Hospital Investments Decisions in Healthcare 4.0 Technologies: Challenges, Trends, and Research Directions (Preprint)

VASSOLO, ROBERTO; MAC CAWLEY, ALEJANDRO; TORTORELLA, GUILHERME LUZ; FOGLIATTO, FLAVIO SANSON; TLAPA MENDOZA, DIEGO; NARAYANAMURTHY, GOPALAKRISHNAN

JOURNAL OF MEDICAL INTERNET RESEARCH

JOURNAL MEDICAL INTERNET RESEARCH

Año: 2021

1438-8871

Background: The literature has increasingly discussed alternative approaches to analyze and evaluate healthcare investments in state-of-the-art technologies, especially with the advent of Healthcare 4.0 technologies or e-health. Such investments generally involve computer hardware and software that deals with the storage, retrieval, sharing, and use of healthcare information, data, and knowledge for communication and decision-making. Besides, the utility of these technologies significantly increases when addressed in bundles. However, a structured and holistic approach for analyzing investments in Healthcare 4.0 technologies is not available in the literature.Objective: This study aims to analyze previous research related to the evaluation of Healthcare 4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with Hospitals 4.0 investment decisions and suggest five main research directions on the topic.Method: To achieve our goal, we carried out the standard procedure for scoping reviews. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords "investment," "health," "industry 4.0," "investment," "health technology assessment," "healthcare 4.0," and "smart" in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all databases. After removing papers prior to 2011, duplicates, and performing further screening, we arrived at 244 articles from which 33 were selected after in-depth analysis to compose the final publications´ portfolio.Results: Our findings show the multidisciplinary nature of the research related to evaluating hospital investments in H4.0. We detect that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominates over bundle analysis, H4.0 value considerations, and multiple decision-maker involvement. We propose a framework for clasifying H4.0 investment methodologies and suggest five main research directions for this topic.Conclusions: Some of our findings were unexpected given the interrelated nature of H4.0 and its multidimensional impact. Given the absence of a more holistic approach for H4.0 investment decisions, we identified five promising research directions on the topic: (i) development of economic valuation methodologies tailored for healthcare 4.0 technologies, (ii) account for technology interrelations in the form of bundles, (iii) account for uncertainties in the process of evaluating such technologies, (iv) integration of administrative, medical and patient perspectives into the evaluation process, and (v) balancing and handling of complexity in the decision-making process.