Digital Health Transformation
When the COVID-19 pandemic was announced globally in 2019, the delivery and
organization of health care were thrown into a state of fast disruption. The adjustment was
related with staff deployment, patient isolation, staff well-being protection, and public health
education and attempts to minimize or delay the propagation of the virus. The epidemic most
certainly has expedited the acceptance of digital health implementation. Due to the availability
of many innovations and the urgent need for treatment and prevention, digital health is likely
to play an increasingly important role in the future and even the post pandemic age. The
epidemic caused extensive and quick adaptation to previously limited or underutilized kinds of

2
International Conference on Economic Issues (ICONES)

technology, which has transformed the ways clinicians and patients communicate (Abdolkhani
et al., 2022).
The understanding of health, treatment, diagnosis, and communication has evolved to
new levels. The Fourth Industrial Revolution has impacted research, policymaking, and business
activities among healthcare and management researchers and practitioners. These events have
significantly altered the administration and organization of health systems (Drago et al., 2023).
Telemedicine, AI, big data analytics, and mobile surveillance apps have been widely used to
diagnose, prevent, monitor, and treat patients globally (Omboni et al., 2022).
The World Health Organization (WHO) defines digital health technologies as the
knowledge and practice of using digital technology to improve health outcomes. Digital health
broadens the scope of eHealth to encompass digital users and a wider range of smart and
connected devices. It also includes additional uses of digital technology for health, such as the
Internet of Things (IoT), advanced computing, big data analytics, artificial intelligence (including
machine learning), and robotics. Importantly, in the context of digital health technologies,
several terms such as eHealth (electronic health), telemedicine, and mHealth (mobile health)
have been widely used, unfortunately, on some occasions with overlapping meaning,
underlining the necessity of using more precise scientific language reflecting the subtle
differences between such relevant terms. In keeping with this, the term "digital health" was
created to refer to the widest range of applications of digital technologies in the context of
health. Although it has its roots in electronic health, it also includes related fields like artificial
intelligence, genomics, and "big data" applications. Furthermore, mHealth is seen as a subset of
eHealth that refers to the use of wireless mobile technologies for public health (gaining
particular momentum with the widespread adoption of smartphones and corresponding apps),
and telemedicine is a term reflecting the use of electronic communications and information
technologies for the remote provision of health care services. eHealth is frequently defined as
the use of information and communications technology in support of health. For instance,
telemedicine has become a popular topic of conversation in the scientific, political, and medical
communities lately. This is because during the COVID-19 global pandemic, most of the world's
population was subjected to varying degrees of home quarantines, community lockdowns, and
reduced access to medical care (Yeung et al., 2023).
Telemedicine refers to the use of technology to provide medical treatment and
healthcare services remotely. The prolonged crisis has led to increased use of telemedicine
technologies. The consumer's perspective and necessary investments have been key factors
pushing the sector. Telemedicine has been utilized for many years. Data shows that it can
improve medical performance and health outcomes for patients. Telemedicine can minimize
hospitalizations and expenditures for healthcare players, including individuals and
organizations. Telemedicine is becoming more popular as physicians recognize its benefits,
patients have greater access to therapy, and payers perceive a decrease in the cost of care
(Drago et al., 2023).
According to Smith et al. (2020), implementing telehealth requires a considerable shift
in management and reconsidering current medical care models. The reliance on individual
practitioners to lead telehealth is not a sustainable method to its expansion. Telehealth

3
International Conference on Economic Issues (ICONES)

adoption necessitates a multi-system approach. The most effective strategy to ensure that
telehealth can be used during an emergency is for all healthcare practitioners to incorporate it
into their usual service delivery. This necessitates operating telehealth networks, telehealth
policies and procedures, and scalable technology infrastructure in the event of a disaster. One
advantage of these technologies is their ability to facilitate communication, which is particularly
useful in specialized medical services.
Additionally, adopting practices that reduce COVID-19 preventive expenses while
avoiding patient interaction may increase uptake. Telehealth is a disruptive procedure, thus
physicians with limited telehealth expertise require strong change-management tactics (Smith
et al., 2020).

Health Data Management and Interoperability

Over the last century, disruptive episodes in clinical and biomedical research have
resulted in significant changes to health data management systems. This is owing to a number
of medical advancements, as well as the necessity to incorporate big data analytics and the
Internet of Things (IoT) into a real-time smart health information management system.
Furthermore, the needs of patient care have developed over time, allowing for more precise
prognoses and diagnoses. The concept of health data management systems has evolved
throughout the past century. With the transfer of medical records from paper charts to
electronic health records (EHRs), health data management has experienced disruptive changes
in order to deliver more accurate and better patient care while also making meaningful use of
these resources. This change is supported by advancements in information technology, which
led to the creation of numerous concepts for health data management systems. The
introduction of EHRs altered the health care business by expanding services, improving patient
care quality, and boosting real-time data access, resulting in a diverse range of health data
management systems (Ismail et al., 2020).
The concept of EHRs is that they provide a longitudinal perspective of a patient's
medical history over the course of his or her life, as generated by one or more health care
providers or medical organizations providing treatments to that patient. These comprehensive
and summary records include the patient's demographic and biographical information, prior
and current diagnoses and treatments, progress notes, laboratory and radiological results,
allergies, and immunizations. With improvements in technology and the need to provide better
and more efficient health care, health data management systems have moved from a
computer-based approach to client-server-based, cloud-based, Internet of Things (IoT), and
finally blockchain-based alternatives. With the rise of big health care data and the recognition
that medical data may be used for governance and research, it is becoming increasingly vital to
integrate big data analytics into health data management systems (Ismail et al., 2020).
However, this introduces new issues of data gathering and pre-processing from
numerous sources to produce insights, data security, and privacy to deal with an increasing
number of data breaches and hacker incidents. A client-server-based health data management
system was established to meet the need for real-time data access as well as medical record

4
International Conference on Economic Issues (ICONES)

data and exchange. This method enables patients and healthcare practitioners to access
medical data via the internet using a mobile device or a desktop computer. However, it suffers
from single point of failure, data fragmentation, system vulnerability, insufficient scalability,
and significant data security and patient privacy problems. To reduce infrastructure costs and
manage data fragmentation, medical organizations and health care providers migrated to a
cloud-based system (Ismail et al., 2020).

