{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:44:25Z","timestamp":1791855865345,"version":"4.3.4"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":89,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Digital transformation is increasingly reshaping healthcare delivery worldwide; however, the adoption of digital health systems in developing and resource-constrained economies remains constrained by infrastructural limitations, poor alignment with clinical workflows, inadequate user involvement, and resistance to organizational change. Many digital healthcare initiatives in these settings continue to experience implementation and sustainability challenges, partly due to the absence of context-specific and evidence-based transformation models. Consequently, this study aimed to develop a customized evidence-based digital transformation framework to support the sustainable adoption of digital healthcare systems within tertiary and university teaching hospitals in developing economies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study emerged from a prolonged mixed-methods doctoral research project conducted across three tertiary healthcare institutions in southeastern Nigeria: the University of Nigeria Teaching Hospital (UNTH), ESUT Teaching Hospital (ESUTTH), and the National Orthopaedic Hospital Enugu (NOHE). The research involved close to 600 stakeholders, including doctors, nurses, medical records officers, patients, and clinical consultants. Data were collected through structured questionnaires, qualitative interviews, participatory co-design interactions, observational methods, usability testing, and iterative system evaluations. The study adopted an agile human-centered software engineering and participatory development approach to guide the design, implementation, and evaluation of the proposed TUMERIC digital healthcare support system and the resulting transformation framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings demonstrated generally positive institutional readiness toward digital transformation, with over 70% of participating healthcare professionals indicating support for future digital initiatives within their institutions. Usability evaluations of the implemented TUMERIC system also demonstrated high levels of user acceptance and perceived usability among clinicians and patients. Qualitative findings further highlighted the importance of aligning digital systems with existing clinical workflows, involving end users throughout the development lifecycle, and addressing infrastructural and organizational constraints during implementation. These findings informed the development of the proposed evidence-based digital transformation framework tailored to resource-constrained healthcare environments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study demonstrates that agile human-centered and participatory design approaches can support the development and adoption of context-appropriate digital healthcare systems in developing economies. The proposed framework provides an empirically informed model that may assist healthcare institutions and policymakers in planning and implementing more sustainable and user-aligned digital transformation initiatives within tertiary healthcare settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12911-026-03713-9","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T20:24:36Z","timestamp":1784233476000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The consultant\u2019s guide: evidence-based digital transformation framework for healthcare institutions in developing and resource-constrained economies"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4409-7424","authenticated-orcid":false,"given":"Uchechukwu Solomon","family":"Onyeabor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okechukwu","family":"Onwuasoigwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfred Okwudili","family":"Okenwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omolade Ayoola","family":"Lasebikan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Schaaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Pinkwart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Balzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"3713_CR1","doi-asserted-by":"crossref","unstructured":"Kraus S, Jones P, Kailer N, Weinmann A, Banegas NC, Tierno NR. Digital transformation: an overview of the current state of the art of research. SAGE Open [Internet]. 