Document Type : Narrative Review
Authors
1 Master’s Degree in Public Administration (Transformation Management), Islamic Azad University, Khorasgan Branch, Isfahan, Iran, and Director of Shafa Specialized Hospital
2 PhD student. public administration:comparative & development management .dehaghan unit.Islamic Azad University, Isfahan., Iran
3 Ph.D., Faculty Member at Islamic Azad University, Dehaghan Branch, Iran
4 Expert in Healthcare Management, Master's student in Healthcare Management at Isfahan University of Medical Sciences, Iran,
Abstract
Introduction
Smart hospitals, by leveraging technologies such as the Internet of Things (IoT) and artificial intelligence (AI), are transforming efficiency and quality in healthcare delivery. However, the adoption and implementation of these technologies in healthcare settings face numerous challenges and barriers. This study aims to identify and systematically analyze the key factors affecting the adoption of smart hospital technologies, based on a literature review and using the Technology–Organization–Environment framework.
Methods
This study was conducted in 2023 through a narrative review of scientific literature published in databases such as PubMed, Scopus, EBSCOhost, and ScienceDirect. Keywords such as “smart health,” “health information technology,” “adoption,” “barriers,” and “challenges” were used for the search. After the initial screening of 10,418 retrieved articles, 26 studies were selected and analyzed using the TOE framework to extract the main challenges and barriers to technology adoption in smart hospitals.
Results
Findings show that the challenges in adopting smart hospital technologies can be categorized into three main domains: technological, organizational, and environmental. Issues such as data security, high costs, system incompatibility, staff resistance, lack of financial and human resources, weak leadership, regulatory constraints, low digital literacy among users, and insufficient training were identified. Among these, organizational challenges had the most significant impact on the adoption process.
Conclusion
Overcoming these barriers requires integrated strategies including strengthening data governance, investing in technology infrastructure, workforce training, and effective management change. Future research should focus on developing practical solutions to facilitate smart hospital adoption. Implementing these strategies can support policymakers and healthcare managers in improving hospital performance and service quality.
Highlights
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2 . Pradhan B, Bhattacharyya S, Pal K. IoT-based applications in healthcare devices. J Healthc Eng. 2021;2021:1–16 .
3 . Al-khafajiy, M., Kolivand, H., Baker, T. et al. Smart hospital emergency system. Multimed Tools Appl 78, 20087–20111 (2019).https://doi.org/10.1007/s11042-019-7274-4
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5 . De Grood C, Raissi A, Kwon Y, Santana MJ. Adoption of e-health technology by physicians: A scoping review. J Multidiscip Healthc. 2016;9(1):335 .
6 . Lee SM, Lee D. Opportunities and challenges for contactless healthcare services in the post-COVID-19 era. Technol Forecast Soc Change.2021;167:120712 .
7 . Radanliev P, De Roure D, Maple C, Nurse JR, Nicolescu R, Ani U. AI security and cyber risk in IoT systems. Frontiers in Big Data. 2024 Oct 10;7:1402745.
8 . Baker J. The technology–organization–environment framework. Information Systems Theory: Explaining and Predicting Our Digital Society, Vol.1. 2011 Aug 1:231-45 .
9 . Porter A, Dale J, Foster T, Logan P, Wells B, Snooks H. Implementation and use of computerized clinical decision support in emergency prehospital care: A qualitative study. Implement Sci. 2018;13(1):91 .
10 . Ameri A, Salmanizadeh F, Keshvardoost S, Bahaadinbeigy K. Investigating pharmacists’ views on telepharmacy: Prioritizing key relationships,barriers, and benefits. J Pharm Technol. 2020;8755122520931442, [In Persian].
11 . Poudel A, Nissen LM. Telepharmacy: A pharmacist’s perspective on the clinical benefits and challenges. Integr Pharm Res Pract. 2016;5:75–82 .