Integration of Digital Tools into Health Systems

Doctors and patients have shown support for an integrated model of care, which
consists of holistic, patient-centered systems that allow for clear, effective communication
between clinicians and patients at all levels of care. Integrated care provides for the
simultaneous treatment of both physical and mental health issues, facilitating the transition of
healthcare from reactive to preventative. Digital Health is critical to the transformation of the
current system to a more integrated one since it enables interoperability, data visualization,
and sharing where appropriate. While the desire for integrated care and the use of digital
health is not new, the COVID-19 epidemic has hastened the discovery of new options for
effective implementation (Shah et al., 2022).
A major impediment to the successful application of digital health technology is the
continued emphasis on technology in isolation, which is at odds with the realities of
complicated health and care systems. Digital health technology must be designed from a
systems approach. A systems view looks at how technology fits into the larger healthcare
system, where success is determined by interactions with people, other IT systems, the physical
environment, and the organization of clinical and administrative operations. Successful
integration of digital health technologies into complex clinical systems necessitates a shift away
from a limited and limiting technological focus and toward a systems viewpoint, which must be
reflected in the technology's design, implementation, and evaluation. Practitioners must be
given significant tools and guidance in order to manage and monitor the operation of digital
health technologies, as well as ask the proper questions of developers. Another example is the
recently released British Standard BS 30440, which describes an auditable validation framework
for healthcare AI (Sujan, 2023).
Technology, like the digitization of other human capital-intensive industries, can allow
trained personnel to focus on more technically sophisticated tasks while increasing access and
operating efficiency. However, in order to reach this goal, the current and growing workforces
in health and social care must be comfortable with data and technology (Integrating Social Care
into the Delivery of Health Care, 2019). AI and machine learning have the potential to enhance
healthcare by enhancing community health, remote care, early detection, and resource
utilization. AI systems may use vast datasets to discover trends and forecast patient outcomes,
enabling healthcare providers to give more accurate diagnoses and individualized treatments.
AI in healthcare includes computer-aided diagnosis (CAD) systems that utilize machine learning
algorithms to analyze medical pictures and help radiologists discover problems. AI can examine
EHRs to predict patient outcomes and identify those at risk for specific illnesses. However, the
application of artificial intelligence in healthcare creates ethical and privacy concerns. Concerns

5
International Conference on Economic Issues (ICONES)

have been raised concerning how AI algorithms may reinforce biases and discriminate against
specific patient groups. Concerns have been raised regarding patient data security and the risk
of unauthorized access or misuse (Shipu Debnath, 2023).
Mobile health apps are one example of digital tools that health providers use. Mobile
health apps offer patients easy access to health information, self-management tools, and
communication channels with physicians, transforming their healthcare experience. Patient
engagement, which involves people in healthcare decisions and treatment plans, is vital for
improving health outcomes and quality. Patient engagement encompasses patients' active
involvement in their healthcare experience. It includes activities such as obtaining health
information, making treatment decisions, following treatment programs, and managing chronic
illnesses. Engaged patients receive better health outcomes, more satisfaction with care, and
lower healthcare expenditures. Mobile health apps encourage patient engagement by
providing tools and resources to manage their health. These apps allow patients to track health
parameters, monitor progress, and communicate with healthcare providers. Mobile health
applications provide tailored health information and services, allowing patients to make
informed decisions about their health and treatment alternatives. Mobile health apps have
been shown in numerous studies to improve health outcomes across groups and situations.
Apps can help improve medication adherence, manage chronic illnesses, promote healthy
behaviors, and increase communication between patients and providers. Several researches
have demonstrated that mobile health apps improve health outcomes.
A study published in Diabetes Care found that individuals with type 2 diabetes who used
a smartphone app to track their diet and exercise habits lost more weight and improved their
glycemic control than those who did not. A study published in the American Journal of
Preventive Medicine found that patients who used a smartphone app to track their physical
activity had higher daily step counts and better cardiovascular fitness than those who did not
use the app. Mobile health apps can improve healthcare delivery by offering easy access to
health information, monitoring tools, and behavior modification support. However, there are
obstacles and constraints that must be addressed for these apps to be as effective as possible
(Chioma Anthonia Okolo et al., 2024).

The role of digital health in Sustainable Development Goals

The United Nations (UN) has twice agreed to a precise agenda that must be followed by
all 189 member states in order to advance global development targets. The Sustainable
Development Goals (SDGs), the current framework for 2015–2030, replaced the Millennium
Development Goals (MDGs), which were set for 2000–2015, as the initial accord. The 17 SDGs
were enacted to build on the MDGs' achievements. SDG 3 intends to "ensure healthy lives and
promote well-being for all at all ages" and includes numerous specific targets to achieve this
goal. However, war and political instability have a negative impact on the healthcare system,
and the casualties of war go well beyond the battlefield. Conflict, a social determinant of health,
greatly contributes to health disparity by reducing the quality and delivery of care throughout
the entire system. The SDGs push the global community to reassess established health-care
delivery practices. Traditional on-the-ground health facilities, with access to resources and an

6
International Conference on Economic Issues (ICONES)

adequate workforce, are uncommon in conflict-affected areas, particularly those with current
violence and severe political instability. According to projections, nearly half of the world's
poorest population would live in conflict-affected areas by 2030. It is clear that in order to meet
the goals of SDG 3, governments and practitioners must be willing to reconsider healthcare
delivery. The convergence of medicine and technology has the opportunity to use innovative
and low-cost platforms in vulnerable places to increase global and local capacity. To "ensure
healthy lives and promote well-being for all at all ages," low-income countries must acquire
some level of independent capability. In order to achieve global health goals, digital health
technology can facilitate access to the internet, personal health and non-health data, and
environmental data. Fragile states stand to benefit greatly from the deployment of digital
health technologies such as telemedicine, electronic medical records (EMRs), wearables, mobile
health (mHealth), and creative software (Asi & Williams, 2018).
While acknowledging that there are disparities in this area between nations, it is also
true that the telecommunications industry advanced significantly between 2000 and 2015. In
particular, the number of mobile phone subscriptions worldwide increased from 738 million to
7 billion, the percentage of people using the Internet globally increased sevenfold from 6.5% to
43%, and the percentage of people living in areas serviced by 2G mobile cellular networks
increased from 58% in 2001 to 95% in 2015. All of these changes have allowed us to go about
our daily lives in a new way, which has had a direct impact on the health sector, influencing
how we approach our health throughout our lives, how we communicate with health
professionals, and how we access and receive health services at various levels of care. New
wireless technology advancements are offering chances to change the healthcare industry.
As the healthcare system transitions from treating individual patients' acute health
problems to managing population-based diseases and prevention, these new technologies help
address issues related to geographic accessibility, make it easier to provide appropriate
interventions, lower the cost of those interventions, and even help increase public knowledge
of how to treat illnesses and encourage healthy lifestyles, all of which support patient
empowerment. These and other digital healthcare initiatives to meet the SDGs have problems
that extend beyond the adoption of technology to include social, cultural, and organizational
aspects, as outlined by the WHO and its regional office in the Americas, the Pan American
Health Organization. These include the necessity for a qualified workforce capable of
implementing digital health solutions, as well as effective governance and finance. To overcome
these barriers, work must take an interdisciplinary and cross-sectoral approach, bringing
together all of the major actors in the digital health ecosystem: governments, international
organizations, health service institutions, academia, research centers, and public and private
industry. First and foremost, nations must establish and put into place public-facing governance
mechanisms for digital health. The development of national strategies and policies that
demonstrate potential forms of inter-sectoral cooperation and a "vision of state" is required in
order to achieve this. These strategies should involve healthcare professionals from the outset,
look for sources of funding, and modify academic curricula to reflect the changes brought about
by the introduction of ICTs. In addition, they ought to address the necessary legal changes
pertaining to the regulatory elements of digital health (data protection, privacy, and
confidentiality, individual patient rights, and data responsibility) (Novillo-Ortiz et al., 2018).