2021;11(3):215824402110475. Available from: https:\/\/journals.sagepub.com\/doi\/full\/10.1177\/21582440211047576.","DOI":"10.1177\/21582440211047576"},{"key":"3713_CR2","unstructured":"How COVID-19 has pushed companies over the technology tipping point\u2014and transformed business forever [Internet]. McKinsey & Company; 2020 [cited 2023 May 30]. Available from: https:\/\/www.mckinsey.com\/capabilities\/strategy-and-corporate-finance\/our-insights\/how-covid-19-has-pushed-companies-over-the-technology-tipping-point-and-transformed-business-forever."},{"key":"3713_CR3","unstructured":"What is digital transformation? Your top questions answered [Internet]. The Enterprisers Project; 2020 [cited 2023 May 30]. Available from: https:\/\/enterprisersproject.com\/sites\/default\/files\/what_is_digital_transformation_2020.pdf."},{"key":"3713_CR4","unstructured":"KPMG Digital Transformation Playbook [Internet]. KPMG; 2020 [cited 2023 May 30]. Available from: https:\/\/assets.kpmg.com\/content\/dam\/kpmg\/sa\/pdf\/2020\/digital-transformation-playbook.pdf."},{"key":"3713_CR5","doi-asserted-by":"crossref","unstructured":"Dohan MS, Califf CB, Ghosh K, Tan J. Digital transformation in healthcare: new value for a new movement. Health Policy Technol. 2020;9(2):177-178. Available from: https:\/\/www.semanticscholar.org\/paper\/Digital-transformation-in-healthcare%3A-New-value-for-Dohan-Califf\/987a4ba5bd58aca876acfa774327abaa02cab47e.","DOI":"10.1016\/j.hlpt.2020.04.003"},{"key":"3713_CR6","unstructured":"PECB. Digital transformation in healthcare [Internet]. PECB. [cited 2023 Jan 21]. Available from: https:\/\/pecb.com\/article\/digital-transformation-in-healthcare."},{"key":"3713_CR7","unstructured":"Digital transformation in healthcare: customising care, unlocking the future [Internet]. BDO Global; [cited 2023 May 30]. Available from: https:\/\/www.bdo.global\/getmedia\/d32954a9-dc54-460c-989c-d36ed42893d7\/Digital-Transformation-in-Healthcare-(1).pdf."},{"key":"3713_CR8","doi-asserted-by":"crossref","unstructured":"Seitzinger P, Rafid-Hamed Z, Kalra J. Healthcare delivery: leveraging artificial intelligence to strengthen healthcare quality. In: Advances in Human Factors and Ergonomics in Healthcare and Medical Devices. 2021. p. 16-21. Available from: https:\/\/link.springer.com\/chapter\/10.1007\/978-3-030-80744-3_3.","DOI":"10.1007\/978-3-030-80744-3_3"},{"key":"3713_CR9","doi-asserted-by":"crossref","unstructured":"Anthony Jnr B. Use of telemedicine and virtual care for remote treatment in response to COVID-19 pandemic. J Med Syst. 2020;44(7):132. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/32542571\/.","DOI":"10.1007\/s10916-020-01596-5"},{"key":"3713_CR10","unstructured":"Bartley A. Predictive analytics in healthcare [Internet]. Intel; [cited 2023 May 30]. Available from: https:\/\/01.org\/sites\/default\/files\/downloads\/model-predicting-rapid-response-events\/intelpredictiveanalyticswhitepaperfinal.pdf."},{"key":"3713_CR11","doi-asserted-by":"crossref","unstructured":"Lin SY, Mahoney MR, Sinsky CA. Ten ways artificial intelligence will transform primary care. J Gen Intern Med. 2019;34(8):1626-1630. Available from: https:\/\/www.ama-assn.org\/practice-management\/digital\/10-ways-health-care-ai-could-transform-primary-care.","DOI":"10.1007\/s11606-019-05035-1"},{"key":"3713_CR12","doi-asserted-by":"crossref","unstructured":"Hazarika I. Artificial intelligence: opportunities and implications for the health workforce. Int Health [Internet]. 2020;12(4):241-245. Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7322190\/.","DOI":"10.1093\/inthealth\/ihaa007"},{"key":"3713_CR13","unstructured":"Unlocking the digital potential of healthcare | CGI United States [Internet]. CGI. [cited 2023 May 30]. Available from: https:\/\/www.cgi.com\/us\/en-us\/blog\/blockchain\/unlocking-digital-potential-healthcare."},{"key":"3713_CR14","doi-asserted-by":"crossref","unstructured":"Ratwani RM. Electronic health records and improved patient care: opportunities for applied psychology. Curr Dir Psychol Sci. 2017;26(4):359-365. Available from: https:\/\/journals.sagepub.com\/doi\/10.1177\/0963721417700691.","DOI":"10.1177\/0963721417700691"},{"key":"3713_CR15","doi-asserted-by":"crossref","unstructured":"Agarwal R, Gao G, DesRoches C, Jha AK. Research commentary\u2014the digital transformation of healthcare: current status and the road ahead. Inf Syst Res. 2010;21(4):796-809. Available from: https:\/\/pubsonline.informs.org\/doi\/abs\/10.1287\/isre.1100.0327.","DOI":"10.1287\/isre.1100.0327"},{"key":"3713_CR16","unstructured":"Takyar A. The impact of digital transformation in healthcare [Internet]. LeewayHertz; 2020 [cited 2023 May 30]. Available from: https:\/\/www.leewayhertz.com\/digital-transformation-in-healthcare."