12 . Melchiorre MG, Papa R, Rijken M, van Ginneken E, Hujala A, Barbabella F. eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project. Health Policy. 2018;122(1):53–63 .
13 . Gagnon MP, Payne-Gagnon J, Breton E, Fortin JP, Khoury L, Dolovich L, et al. Adoption of electronic personal health records in Canada: Perceptions of stakeholders. Int J Health Policy Manag. 2016;5(7):425–33 .
14 . Borries TM, Dunbar A, Bhukhen A, Rismany J, Kilham J, Feinn R, et al. The impact of telemedicine on patient self-management processes and clinical outcomes for patients with type I or II diabetes mellitus in the United States: A scoping review. Diabetes Metab Syndr. 2019;13(2):1353–7 .
15 . Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: Systematic review. JMIR Med Inform. 2017;5(4):e41 .
16 . Mansour RF, El Amraoui A, Nouaouri I, Díaz VG, Gupta D, Kumar S. Artificial intelligence and IoT-enabled disease diagnosis model for smart healthcare systems. IEEE Access. 2021;9:45137–46 .
17 . Paaske S, Bauer A, Moser T, Seckman C. The benefits and barriers to RFID technology in healthcare. On-Line J Nurs Inform. 2017;21(2):10–11 .
18 . Kapadia V, Ariani A, Li J, Ray PK. Emerging ICT implementation issues in aged care. Int J Med Inform. 2015;84(11):892–900 .
19 . Eden KB, Totten AM, Kassakian SZ, Gorman PN, McDonagh MS, Devine B, et al. Barriers and facilitators to exchanging health information: A systematic review. Int J Med Inform. 2016;88:44–51 .
20 . Tian S, Yang W, Le Grange JM, Wang P, Huang W, Ye Z. Smart healthcare: Making medical care more intelligent. Glob Health J. 2019;3(3):62–5 .
21 . Lim MC, Boland MV, McCannel CA, Saini A, Chiang MF, Epley KD, et al. Adoption of electronic health records and perceptions of financial and clinical outcomes among ophthalmologists in the United States. JAMA Ophthalmol. 2018;136(2):164–70 .
22 . Lukaschek K, Mergenthal K, Heider D, Hanke A, Munski K, Moschner A, et al. eHealth-supported case management for patients with panic disorder or depression in primary care: Study protocol for a cRCT (PREMA). Trials. 2019;20(1):662 .
23 . Treisman GJ, Jayaram G, Margolis RL, Pearlson GD, Schmidt CW, Mihelish GL, Kennedy A, Howson A, Rasulnia M, Misiuta IE. Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia. J Nerv Ment Dis. 2016 Aug;204(8):620-9. doi:10.1097/NMD.0000000000000471. PMID: 26828911; PMCID: PMC4972482
24 . Zadvinskis IM, Garvey Smith J, Yen PY. Nurses’ experience with health information technology. JMIR Med Inform. 2018;6(2):e38 .
25 . Alami H, Fortin JP, Gagnon MP, Pollender H, Tetu B, Tanguay F. The challenges of a complex and innovative telehealth project: A qualitative evaluation of the Eastern Quebec Telepathology Network. Int J Health Policy Manag. 2017;7(5):421–32 .
26 . Kruse CS, Mileski M, Alaytsev V, Carol E, Williams A. Adoption factors associated with electronic health record among long-term care facilities: A systematic review. BMJ Open. 2015;5(1):e006615 .
27 . Kooij L, Groen WG, van Harten WH. Barriers and facilitators affecting patient portal implementation from an organizational perspective: Qualitative study. J Med Internet Res. 2018;20(5):e183 .
28 . Kruse CS, Stein A, Thomas H, Kaur H. The use of electronic health records to support population health: A systematic review of the literature. J Med Syst. 2018;42(11):214 .
29 . Papa A, Mital M, Pisano P, Del Giudice M. E-health and wellbeing monitoring using smart healthcare devices: An empirical investigation. Technol Forecast Soc Change. 2020;153:119226 .