7
International Conference on Economic Issues (ICONES)

Environmental and Equity Considerations

Digital health can also help to improve environmental sustainability by eliminating the
need for physical travel and the infrastructural strain on healthcare systems. This supports
climate action goals by lowering the carbon footprint of healthcare services. Many
governments are undertaking carbon-reducing plans and activities to combat climate change. In
this perspective, public procurement is viewed as an important tool for accelerating the green
transition since it can, for example, include environmental norms and standards in public
tenders. Procurement by the government is the method used by a public service to obtain
products, services, works, and other supplies, usually through a contractual arrangement
following public competition. Healthcare systems, which account for around 4.6% of global
greenhouse gas (GHG) emissions, are required to reduce their environmental effect in order to
better match with their goal. However, due to the particular nature of healthcare, the green
transition confronts numerous hurdles, including meeting strict safety, efficacy, and efficiency
standards in order to safeguard patients and provide quality care. The design of eco-friendly
health technologies that meet public procurement standards is extremely problematic, because
health innovators fear that additional environmental criteria may impair the quality and safety
of care for patients and increase costs for healthcare systems (Alami et al., 2023).
The most well-known type of telemedicine is digital consultation, which includes both
teleconsultation and video consultation. Digital consultation enhances the patient experience
and empowers the patient to manage his or her own care. Satisfaction levels are really high. It
also reduces carbon dioxide (CO2) emissions by eliminating the need to go to a surgery for a
face-to-face session, and while the digital procedure consumes more energy, the benefits of
avoiding travel significantly exceed the drawbacks. CO2 is a major greenhouse gas that traps
heat in the atmosphere and contributes significantly to climate change. Climate change has an
influence on every continent and poses a risk to both human health and the environment.
Human activities have been responsible for nearly all of the recent increase in greenhouse gas
concentrations in the atmosphere. The transportation sector accounts for the majority of
greenhouse gas emissions, which are mostly caused by the combustion of fossil fuels in
automobiles, trucks, ships, trains, and airplanes. Electricity production accounts for the second
greatest share of greenhouse gas emissions. Although health-related transportation accounts
for only 1.5% of overall trips, digital health could assist address both challenges, particularly
telemedicine programs, due to the possibility to eliminate patient travel. Digital consultations
have increased significantly since 2020, allowing for continuity of care amid the COVID-19
pandemic. During the testing period, it showed to be a safe and effective alternative to
traditional care. Telemedicine, in addition to being a highly effective tool in rare situations,
offers benefits that will cause us to reconsider its usage in day-to-day care processes outside of
the exceptionality of a pandemic. These advantages benefit the patient, the practitioner, and
the health-care system. In 2020, users highlighted its ease of use, flexibility, comfort, and
savings in time and money by reducing travel, with the consequent environmental impact
achieved by avoiding CO2 emissions, as well as greater security by reducing the risk of

8
International Conference on Economic Issues (ICONES)

contagion throughout the various COVID-19 waves or other infectious disease. These benefits
were also observed by health care staff, who reported enhanced work-life balance due to
remote working and deemed digital tools a well-accepted health care alternative (Morcillo
Serra et al., 2022).
Management strategies for post pandemic recovery
Public Private Partnership
Historically, most countries had separate private and public health sectors. According to
the argument, the private sector mostly serves the wealthy in a country, while the government
serves those who cannot afford to pay for services. Recent research suggests that this model
may not exactly reflect reality. The private sector is often the primary provider of treatment for
the poor, while the government system often prioritizes services for the wealthy. Public-Private
Partnerships (PPPs), have become a vital tool for promoting innovation in the global health
industry. This assessment highlights the importance and influence of the lessons that have been
learnt from various PPP models around the world. PPPs in healthcare innovation involve
working together between public and private sectors, as well as occasionally non-profit groups,
to address issues such scarce infrastructure, knowledge, and resources while utilizing each
sector's advantages. It is impossible to overestimate the importance of PPPs in the healthcare
industry, especially in light of the intricate and constantly changing global healthcare concerns.
PPPs enhance the resources available for healthcare innovation by enabling the mobilization of
financial, technological, and human resources from both the public and private sectors. These
partnerships offer many important advantages. PPPs enable the development and widespread
acceptance of creative solutions to healthcare problems by encouraging cooperation amongst a
variety of stakeholders, improving the efficacy and efficiency of healthcare delivery. In the
healthcare industry, public-private partnerships, or PPPs, have developed into a variety of
models. These models are customized to address particular healthcare issues and make use of
the combined knowledge and resources of public and private organizations. Research-focused
Public-private partnerships bring together government agencies, academic institutions,
pharmaceutical corporations, and other stakeholders to enhance medical research and develop
new treatments or technology. These agreements enable an exchange of scientific knowledge,
talent, and infrastructure, accelerating the discovery and development of novel healthcare
solutions. Service Delivery Public-private partnerships (PPPs) are cooperation between public
healthcare providers and commercial entities to improve healthcare delivery. These
collaborations might cover things like building infrastructure, managing healthcare systems,
and offering medical services. Navigating complicated legal procedures and regulatory
frameworks is a major hurdle in PPP implementation. Diverse legal systems can make it difficult
for people to work together and innovate, especially in global partnerships. Furthermore, strict
rules could impede the timely delivery of healthcare innovations to patients by delaying their
approval and implementation. Establishing open communication channels with regulatory
organizations and actively engaging in dialogue can help to reduce regulatory barriers. PPP
stakeholders must work closely with regulators to successfully handle legal difficulties.
Furthermore, advocating for regulatory reforms to simplify approval processes and standardize
standards can stimulate innovation and speed the implementation of healthcare solutions
(Ebulue et al., 2024).
9
International Conference on Economic Issues (ICONES)