},{"key":"3713_CR17","unstructured":"12 healthcare innovation execs define what disruption means to them [Internet]. Becker's Hospital Review. 2020 [cited 2023 May 30]. Available from: https:\/\/www.beckershospitalreview.com\/digital-transformation\/12-healthcare-innovation-execs-define-what-disruption-means-to-them.html#:~:text=When%20new%20digital%20technologies%20and%20data-driven%20systems%20are."},{"key":"3713_CR18","unstructured":"Ali M. How artificial intelligence is disrupting healthcare [Internet]. Medium. 2022 [cited 2023 May 30]. Available from: https:\/\/moez-62905.medium.com\/how-artificial-intelligence-is-disrupting-healthcare-cef4dd290ec9."},{"key":"3713_CR19","doi-asserted-by":"crossref","unstructured":"Wheatley B. Transforming care delivery through health information technology. Perm J. [Internet]. 2013;17(1):81-86. Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3627785\/.","DOI":"10.7812\/TPP\/12-030"},{"key":"3713_CR20","unstructured":"Virtual reality applications in healthcare [Internet]. Flatworld Solutions. [cited 2023 May 30]. Available from: https:\/\/www.flatworldsolutions.com\/healthcare\/articles\/virtual-reality-applications-in-healthcare.php."},{"key":"3713_CR21","doi-asserted-by":"crossref","unstructured":"Bohr A, Memarzadeh K. The rise of artificial intelligence in healthcare applications. In: Artificial Intelligence in Healthcare. [Internet]. 2020. p. 25-60. Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7325854\/.","DOI":"10.1016\/B978-0-12-818438-7.00002-2"},{"key":"3713_CR22","unstructured":"Landi H. Primary care is ripe for disruption. Here are the players trying to shake up the market [Internet]. Fierce Healthcare. 2020 [cited 2023 May 30]. Available from: https:\/\/www.fiercehealthcare.com\/practices\/primary-care-ripe-for-disruption-here-are-players-trying-to-shake-up-market."},{"key":"3713_CR23","unstructured":"Serajuddin M, Akhtar A, Khan A, Hasan Z. Transformation of healthcare in developing countries by new generation technologies and analyzing tools. Turk J Comput Math Educ. [Internet]. 2021;12(14):4779-4788. Available from: https:\/\/turcomat.org\/index.php\/turkbilmat\/article\/view\/11419\/8420."},{"key":"3713_CR24","doi-asserted-by":"crossref","unstructured":"Al-Kahtani MS, Khan F, Taekeun W. Application of internet of things and sensors in healthcare. Sensors (Basel). 2022;22(15):5738. Available from: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9371210\/.","DOI":"10.3390\/s22155738"},{"key":"3713_CR25","unstructured":"IBM. What is artificial intelligence in healthcare? [Internet]. IBM. 2023 [cited 2023 May 30]. Available from: https:\/\/www.ibm.com\/topics\/artificial-intelligence-healthcare."},{"key":"3713_CR26","doi-asserted-by":"crossref","unstructured":"Olaronke I, Oluwaseun O. Big data in healthcare: prospects, challenges and resolutions [Internet]. 2016. Available from: http:\/\/repository.futminna.edu.ng:8080\/jspui\/bitstream\/123456789\/11552\/1\/olaronke2016.pdf.","DOI":"10.1109\/FTC.2016.7821747"},{"key":"3713_CR27","unstructured":"Serajuddin M, Akhtar A, Khan A, Hasan Z. Transformation of healthcare in developing countries by new generation technologies and analyzing tools. Turk J Comput Math Educ. [Internet]. 2021;12(14):4779-4788. Available from: https:\/\/www.researchgate.net\/publication\/356086949_Transformation_of_healthcare_in_developing_countries_by_new_generation_technologies_and_analyzing_tools."},{"key":"3713_CR28","doi-asserted-by":"crossref","unstructured":"Verina N, Titko J. Digital transformation: conceptual framework. In: Proceedings of the 6th International Scientific Conference Contemporary Issues in Business, Management and Economics Engineering 2019 [Internet]. 2019. Available from: http:\/\/cibmee.vgtu.lt\/index.php\/verslas\/2019\/paper\/viewFile\/191\/197.","DOI":"10.3846\/cibmee.2019.073"},{"key":"3713_CR29","unstructured":"Kotselas V. The importance of digital transformation framework for organizations [Internet]. CEOWORLD Magazine. 2023 [cited 2023 May 28]. Available from: https:\/\/ceoworld.biz\/2023\/03\/28\/the-importance-of-digital-transformation-framework-for-organizations\/."},{"key":"3713_CR30","unstructured":"Digital Transformation Framework: Overview, Features, and Benefits [Internet]. Simplilearn. 2021 [cited 2023 May 30]. Available from: https:\/\/www.simplilearn.com\/digital-transformation-framework-article."},{"key":"3713_CR31","unstructured":"Programmers.io. Understanding digital transformation frameworks [Internet]. Programmers.io. [cited 2023 May 28]. Available from: https:\/\/programmers.io\/blog\/understanding-digital-transformation-frameworks\/."