30 . Nguyen C, McElroy LM, Abecassis MM, Holl JL, Ladner DP. The use of technology for urgent clinician-to-clinician communications: A systematic review of the literature. Int J Med Inform. 2015;84(2):101–10 .
31 . Razmak J, Bélanger CH, Farhan W. Development of a techno-humanist model for e-health adoption. Int J Med Inform. 2018;120:62–76 .
32 . Faber S, van Geenhuizen M, de Reuver M. eHealth adoption factors in medical hospitals: A focus on the Netherlands. Int J Med Inform. 2017 Apr;100:77-89. doi: 10.1016/j.ijmedinf.2017.01.009. Epub 2017 Jan 21. PMID: 28241940.
33. Feng B, He P, Li P, Yao H, Ji Y, He J. Developing a smart healthcare framework with an 'Aboriginal lens'. Procedia Comput Sci. 2019;162:347–54
Keywords
Main Subjects
2 . Pradhan B, Bhattacharyya S, Pal K. IoT-based applications in healthcare devices. J Healthc Eng. 2021;2021:1–16 .
3 . Al-khafajiy, M., Kolivand, H., Baker, T. et al. Smart hospital emergency system. Multimed Tools Appl 78, 20087–20111 (2019).https://doi.org/10.1007/s11042-019-7274-4
4 . Yaqoob I, Salah K, Jayaraman R, Al-Hammadi Y. Blockchain for healthcare data management. Neural Comput Appl. 2021;1–16, [In Persian] .
5 . De Grood C, Raissi A, Kwon Y, Santana MJ. Adoption of e-health technology by physicians: A scoping review. J Multidiscip Healthc. 2016;9(1):335 .
6 . Lee SM, Lee D. Opportunities and challenges for contactless healthcare services in the post-COVID-19 era. Technol Forecast Soc Change.2021;167:120712 .
7 . Radanliev P, De Roure D, Maple C, Nurse JR, Nicolescu R, Ani U. AI security and cyber risk in IoT systems. Frontiers in Big Data. 2024 Oct 10;7:1402745.
8 . Baker J. The technology–organization–environment framework. Information Systems Theory: Explaining and Predicting Our Digital Society, Vol.1. 2011 Aug 1:231-45 .
9 . Porter A, Dale J, Foster T, Logan P, Wells B, Snooks H. Implementation and use of computerized clinical decision support in emergency prehospital care: A qualitative study. Implement Sci. 2018;13(1):91 .
10 . Ameri A, Salmanizadeh F, Keshvardoost S, Bahaadinbeigy K. Investigating pharmacists’ views on telepharmacy: Prioritizing key relationships,barriers, and benefits. J Pharm Technol. 2020;8755122520931442, [In Persian].
11 . Poudel A, Nissen LM. Telepharmacy: A pharmacist’s perspective on the clinical benefits and challenges. Integr Pharm Res Pract. 2016;5:75–82 .
12 . Melchiorre MG, Papa R, Rijken M, van Ginneken E, Hujala A, Barbabella F. eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project. Health Policy. 2018;122(1):53–63 .
13 . Gagnon MP, Payne-Gagnon J, Breton E, Fortin JP, Khoury L, Dolovich L, et al. Adoption of electronic personal health records in Canada: Perceptions of stakeholders. Int J Health Policy Manag. 2016;5(7):425–33 .
14 . Borries TM, Dunbar A, Bhukhen A, Rismany J, Kilham J, Feinn R, et al. The impact of telemedicine on patient self-management processes and clinical outcomes for patients with type I or II diabetes mellitus in the United States: A scoping review. Diabetes Metab Syndr. 2019;13(2):1353–7 .
15 . Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: Systematic review. JMIR Med Inform. 2017;5(4):e41 .
16 . Mansour RF, El Amraoui A, Nouaouri I, Díaz VG, Gupta D, Kumar S. Artificial intelligence and IoT-enabled disease diagnosis model for smart healthcare systems. IEEE Access. 2021;9:45137–46 .