Workforce training and Capacity building

Health service managers require the ability to lead and manage the digital health
transformation as well as the capabilities and necessary competences to enable data-driven,
strategic, and operational decision-making in the quickly evolving, digitally connected
healthcare environment. During this time of systemic change, health care managers must meet
the challenges presented by the remarkable rise in digital health literacy and demonstrate
proficiency in designing and managing digital tools and technology in this dynamic
environment. Success in healthcare innovation and transformation requires a healthy
workforce with the necessary understanding and skill sets, which does not happen overnight
and is an ongoing process of improvement. Using the introduction of electronic health records
(EHR) as an example, after being widely implemented in the healthcare system, particularly in
the hospital sector for more than a decade, mounting evidence indicates that EHRs have not
been adequately utilized by clinicians to guide clinical decision-making. The three main causes
of the low adoption of EHRs were clinicians' inexperience of the tools' advantages, their regular
encounters with access issues, and their perception of the tools' lack of efficacy and efficiency
(Brommeyer&Liang, 2022).
The basic principles of workforce policy, which includes authorized resources and
funding, as well as concurrent activities at the system, institution, organization, and person
levels, should guide and promote the development of the health workforce as a whole. The
Australian Digital Health Agency (ADHA) is responsible for developing the National Digital
Health Workforce and Education Roadmap as well as providing targeted financing and national
policy guidance for digital health in Australia. The roadmap makes it very clear that the
healthcare workforce has to acquire a range of digital literacy and baseline competencies. It
also implies that the digital knowledge and skills needed will vary depending on the various
roles in digital health and the needs of the healthcare system's service delivery. Two of the
profiles, 'leadership and executive profile' and 'the business, administration, and clinical
support digital profile', are especially important because capable leaders and managers of a
digitally-enabled workforce are critical factors in successfully implementing and managing
digital health transformation. In addition to governmental guidance and incentives, the supply
of skill development for the health workforce is contingent on the collaborative efforts of
university programs, professional institutes, and individual healthcare organizations. Digital
health transformation requires competent executives capable of leading and managing, as well
as relevant competences that allow for data-driven, strategic, and operational decision-making.
Health care managers must face the challenges of extraordinary development in digital health
literacy during this moment of systemic transition, as well as be adept in planning and
managing the digital tools and technology throughout this changing landscape (Brommeyer &
Liang, 2022).

Policy Frameworks and Regulation

10
International Conference on Economic Issues (ICONES)

Digital transformation is an ongoing process that, with the right infrastructure and skills,
can open up new opportunities in the health care sector. It is anticipated that in the upcoming
years, the patient will play a more central role in health transformation, adopting the role of the
"health service consumer" and seeking control over their own health care. The demands and
aspirations of this new "consumer of health services," who will demand improved experiences
with the primary attributes of personalization, comfort, speed, and immediacy in the provision
of services, will transform the healthcare sector. For digital health technologies to be
successfully integrated into healthcare systems, it is essential that they adhere to established
regulatory standards (Stoumpos et al., 2023).
Digital Health Technologies (DHTs) enable trial participants to record data (e.g.,
biomarkers, daily activities, sleep, vital signs) from any location, including home, school, work,
and outdoors. The DHT may collect data passively or by active interaction with participants.
DHTs can transport data directly to authorized parties, including investigators, sponsors, and
others, while maintaining data anonymity or masking as needed. In many countries, regulatory
authorities such as the United States Food and Drug Administration (FDA) and the European
Medicines Agency (EMA) provide standards for the approval and monitoring of digital health
devices and applications. These regulations frequently address issues like clinical efficacy, data
security, and user safety. Compliance with these standards protects patients from potential
danger while also ensuring that technologies satisfy basic quality norms (U.S. Department of
Health and Human Services Food and Drug Administration, 2023).
Big data technology adoption in the healthcare industry has a number of opportunities and
advantages, but it also presents certain difficulties. The security and privacy of sensitive data
are indeed becoming more and more of a problem as a result of a number of expanding trends
in healthcare, including cloud computing, wireless networking, clinician mobility, and health
information interchange. In addition, healthcare institutions discovered that a technology-
centric, bottom-up, reactive approach to defining security and privacy needs is insufficient to
safeguard the company and its clients. Healthcare organizations must take proactive efforts to
prevent sensitive information breaches and security events, while also considering future
security and privacy concerns. In the US, the non-profit Indiana Health Information Exchange
connects over 90 hospitals, community health clinics, rehabilitation centers, and other
healthcare providers through a secure technology network. It enables medical information to
follow patients across many doctor offices or hospitals.
At the most recent 2017 Annual Meeting of the American College of Medical Genetics and
Genomics (ACMG), Sophia Genetics, a global leader in data-driven medicine, announced that
African hospitals have begun using its artificial intelligence to improve patient care, following
the lead from Europe, Canada, Australia, Russia, and Latin America. Automations have
improved patient care workflow and cut costs, but they also raise the risk of security and
privacy breaches as healthcare data grows. In 2016, CynergisTek published Redspin's 7th annual
Breach research: Protected Health Information (PHI). According to this research, there was a
320% rise in hacking assaults targeting healthcare providers in 2016, and 81% of records
compromised that year were primarily the result of hacking attempts. Furthermore, the most
common threat to hospitals has been determined to be ransomware, which is characterized as
a kind of malware that encrypts data and holds it captive until a ransom demand is satisfied.
11
International Conference on Economic Issues (ICONES)

Consequently, it is imperative that healthcare institutions adopt data security strategies that
fulfill regulatory requirements and safeguard valuable assets. Healthcare businesses must
manage and preserve personal information, address risks, and comply with data protection
laws. Guidelines for data protection, such as consent requirements, data encryption, and
breach notification procedures, are established by regulations like the General Data Protection
Regulation (GDPR) in the European Union and the Health Insurance Portability and
Accountability Act (HIPAA) in the United States. These regulations guarantee the responsible
management of patient data and the protection of individuals' privacy even as the use of digital
health solutions spreads (Abouelmehdi et al., 2017).

