Efficacy and pitfalls of digital technologies in healthcare services: A systematic review of two decades

Reviewed by: Mohammad Kamrul Hasan, Universiti Kebangsaan Malaysia, Malaysia; Bhabendu Kumar Mohanta, Gandhi Institute of Technology and Management (GITAM), India; Khaled Shuaib, United Arab Emirates University, United Arab Emirates

*Correspondence: Muhammad Imran Qureshi ku.ca.seet@ihseruq.m

This article was submitted to Digital Public Health, a section of the journal Frontiers in Public Health

Received 2022 Feb 5; Accepted 2022 Aug 8. Copyright © 2022 Akhtar, Khan, Qayyum, Qureshi and Hishan.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Associated Data

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.

Abstract

The use of technology in the healthcare sector and its medical practices, from patient record maintenance to diagnostics, has significantly improved the health care emergency management system. At that backdrop, it is crucial to explore the role and challenges of these technologies in the healthcare sector. Therefore, this study provides a systematic review of the literature on technological developments in the healthcare sector and deduces its pros and cons. We curate the published studies from the Web of Science and Scopus databases by using PRISMA 2015 guidelines. After mining the data, we selected only 55 studies for the systematic literature review and bibliometric analysis. The study explores four significant classifications of technological development in healthcare: (a) digital technologies, (b) artificial intelligence, (c) blockchain, and (d) the Internet of Things. The novel contribution of current study indicate that digital technologies have significantly influenced the healthcare services such as the beginning of electronic health record, a new era of digital healthcare, while robotic surgeries and machine learning algorithms may replace practitioners as future technologies. However, a considerable number of studies have criticized these technologies in the health sector based on trust, security, privacy, and accuracy. The study suggests that future studies, on technological development in healthcare services, may take into account these issues for sustainable development of the healthcare sector.

Keywords: healthcare, digital technologies, artificial intelligence, IoT, blockchain, SLR-M

Introduction

Technology has become an integral part of the healthcare sector and entirely transfigures medical practices. Cutting-edge digital technologies have improved the effectiveness of surgeries and helped maintain the quality of patient's life. Even individuals with severe medical complexities can maintain their health with the help of these technologies (1). The involvement of Artificial Intelligence (AI), machine learning, the Internet of Things (IoT), and blockchains revolutionized the healthcare sector, and the application of these technologies is beyond expected boundaries. The most promising advanced usage of these technologies is robotic surgery which has proved to be more efficient than conventional surgical procedures (2). Many digital applications and devices are aiding healthcare professionals in monitoring patients' real-time health status, even without visiting. After years of research, these digital devices are much more intelligent and sensitive and work based on the scientist's algorithm (3, 4). These devices are significantly increasing patients' recovery rates. Wearable devices manage the daily lifestyle routines of the users. The progress of digital technologies is changing the conceptualization of healthcare in recent times. Digital devices are nowadays mostly inbuilt functioning about the healthcare process and procedure.

Although technology and applications are sometimes not straightforward, many researchers developed user-friendly devices to enhance healthcare-related digital technologies. According to, digital healthcare significantly changed modern-day healthcare structure and made life easier for patients and healthcare providers. Despite the effectiveness of digital technologies in healthcare services, stakeholders reported several severe concerns about utilizing these technologies—for example, the security and safety of the patient's history. In digital health records, detailed information and history are available online, and they may not be secure from a privacy point of view.

Blockchain technologies are being introduced to overcome this challenge and considerably improve the security issues (5, 6); however, it is still in its infancy, and applications are minimal. Thus, a fundamental question that needs to be addressed here is what type of digital technologies are effective in the healthcare sector and how digital technologies have shaped the future landscape of digital healthcare? We understand that the penetration of digital technologies in the healthcare sector can't be effective unless interdisciplinary efforts have been made to provide relevant technology development. For this reason, we also aimed to map literature from a multidisciplinary perspective to highlight potential pitfalls and prospects.

This study is divided into five sections: the first section develops the background of the research and explains its goals; the second section talks about the research approach applied in this study; the third section highlights the key results, such as descriptive analysis, in-depth content and bibliometric analysis; the fourth section explains the results, specifically the four classes of digital technologies in healthcare; and the last section talks about conclusion, recommendations and limitations of the study.

Literature on digital technologies in healthcare

Developments in digital technologies in healthcare provide an opportunity to provide uninterrupted healthcare services. The use of digital healthcare systems has benefited monitoring, diagnosis, prevention, and treatment (7, 8). Kapoor et al. (9) demonstrated many digital applications useful for digital health purposes during the pandemic. Rojas et al. (10) highlighted the use of internet-based programs in curing depression. Henkenjohann (11) evident that using patients' digital records improved healthcare services efficiency. Modern health records use blockchain technology to exchange electronic health records between patients and doctors (12).

Robotic surgery based on artificial intelligence helps doctors deliver personalized therapy to patients, eliminate repetitive activities, and prevent significant illnesses (13). However, Artificial intelligence (AI) applications create a tangle of legal issues for healthcare professionals and technology developers, especially if they cannot define AI-generated suggestions (13). Zimmermann et al. (14) provided meta-analytical evidence on the efficacy of eHealth interventions in supporting the emotional and physical wellbeing of people with type 1 and type 2 diabetes and comparing glycemic control and psychosocial support interventions.

While most academics have found evidence of digital technology's efficiency in healthcare systems, a minority have found conflicting outcomes (7). For example, Rojas et al. (10) findings indicated that the intervention should be improved by raising levels of personalization and implementing metrics to promote adherence. They reported mixed results in Chile and Colombia and highlighted the relevance of factors other than the content of the intervention, such as the intervention's location or context. There has been an increase in the usage of digital technologies in digital patient records. According to Henkenjohann (11), integrating an electronic health record offers potential benefits and risks an individual's privacy. Individual motives based on feelings of volition or external requirements influence digital technologies in healthcare adoption, even though internal incentives are more substantial. Blockchain technologies got attention from the practitioners to avoid the concerns raised by the researchers (15). However, blockchain technologies are still in the infancy stage, and many security and environmental concerns question using these technologies in healthcare.

The above discussion can be concluded in the disagreement of the researchers on the effectiveness of a one-fit solution for digital technologies in healthcare services (16). A thorough mapping of existing literature on these digital technologies concerning their efficacy and pitfalls must be done to highlight the potential improvements.

Materials and methods

The current research encompasses literature from two large, reputed databases, Scopus and Web of Science, among the researchers worldwide. We used “digital technologies” AND “healthcare,” “artificial intelligence” AND “healthcare,” “IoT” AND “healthcare,” and “Blockchain” AND “healthcare” keywords for the literature search. Initially, 1,650 records were obtained. The PRISMA framework was used to screen the records as suggested by Moher et al. (17) and shown in Figure 1 . Critical inclusion and exclusion criteria used for this review were published articles in the English language and related to the digital technologies' scope in healthcare. The review papers, conference papers and review papers are excluded. Conclusive 323 studies are selected for stage 1 and used for keyword cloud and keyword occurrence. Later, a careful screening was performed for each identified classification to determine relevant records and only 55 articles were selected to be included to synthesize the review. Figure 1 shows the overall PRISMA statement selection and rejection process of the current study in detail.