17 . Paaske S, Bauer A, Moser T, Seckman C. The benefits and barriers to RFID technology in healthcare. On-Line J Nurs Inform. 2017;21(2):10–11 .
18 . Kapadia V, Ariani A, Li J, Ray PK. Emerging ICT implementation issues in aged care. Int J Med Inform. 2015;84(11):892–900 .
19 . Eden KB, Totten AM, Kassakian SZ, Gorman PN, McDonagh MS, Devine B, et al. Barriers and facilitators to exchanging health information: A systematic review. Int J Med Inform. 2016;88:44–51 .
20 . Tian S, Yang W, Le Grange JM, Wang P, Huang W, Ye Z. Smart healthcare: Making medical care more intelligent. Glob Health J. 2019;3(3):62–5 .
21 . Lim MC, Boland MV, McCannel CA, Saini A, Chiang MF, Epley KD, et al. Adoption of electronic health records and perceptions of financial and clinical outcomes among ophthalmologists in the United States. JAMA Ophthalmol. 2018;136(2):164–70 .
22 . Lukaschek K, Mergenthal K, Heider D, Hanke A, Munski K, Moschner A, et al. eHealth-supported case management for patients with panic disorder or depression in primary care: Study protocol for a cRCT (PREMA). Trials. 2019;20(1):662 .
23 . Treisman GJ, Jayaram G, Margolis RL, Pearlson GD, Schmidt CW, Mihelish GL, Kennedy A, Howson A, Rasulnia M, Misiuta IE. Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia. J Nerv Ment Dis. 2016 Aug;204(8):620-9. doi:10.1097/NMD.0000000000000471. PMID: 26828911; PMCID: PMC4972482
24 . Zadvinskis IM, Garvey Smith J, Yen PY. Nurses’ experience with health information technology. JMIR Med Inform. 2018;6(2):e38 .
25 . Alami H, Fortin JP, Gagnon MP, Pollender H, Tetu B, Tanguay F. The challenges of a complex and innovative telehealth project: A qualitative evaluation of the Eastern Quebec Telepathology Network. Int J Health Policy Manag. 2017;7(5):421–32 .
26 . Kruse CS, Mileski M, Alaytsev V, Carol E, Williams A. Adoption factors associated with electronic health record among long-term care facilities: A systematic review. BMJ Open. 2015;5(1):e006615 .
27 . Kooij L, Groen WG, van Harten WH. Barriers and facilitators affecting patient portal implementation from an organizational perspective: Qualitative study. J Med Internet Res. 2018;20(5):e183 .
28 . Kruse CS, Stein A, Thomas H, Kaur H. The use of electronic health records to support population health: A systematic review of the literature. J Med Syst. 2018;42(11):214 .
29 . Papa A, Mital M, Pisano P, Del Giudice M. E-health and wellbeing monitoring using smart healthcare devices: An empirical investigation. Technol Forecast Soc Change. 2020;153:119226 .
30 . Nguyen C, McElroy LM, Abecassis MM, Holl JL, Ladner DP. The use of technology for urgent clinician-to-clinician communications: A systematic review of the literature. Int J Med Inform. 2015;84(2):101–10 .
31 . Razmak J, Bélanger CH, Farhan W. Development of a techno-humanist model for e-health adoption. Int J Med Inform. 2018;120:62–76 .
32 . Faber S, van Geenhuizen M, de Reuver M. eHealth adoption factors in medical hospitals: A focus on the Netherlands. Int J Med Inform. 2017 Apr;100:77-89. doi: 10.1016/j.ijmedinf.2017.01.009. Epub 2017 Jan 21. PMID: 28241940.
33. Feng B, He P, Li P, Yao H, Ji Y, He J. Developing a smart healthcare framework with an 'Aboriginal lens'. Procedia Comput Sci. 2019;162:347–54
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