RESEARCH METHODOLOGY
This research is a descriptive and analytical literature review that utilizes data from
scientific journals, research reports, news articles, government policies, and relevant
organizational documents. Data were collected through literature searches in databases and
analyzed using thematic analysis to identify main themes and subthemes, ultimately
synthesizing the findings to create a conceptual framework. Using Google Scholar, PubMed,
Scopus, ScienceDirect and Emerald Insight, as search engines and databases for the selected
researches in our research were chosen on the basis of medical and management background.
The literature review involved a thorough analysis of structured knowledge, ideas, or findings
from previous researches relevant to a specific topic.
Our study is based on a literature review of studies related to medical sectors in association
to digital transformation and management. We eliminate based on repeating the same sectors
or duplication of study until arrive to 20 study literature reviews, and picked the past five years
researches, in various dealings with digital health transformation and management. The
database search yielded a number of articles, which were then checked for duplication.
Following this, the reviewer conducted a screening of titles and abstracts, resulting in the
selection of 7 articles relevant to the topic to be discussed. These articles were subsequently
reviewed for quality and discussed in this literature review. To further elaboration, the process
involved a meticulous selection of articles to ensure their relevance and quality. After
eliminating duplicates, the reviewer carefully assessed the titles and abstracts to filter out
articles that best addressed the research topic. The final selection of 7 articles underwent a
rigorous quality evaluation to ensure that they met the standards required for inclusion. This
thorough review process is essential for providing a comprehensive and accurate analysis of the
current state of research on the topic at hand.
We first have to get further elaboration about digital health and its transformation
especially for post COVID-19 pandemic recovery. Secondly, by collaborating digital tools into
health system and management, we elaborate the integration of digital tools into the health
system and most importantly its role in Sustainable Development Goals (SDGs) and even for
management strategies. Thirdly, the research compares few researches to gain more insight
and explanation in relation to digital health transformation and management on SDGs for post
pandemic recovery.

12
International Conference on Economic Issues (ICONES)

RESULT AND DISCUSSION

The database yielded a number of articles, which were then selected to be reviewed, the
findings from the selected articles are detailed and discussed in the following sections.

Authors Title Method Results

Biancuzzi Economic and The study utilized a The literature review reveals a
, H., Dal performance structured literature significant gap in the integration of
Mas, F., evaluation of review to explore economic and managerial perspectives
Bidoli, C., E-health methods for measuring within the clinical setting of e-Health.
Pegoraro before and the economic value and Most studies focus exclusively on
, V., after the performance of e- clinical aspects, highlighting the need
Zantedes pandemic era: Health services pre- for more research into the economic
chi, M., a literature and post-pandemic. and managerial impacts of e-Health
Negro, review and technologies. This gap reflects the
Searches were
P.A., future growing role of medical doctors as
conducted in Scopus,
Campost perspectives. "hybrid managers" who must handle
Web of Science, and
rini, S. cost and budget responsibilities,
Pubmed using terms
and emphasizing the importance of
like “e-health” and
Cobianch including managerial issues in clinical
“telemedicine,”
i, L., discussions.
resulting in 2063, 5136,
2023. and 2447 initial results, Geographically, e-Health appears more
respectively. After advanced in Northern Europe, with
refining the search to fewer quantitative studies from other
include only English continents suggesting that Europe is
journal articles related leading in this field. The review also
to medicine, highlights that while the COVID-19
economics, and finance pandemic accelerated the adoption of
published post-2019, e-Health tools, there was no significant
439 unique articles shift in cost or performance evaluations
were identified. reported in the literature. The potential
of Virtual Hospitals to enhance remote
Following a review of
patient care, especially for chronic and
titles and abstracts, 21
elderly patients, is noted, yet there is a
papers were selected
need for further research to better
for full-text analysis,
understand the effectiveness of
with 20 deemed
different e-Health tools for various
relevant. These papers
pathologies.
were coded and
analyzed using Nvivo
software, focusing on

13
International Conference on Economic Issues (ICONES)

author profiles, study

locations, sector
analyzed, research
methodology, clinical
disciplines, and e-
Health tools used.

Leal Digital The research utilized a The research found that the COVID-19
Filho, W., transformation questionnaire with 14 pandemic significantly accelerated
Lange and questions, covering digital transformation in higher
Salvia, A., sustainable demographic education, particularly in teaching,
Beynaghi information, digital which saw the greatest increase
development
, A., higher transformation according to 52% of respondents.
in
Fritzen, education in a deployment, its Research followed with 24%, while
B., post-pandemic contribution to SD, and outreach and event organization
Ulisses, challenges faced. The accounted for 11% and 10%,
world
A., Avila, survey was conducted respectively. In terms of digital skills
L.V., online via Google Forms development, 64% of respondents
Shulla, using a snowball reported receiving support from their
K., sampling technique, universities to acquire new skills, while
Vasconce and responses were 30% developed these skills
los, C.R., analyzed using SPSS for independently and 4% paid for their
Moggi, descriptive and own training. A large majority, 99%,
S., inferential statistics. agreed that digital transformation could
Mifsud, Principal Component be applied in the context of sustainable
M. and Analysis (PCA) was development (SD), addressing
Anholon, performed to explore environmental, social, and economic
R., 2024. how digital aspects.
technologies influence Despite the positive shift towards
SD initiatives and digitalization, only 32% of respondents
innovative indicated they had developed digitally-
opportunities at HEIs. based business models for
The study assessed the sustainability during the pandemic,
adequacy of the PCA while 67% had not. The study also
model using measures highlighted several challenges, with
like the Measure of 61% of respondents citing time
Sampling Adequacy management during lockdown as a
(MSA), Bartlett’s Test of major issue, 59% pointing to the need
Sphericity, and to learn new digital tools, and 56%
Cronbach’s Alpha for mentioning difficulties in continuing
reliability. academic networking and conferences.

