{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:57:09Z","timestamp":1772632629465,"version":"3.50.1"},"reference-count":100,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stated aims for digital healthcare transformation frequently cite goals for better coordinated patient-centric systems. However, despite advances in medical science, digital technologies, health policies, and billions of dollars invested over the past 25 years, most healthcare providers are far from fully realizing the demonstrated benefits of today's digital technologies for improving patient care. Sharing information across healthcare systems remains challenging. Problems with fragmentation, quality, inequities, and rising costs of care delivery persist. A recent study of 1,026 U.S. hospital systems found that only 15.8 percent achieved a digital maturity level needed to provide digitally enabled healthcare services to better coordinate patient care. More importantly, hospital systems that were most successful in digitally transforming demonstrated significantly superior patient outcomes. From a system engineering framework, we pose the problem as: How do we transform a system as complex as U.S. healthcare delivery from today's costly, fragmented provider-centric system to a better coordinated patient-centric system with improved quality, access, affordability, and patient and provider experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This mixed methods, cross disciplinary research employs an integrative approach, synthesizing diverse sources of evidence to explore challenges and issues associated with healthcare digital transformation. Data extraction was performed by studying the full text of over 100 articles, case studies, and other sources, which were then analyzed thematically employing a \u201cframework synthesis\u201d methodology, which uses a deductive approach rather than the more common inductive synthesis approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Research points to multiple factors impeding progress, not the least of which is the sheer complexity of the problem. Healthcare systems that achieved significantly superior results reported different approaches to digital transformation in ways that may not necessarily be apparent on the surface, primarily because it is not just about what they did but, more importantly, about how they did it. A growing body of knowledge indicates that achieving digital transformation requires substantially different systemic approaches to the problem that intersect across clinical, technical, behavioral, and organizational domains. In other words, systemic problems cannot be solved with siloed solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      This research explores these differences with the aim of determining how approaches differ, why the differences matter, and implications for achieving better results. Conceptualizing the healthcare delivery system as distinct from the practice of healthcare (medical practice) makes an important contribution to the evolving science of healthcare delivery \u2013 working\n                      <jats:italic>on<\/jats:italic>\n                      the healthcare delivery system versus working\n                      <jats:italic>in<\/jats:italic>\n                      the system.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1729616","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:02:59Z","timestamp":1772607779000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impediments to transforming the healthcare delivery system: shifting the paradigm from provider centric to patient centric"],"prefix":"10.3389","volume":"6","author":[{"given":"Elizabeth A.","family":"Regan","sequence":"first","affiliation":[{"name":"Health Informatics Lab, Integrated Information Technology Department, Molinaroli College of Engineering and Computing, University of South Carolina","place":["Columbia, SC, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manasa Devi","family":"Chinta","sequence":"additional","affiliation":[{"name":"Health Informatics, Integrated Information Technology Department, Molinaroli College of Engineering and Computing, University of South Carolina","place":["Columbia, SC, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e56316","DOI":"10.2196\/56316","article-title":"Digital maturity as a predictor of quality and safety outcomes in US hospitals: cross-sectional observational study","volume":"26","author":"Snowdon","year":"2024","journal-title":"J Med Internet Res"},{"key":"B2","first-page":"1","volume-title":"Transforming Health Care: Virginia Mason Medical Center\u2019s Pursuit of the Perfect Patient Experience","author":"Kenney","year":"2011"},{"key":"B3","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1089\/pop.2016.0076","article-title":"An innovative approach to health care delivery for patients with chronic conditions","volume":"20","author":"Clarke","year":"2017","journal-title":"Popul Health Manag"},{"key":"B4","first-page":"62","article-title":"Fixing health care on the frontlines","volume":"88","author":"Bohmer","year":"2010","journal-title":"Harv Bus Rev"},{"key":"B5","first-page":"Article 2","article-title":"Innovation in healthcare delivery systems: a conceptual framework","volume":"15","author":"Omachonu","year":"2010","journal-title":"Innovation J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1370\/afm.971","article-title":"The problem of fragmentation and the need for integrative solutions","volume":"7","author":"Stange","year":"2009","journal-title":"Ann Fam Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.dss.2012.10.001","article-title":"Improving the science of healthcare delivery and informatics using modeling approaches","volume":"55","author":"Gupta","year":"2013","journal-title":"Decis Support Syst"},{"key":"B8","first-page":"58","article-title":"Why innovation in health care is so hard","volume":"84","author":"Herzlinger","year":"2006","journal-title":"Harv Bus Rev"},{"key":"B9","first-page":"20","article-title":"Why the U.S. Healthcare system is so sick\u2009\u2026\u2009and what O.R. 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