},{"key":"3713_CR32","unstructured":"Konopik J, Jahn C, Schuster T, Ho\u00dfbach N, Pflaum A. Mastering the digital transformation through organizational capabilities: a conceptual framework. Digit Bus. 2021;1(1):100019. Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2666954421000181#:~:text=Based%20on%20a%20comprehensive%20literature%20review%2C%20this%20study,into%20seven%20relevant%20themes%20for%20managing%20digital%20transformation."},{"key":"3713_CR33","unstructured":"University of Nigeria Teaching Hospital [Internet]. University of Nigeria Teaching Hospital; 2020 [cited 2023 May 30]. Available from: https:\/\/unth.edu.ng."},{"key":"3713_CR34","unstructured":"ESUT Teaching Hospital [Internet]. ESUT Teaching Hospital; 2020 [cited 2023 May 30]. Available from: https:\/\/esutth.org.ng\/index.php\/about-us."},{"key":"3713_CR35","unstructured":"National Orthopaedic Hospital Enugu [Internet]. Enugu: National Orthopaedic Hospital Enugu; 2020 [cited 2023 May 30]. Available from: https:\/\/nohenugu.org.ng\/site\/history.php."},{"key":"3713_CR36","doi-asserted-by":"crossref","unstructured":"Par\u00e9 G, Sicotte C, Poba-Nzaou P, Balouzakis G. Clinicians' perceptions of organizational readiness for change in the context of clinical information system projects: insights from two cross-sectional surveys. Implement Sci [Internet]. 2011;6(1). Available from: https:\/\/implementationscience.biomedcentral.com\/articles\/10.1186\/1748-5908-6-15.","DOI":"10.1186\/1748-5908-6-15"},{"key":"3713_CR37","unstructured":"Usability.gov. System Usability Scale (SUS) [Internet]. 2019. Available from: https:\/\/www.usability.gov\/how-to-and-tools\/methods\/system-usability-scale.html."},{"key":"3713_CR38","unstructured":"Brooke J. SUS: a quick and dirty usability scale [Internet]. 1986. Available from: https:\/\/hell.meiert.org\/core\/pdf\/sus.pdf."},{"key":"3713_CR39","doi-asserted-by":"crossref","unstructured":"Magdalena LM, Loaeza LS, Lazaro-Carrera B, Bourguet-Ramirez B, V\u00e1zquez Rodr\u00edguez A, Peralta-Pedrero ML, et al. Spanish version of the System Usability Scale for the assessment of electronic tools: development and validation. JMIR Hum Factors [Internet]. 2020;7(4):e21161. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/33325828\/.","DOI":"10.2196\/21161"},{"key":"3713_CR40","doi-asserted-by":"crossref","unstructured":"Onyeabor US, Onwuasoigwe O, Okenwa WO, Schaaf T, Pinkwart N, Balzer F. Exploring user experiences of clinicians engaged with digital healthcare interventions across referral and university teaching hospitals in Nigeria: a qualitative study. Front Digit Health [Internet]. 2025;7. Available from: https:\/\/www.frontiersin.org\/journals\/digital-health\/articles\/10.3389\/fdgth.2025.1488880\/full.","DOI":"10.3389\/fdgth.2025.1488880"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-026-03713-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-026-03713-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-026-03713-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:44:31Z","timestamp":1791852271000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12911-026-03713-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3713"],"URL":"https:\/\/doi.org\/10.1186\/s12911-026-03713-9","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"5 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Approval was granted by the ethical committees of the tertiary\/university teaching hospitals to conduct research at their facilities. We obtained three certificates of approval, one from each of the ethical committees, and presented them to department and unit heads for their support. The following ethical committees granted us permission to conduct research: University of Nigeria Teaching Hospital Ethical Clearance Committee. ESUT Teaching Hospital Ethical Committee. National Orthopaedic Hospital Enugu Ethical Clearance Committee.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We confirm that informed consent was received from all participants in this study; and also all appropriate ethical committees studied the scope of our research, which they found breaching no ethical protocols, before approval was given.","order":3,"name":"Ethics","label":"Informed consent to participate in the stud<b>y<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We confirm that all methods were performed in accordance with any relevant guidelines and regulations from the approving institutions.","order":4,"name":"Ethics","label":"<b>Conduct of research within approved ethical guidelines<\/b>","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"405"}}