14
International Conference on Economic Issues (ICONES)

These findings demonstrate that while

digital transformation has brought
notable advancements, significant
challenges remain in fully harnessing its
potential for sustainable development
in higher education

Stoumpo Digital The study conducted a This study provides several insights into
s, A.I., Transformatio systematic how healthcare systems are adapting to
Kitsios, F. n in bibliographic review digital technologies. One of the primary
and Healthcare: using Scopus, Science findings is the widespread adoption of
Talias, Technology Direct, and PubMed, technologies such as electronic health
M.A., Acceptance covering literature from records, telemedicine, and mobile
2023. Its 2008 to 2021. From health (m-health) across various
and
5,847 initially identified healthcare sectors. For example, 75% of
Applications
articles, 287 were hospitals in the United States have
ultimately selected implemented EHR systems, though
based on relevance to many healthcare professionals report
digital healthcare topics challenges in using these systems
like e-health, m-health, effectively due to technological
and telemedicine. The complexity and integration issues.
researchers used The study also reveals that digital
Webster and Watson's transformation in healthcare remains in
concept-centric method its early stages globally, with significant
to group articles by variations across different countries.
themes, including For instance, while the U.S. has made
information technology substantial progress in adopting digital
in health, e-health health solutions, other countries, such
education, technology as the United Kingdom and Australia,
acceptance, have encountered difficulties in
telemedicine, and implementing large-scale e-health
security. They also initiatives 【 16†source 】 . Moreover,
employed VOSviewer telemedicine and digital health
software to visualize applications have seen rapid growth
relationships between during the COVID-19 pandemic,
key concepts, providing providing more accessible healthcare
a comprehensive services. However, the effectiveness of
analysis of digital these digital solutions varies, depending
healthcare adoption on the infrastructure and policies in
and its impact place to support their deployment.

15
International Conference on Economic Issues (ICONES)

The results also highlight the need for

improving healthcare professionals'
digital literacy and addressing security
concerns related to patient data. The
development of secure communication
systems in telemedicine and health
information exchange, is essential to
ensure patient confidentiality and trust
in digital health systems.

Morcillo Impact on the This study is a In 2020, Sanitas health care company
Serra, C., reduction of retrospective study, conducted a total of 3,015,530 medical
Aroca CO2 emissions evaluated the appointments, with 640,122 in digital
Tanarro, due to the use environmental impact format (495,913 video appointments
A., of of digital health and 144,209 telephone appointments),
Cumming telemedicine. activities for Sanitas averaging 3,700 digital appointments
s, C.M., insurance policyholders per day. This digital shift is estimated to
Jimenez in Spain in 2020. The have avoided 1,957 net tons of CO2
Fuertes, study analyzed average emissions. Additionally, patients
A. and travel distances (13 km downloaded 3,064,646 medical reports
Tomás round trip) and travel to their digital health folders, avoiding
Martínez modes (car, bus, train) an estimated 4,698 net tons of CO2
, J.F., for patients. emissions. Together, these digital
2022. The study measured solutions avoided 6,655 net tons of CO2
CO2 emissions from emissions for the year.
digital tools such as Among the digital appointments,
video consultations and 66,510 were with general practitioners
report downloads, and 573,612 with specialists. Of the
while also calculating video appointments, 74.7% were made
the emissions avoided via mobile phone app and 25.3% via
from reduced travel web.
and paper use. By The average age of patients using
subtracting emissions digital appointments was 39, compared
from digital activities to 44 for in-person consultations. Most
from the total savings digital appointments were made by
achieved through individuals aged 30-39 (54,812
reduced travel and appointments) and 45-54 (47,372
avoided printing, the appointments), though patients over 70
study found that digital made over 18,000 video appointments.
consultations
significantly lowered Patient satisfaction with digital
carbon emissions, appointments, measured by the net

16
International Conference on Economic Issues (ICONES)

primarily by decreasing promoter score (NPS), was high at

patient travel. 62.1%, with 48.7% of customers
repeating this communication method.
The net carbon saving for digital
appointments and download reports
were calculated by summing the carbon
saving derived from the avoided patient
travel and document printing and
subtracting the videoconferencing and
downloading emissions.

Alami, Integrating This study involved The research findings indicate that the
H., environmental interviews with 29 integration of environmental
Rivard, considerations stakeholders from a considerations into the assessment and
L., digital large Canadian health- procurement of digital health
in
Lehoux, care center. These technologies (DHT) is influenced by
health
P., Ag stakeholders included various factors at the micro, meso, and
technology
Ahmed, clinicians, health macro levels. At the micro level, factors
assessment
M.A., technology assessment include stakeholders' recognition of
and
Fortin, specialists, managers, environmental issues and the suitability
J.P. and procurement: and technology of the technology. At the meso level,
Fleet, R., Stakeholders’ providers. The data was organizational factors such as culture,
2023. perspectives. collected through a policies, and infrastructure can either
mixed deductive- hinder or support this integration. At
inductive analysis the macro level, political and regulatory
approach. The analysis challenges, as well as economic
explored factors that uncertainties, pose major obstacles.
impact the integration The study emphasizes the need for
of environmental systemic changes to support more
considerations in the environmentally friendly DHT.
assessment and
procurement of digital
health technologies.

Shifa, N., This study utilized a

Implementation This study highlights the significance of
Tiasari, of Digital
descriptive design and a adopting digital health solutions in
A. and Health in
systematic literature Indonesia during the COVID-19
Siregar, Addressing review methodology. pandemic. The integration of digital
K.N., Global Threats:
The review involved a health technologies has been vital for
2024. Lessons from analysis of structured improving the efficiency of the
the Use of knowledge, ideas from healthcare system, enabling remote
Technology previous research medical services, and strengthening

17
International Conference on Economic Issues (ICONES)

during COVID- relevant to the topic. epidemic monitoring through mobile

19 Pandemic The literature search applications and contact tracing tools.
was conducted using The partnership between the
in Indonesia.
search engines and government and telemedicine
databases such as platforms has delivered various digital
Scopus, ScienceDirect, health services, benefiting COVID-19
SAGE, ProQuest, and patients and aiding in resource
Portal Garuda. Data management. Nonetheless, issues
collection was carried related to infrastructure and equitable
out by accessing these access to digital health services remain,
databases. especially in remote areas.

Drago, Telemedicine This study used a two- The study found that telemedicine
C., Gatto, as techno- phase approach. First, a played a crucial role during the COVID-
A. and innovation to scoping review of 19 pandemic by improving healthcare
Ruggeri, tackle COVID- articles from the Scopus access, reducing costs, and minimizing
M., 2023. 19: A database (2020-2021) hospitalizations. However, challenges
bibliometric on telemedicine, such as tech costs, patient privacy, and
analysis. COVID-19, and digital literacy slowed its adoption.
innovation. Then, a Telemedicine highlighted the need for
bibliometric analysis significant organizational changes in
using keyword network healthcare systems. The key themes in
analysis and community the literature, such as the importance
detection to identify of innovation, healthcare management,
key themes and trends and the potential for telemedicine to
in the literature. address future pandemics.

During the COVID-19 pandemic, telemedicine emerged as a critical tool for enhancing
healthcare access, reducing costs, and minimizing hospitalizations. Studies by Drago et al.
(2023) demonstrate that while telemedicine has proven effective in improving healthcare
delivery, which helping in fulfilling the Sustainable Development Goals (SGDs) in the effort of
enhancing good health and well-being. Telemedicine’s role in enhancing healthcare access
plays as an innovated way in promoting health, preventing disease, and consultation especially
during the COVID-19 pandemic, where people being depressed staying alone in isolation and
quarantine can get an opportunity to talk and share their problems with doctors through the
means of telemedicine (Koirala et al., 2021). However, its widespread adoption has been
hampered by issues such as technology costs, patient privacy concerns, and varying levels of
digital literacy. These challenges highlight the need for substantial organizational changes in
healthcare systems to fully leverage the benefits of telemedicine. In addition, the integration of
environmental considerations into digital health technology assessments is crucial yet fraught
with difficulties. Alami et al. (2023) identify that at the micro level, individual stakeholders'
recognition of environmental issues influences technology assessment, while at the meso and
macro levels, organizational culture, policies, and broader political and economic factors either

18
International Conference on Economic Issues (ICONES)

support or hinder this integration. This highlights the need for systemic changes to incorporate
environmental sustainability into digital health practices more effectively.
The experience in Indonesia, as explored by Shifa et al. (2024), illustrates the potential of
digital health technologies to enhance healthcare efficiency, particularly in epidemic monitoring
and remote medical services. However, issues related to infrastructure and equitable access
remain significant, especially in remote areas. This points to a need for better infrastructure and
broader access to ensure that digital health solutions benefit all populations equally.
The environmental impact of telemedicine, as discussed by Morcillo Serra et al. (2022),
confirmed that digital health, specifically digital consultation and the download of digital vs
paper reports, reduces the environmental impact of health care by reducing the number of
journeys for a face-to-face visit and the number of the printing of medical reports. This shows
substantial reductions in CO2 emissions due to decreased travel and paper use, emphasizing
the role of digital health in promoting sustainability. This environmental benefit reinforces the
importance of continuing to develop and implement digital health solutions.
Despite these advancements, there is a notable gap in understanding the economic and
managerial impacts of digital health technologies. Biancuzzi et al. (2023) found that while there
is a growing interest in e-Health, most studies have focused on clinical aspects, underscoring
the need for more research into the economic and managerial dimensions of digital health. The
COVID-19 pandemic has accelerated the adoption of digital health tools, but there has been no
significant shift in cost or performance evaluations, pointing to a need for further investigation
into these areas. In a paper by Shaw and Glover (2024) there were 6 structural challenges to the
effort to promote health equity through digital health, as follows: (1) the revenue-first
incentives of technology corporations, (2) the influence of venture capital, (3) inequitable
access to the internet and digital devices, (4) underinvestment in digital health literacy, (5)
uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital
health. Building on these challenges, immediate and long-term directions for work to support
meaningful change for digital equity are needed, including the managerial dimensions of digital
health.
Finally, Stoumpos et al. (2023) highlight the global disparities in digital health adoption,
noting that while some countries have made significant progress, others face substantial
challenges. The development of secure communication systems and improved digital literacy
among healthcare professionals are essential for addressing these challenges. Overall, the
review suggests that while digital health technologies offer considerable benefits, addressing
the associated challenges is crucial for optimizing their impact and achieving a more equitable,
efficient, and sustainable healthcare system.

CONCLUSION
In conclusion, this literature review has examined the role of digital health transformation
and management on sustainable development practices in the context of post-pandemic

19
International Conference on Economic Issues (ICONES)

recovery, addressing the research problem by demonstrating the significant impact of digital
health technologies in overcoming traditional healthcare challenges. The findings underscore
the potential of telemedicine, mobile health applications, artificial intelligence, and big data
analytics to enhance healthcare accessibility and efficiency, particularly in low-resource
settings. However, the review also identifies key challenges, including disparities in digital
literacy, inadequate infrastructure, regulatory frameworks and concerns about privacy and
costs, which must be addressed to fully realize the benefits of digital health innovations and
require strategic leadership, cross-sector collaboration, and continuous evaluation to
overcome.
To ensure the successful integration of these technologies, several practical
recommendations are proposed. Governments and healthcare organizations should prioritize
the development of robust policy frameworks and regulatory reforms to address privacy
concerns, facilitate system interoperability, and establish reimbursement guidelines for
telemedicine services. Investments in digital infrastructure, particularly in underserved areas,
are essential to ensuring equitable access to these innovations. Additionally, improving digital
literacy through workforce training and patient education initiatives is critical to bridging the
digital divide. Furthermore, integrating environmental sustainability into the assessment of
digital health technologies should be a priority, ensuring that telemedicine and other solutions
contribute to Sustainable Development Goals (SDGs).
Future research should focus on the economic and managerial impacts of digital health
technologies, as these areas remain underexplored. Studies should also address global
disparities in the adoption of digital health solutions, with particular attention to developing
secure communication systems and improving digital literacy in under-resourced settings.
Longitudinal research on the long-term impact of digital health on patient outcomes, costs, and
system efficiency will provide valuable insights for refining strategies and ensuring the
sustainability of healthcare systems. Through these recommendations, the review aims to
contribute to the ongoing efforts to optimize digital health transformation and inspire further
investigation in this field.

ACKNOWLEDGEMENT
The completion of this literature review would not have been possible without the support
and guidance of the lecturers of Master Management of ARS University. The encouragement
and insightful feedback were instrumental in accomplishing this paper. Finally, thank to ARS
University for providing the necessary facilities and resources to complete this literature
review. We extend our gratitude to all the invaluable contributions that significantly enhanced
the quality of the paper.

REFERENCES

20
International Conference on Economic Issues (ICONES)

1. Abdolkhani, R., Petersen, S., Walter, R., Zhao, L., Butler-Henderson, K., & Livesay, K.
(2022). The Impact of Digital Health Transformation Driven by COVID-19 on Nursing
Practice: Systematic Literature Review. JMIR Nursing, 5(1), e40348.
https://doi.org/10.2196/40348
2. Abou El Mehdi, K., Beni-Hssane, A., Khaloufi, H., & Saadi, M. (2017). Big data security
and privacy in healthcare: A Review. Procedia Computer Science, 113, 73–80.
https://doi.org/10.1016/j.procs.2017.08.292
3. Alami, H., Rivard, L., Lehoux, P., Ag Ahmed, M. A., Fortin, J.-P., & Fleet, R. (2023).
Integrating environmental considerations in digital health technology assessment and
procurement: Stakeholders’ perspectives. DIGITAL HEALTH, 9.
https://doi.org/10.1177/20552076231219113
4. Asi, Y. M., & Williams, C. (2018). The role of digital health in making progress toward
Sustainable Development Goal (SDG) 3 in conflict-affected populations. International
Journal of Medical Informatics, 114, 114–120.
https://doi.org/10.1016/j.ijmedinf.2017.11.003
5. Brommeyer, M., & Liang, Z. (2022). A Systematic Approach in Developing Management
Workforce Readiness for Digital Health Transformation in Healthcare. International
Journal of Environmental Research and Public Health, 19(21), 13843.
https://doi.org/10.3390/ijerph192113843
6. Charles Chukwudalu Ebulue, Ogochukwu Roseline Ebulue, & Chukwunonso Sylvester
Ekesiobi. (2024). PUBLIC-PRIVATE PARTNERSHIPS IN HEALTH SECTOR INNOVATION:
LESSONS FROM AROUND THE WORLD. International Medical Science Research Journal,
4(4), 484–499. https://doi.org/10.51594/imsrj.v4i4.1051
7. Chioma Anthonia Okolo, Oloruntoba Babawarun, Jeremiah Olawumi Arowoogun,
Adekunle Oyeyemi Adeniyi, & Rawlings Chidi. (2024). The role of mobile health
applications in improving patient engagement and health outcomes: A critical review.
International Journal of Science and Research Archive, 11(1), 2566–2574.
https://doi.org/10.30574/ijsra.2024.11.1.0334
8. Drago, C., Gatto, A., & Ruggeri, M. (2023). Telemedicine as techno innovation to tackle
COVID-19: A bibliometric analysis. Technovation, 120, 102417.
https://doi.org/10.1016/j.technovation.2021.102417
9. Integrating Social Care into the Delivery of Health Care. (2019). National Academies
Press. https://doi.org/10.17226/25467
10. Ismail, L., Materwala, H., Karduck, A. P., & Adem, A. (2020). Requirements of Health
Data Management Systems for Biomedical Care and Research: Scoping Review. Journal
of Medical Internet Research, 22(7), e17508. https://doi.org/10.2196/17508
11. Koirala, S., Parajuli, B.R. (2021). The Scope of Telemedicine in Nepal during COVID-19
Pandemic. Journal of Nepal Medical Association, 59(244): 1326-1327. doi:
10.31729/jnma.6692
12. Morcillo Serra, C., Aroca Tanarro, A., Cummings, C. M., Jimenez Fuertes, A., & Tomás
Martínez, J. F. (2022). Impact on the reduction of CO2 emissions due to the use of
telemedicine. Scientific Reports, 12(1), 12507. https://doi.org/10.1038/s41598-022-
16864-2

21
International Conference on Economic Issues (ICONES)

13. Novillo-Ortiz, D., De Fátima Marin, H., & Saigí-Rubió, F. (2018). The role of digital health
in supporting the achievement of the Sustainable Development Goals (SDGs).
International Journal of Medical Informatics, 114, 106–107.
https://doi.org/10.1016/j.ijmedinf.2018.03.011
14. Omboni, S., Padwal, R. S., Alessa, T., Benczúr, B., Green, B. B., Hubbard, I., Kario, K.,
Khan, N. A., Konradi, A., Logan, A. G., Lu, Y., Mars, M., McManus, R. J., Melville, S.,
Neumann, C. L., Parati, G., Renna, N. F., Ryvlin, P., Saner, H., … Wang, J. (2022). The
worldwide impact of telemedicine during COVID-19: current evidence and
recommendations for the future. Connected Health.
https://doi.org/10.20517/ch.2021.03
15. Shah, B., Allen, J. L. Y., Chaudhury, H., O’Shaughnessy, J., & Tyrrell, C. S. B. (2022). The
role of digital health in the future of integrated care. Clinics in Integrated Care, 15,
100131. https://doi.org/10.1016/j.intcar.2022.100131
16. Shaw, J. and Glover, W. (2024). The Political Economy of Digital Health Equity: Structural
Analysis. Journal of Medical Internet Research, 26: e46971. doi: 10.2196/46971
17. Shipu Debnath. (2023). Integrating Information Technology in Healthcare: Recent
Developments, Challenges, and Future Prospects for Urban and Regional Health. World
Journal of Advanced Research and Reviews, 19(1), 455–463.
https://doi.org/10.30574/wjarr.2023.19.1.1335
18. Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., &
Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus
disease 2019 (COVID-19). Journal of Telemedicine and Telecare, 26(5), 309–313.
https://doi.org/10.1177/1357633X20916567
19. Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital Transformation in Healthcare:
Technology Acceptance and Its Applications. International Journal of Environmental
Research and Public Health, 20(4), 3407. https://doi.org/10.3390/ijerph20043407
20. Sujan, M. (2023). Integrating digital health technologies into complex clinical systems.
BMJ Health & Care Informatics, 30(1), e100885. https://doi.org/10.1136/bmjhci-2023-
100885
21. U.S. Department of Health and Human Services Food and Drug Administration. (2023).
Digital Health Technologies for Remote Data Acquisition in Clinical Investigations
Guidance for Industry, Investigators, and Other Stakeholders.
22. Yeung, A. W. K., Torkamani, A., Butte, A. J., Glicksberg, B. S., Schuller, B., Rodriguez, B.,
Ting, D. S. W., Bates, D., Schaden, E., Peng, H., Wilschke, H., van der Laak, J., Car, J.,
Rahimi, K., Celi, L. A., Banach, M., Kletecka-Pulker, M., Kimberger, O., Eils, R., …
Atanasov, A. G. (2023). The promise of digital healthcare technologies. Frontiers in
Public Health, 11. https://doi.org/10.3389/fpubh.2023.1196596

22