ObjectiveThe objective of this research is to examine the relationship between digital maturity and hospital care provided to patients who are living with high social disparities.Materials and methodsThis cross-sectional observational study used digital maturity data from 2,247 acute-care hospitals in the United States, linked to CMS Cost Report data, CMS Hospital Service Area data, and ZIP-code-level Social Deprivation Index (SDI) data. EMRAM maturity was classified into three categories: Low=Stage 0, Medium=Stages 1–5, and High=Stages 6–7. The primary measure of social disparity was hospital-level weighted average SDI, dichotomized at the top 20%. Hospital-level administrative indicators included Medicaid caseload, charity-care burden, and bad-debt burden. Multinomial logistic regression was used as the primary model, adjusted for hospital characteristics and U.S. region. Results are reported as average differences in predicted probabilities of Low, Medium, and High EMRAM maturity. Pearson correlations and principal component analysis were used to assess convergence between SDI and hospital-level administrative proxy indicators.ResultsHospitals treating patient populations in communities with the top 20% of SDI were more likely to have Low EMRAM maturity and less likely to have High EMRAM maturity. In the adjusted multinomial logistic regression model, hospitals in the top SDI category were 5.9 percentage points more likely to have Low EMRAM maturity and 4.6 percentage points less likely to have High EMRAM maturity; the association with Medium EMRAM maturity was not statistically significant. Medicaid caseload and bad-debt burden were not significantly associated with EMRAM maturity. Charity-care burden was associated with EMRAM maturity differently by hospital ownership. Among nonprofit hospitals, top charity-care burden was associated with lower probability of Low EMRAM maturity and higher probabilities of Medium and High EMRAM maturity. Among proprietary hospitals, top charity-care burden was associated with lower probability of Low EMRAM maturity and higher probability of Medium EMRAM maturity, but not High EMRAM maturity. Among government hospitals, charity-care burden was not significantly associated with EMRAM maturity.Discussion and conclusionsHospitals serving populations with the highest social disparities were more likely to have Low EMRAM maturity and less likely to have High EMRAM maturity, suggesting that patients in these communities may have reduced access to hospitals with advanced digital maturity that supports coordinated, data-driven, safe, and high-quality care. Hospital administrative measures, including Medicaid caseload, uncompensated care, charity care, and bad debt, did not measure the same construct as community-level social deprivation. Charity-care burden was not uniformly associated with digital maturity across all hospitals; rather, its association differed by ownership type, with the strongest pattern observed among nonprofit hospitals. These findings should be interpreted as observational associations from pre-pandemic data and not as evidence of causal relationships.
Digital transformation is critical to strengthening public health infrastructure, yet implementation across jurisdictions remains uneven. In the United States, state-level public health systems vary widely in their digital capabilities. Missouri's Department of Health and Senior Services (DHSS) launched a digital modernization strategy to address these gaps. The objective of this work was to assess the digital maturity of Missouri's public health system and examine how a validated digital maturity framework can inform strategic planning and investment. This was a cross-sectional, quantitative study using primary data collected from 59 public health teams across six DHSS divisions in 2024. The validated Digital Health Indicator (DHI) framework was applied via structured interviews to assess digital maturity across four dimensions: governance and workforce, interoperability, person-enabled health, and predictive analytics. Descriptive statistics and ANOVA were used to compare results across divisions, with forest plots used to visualize pairwise differences. The mean DHI score was 35.6/100, with substantial variation across divisions (range: 7-68). The Division of Community and Public Health achieved the highest scores (mean 50.8), while the State Public Health Laboratory scored lowest (mean 19.0). Interoperability and predictive analytics showed the greatest variability. Organizational readiness was consistently high, but constrained by limited infrastructure and uneven workforce digital training. A standardized digital maturity framework can reveal systemic strengths and gaps within public health systems, guiding targeted, specific, measurable, achievable, relevant, and time-bound (SMART) digital investments. Missouri's experience demonstrates how structured assessment tools can support scalable and replicable digital transformation strategies applicable across U.S. states and other jurisdictions seeking to modernize public health services.
Canada's healthcare supply chain faces persistent disruptions, and its fragility has been well documented. This jeopardizes patients' access to critical care and places significant stress on healthcare professionals, which points to the essential need for a collaborative approach to building relationships, strengthening self-reliance and advancing healthcare supply chain resilience in Canada. This paper documents the design and development of a community of practice (CoP) strategy, bringing together representatives from different sectors, including the private sector, government, health workforce, health system leadership and citizens, to successfully mobilize their diverse expertise and co-design practical solutions to support supply chain resilience in Canada.
The purpose of this study was to investigate how the COVID-19 pandemic’s inaugural wave impacted the professional autonomy of family physicians in Canada. This study highlights how family physician’s resilience enabled them to overcome the many challenges they faced to provide health services to patients and has enabled them to rebuild their sense of purpose and duty of care. Four themes were found to summarize physician experiences: (1) loss of clinical autonomy and control; (2) abandonment and neglect by the health system; (3) a fear of patients “falling through the cracks” and moral injury; and (4) building resilience to support duty of care in family practice. These results highlight the emergence of resilience among family physicians to restore professional autonomy in family practice, overcoming moral injury in order to fulfil their “duty of care” to their patients. Physicians believe the health system’s crisis preparedness efforts need to be dedicated to protecting the autonomy of practicing physicians to maintain the continuity of quality patient care in future health crises.
Patient experience is globally recognized as an important indicator of health system performance, linked to health system quality and improving patient outcomes. Post COVID-19, health systems have embraced digital health and advanced digital transformation efforts; however, the relationship between digital health and patient experience outcomes is not well-documented. Using HCAHPS hospital survey data to measure patient experience, and HIMSS EMRAM Maturity Model data to measure digital maturity, a cross-sectional design using multivariate analyses examined the impact of digital maturity on patient experience in US hospitals. Our analysis shows that advanced digital maturity in US hospitals is associated with stronger patient experience outcomes, particularly relative to communication with nurses, doctors, and communication about medicines and therapies. The findings suggest that there are significant differences in patient experience associated with teaching versus nonteaching hospitals, urban versus rural hospitals. As hospitals advance and progress digital transformation initiatives, evidence to inform how transformation efforts can engage and advance patient experience will contribute to health system performance well into the future.
Background This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that an advanced digitally enabled workforce is associated with strong safety leadership and culture and better patient health and safety outcomes. Objective This study aimed to examine the relationship between digital maturity and quality and safety outcomes in US hospitals. Methods The data sources were hospital safety letter grades as well as quality and safety scores on a continuous scale published by The Leapfrog Group. We used the digital maturity level (measured using the Electronic Medical Record Assessment Model [EMRAM]) of 1026 US hospitals. This was a cross-sectional, observational study. Logistic, linear, and Tweedie regression analyses were used to explore the relationships among The Leapfrog Group's Hospital Safety Grades, individual Leapfrog safety scores, and digital maturity levels classified as advanced or fully developed digital maturity (EMRAM levels 6 and 7) or underdeveloped maturity (EMRAM level 0). Digital maturity was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership as confounding variables. Hospitals were divided into the following 2 groups to compare safety and quality outcomes: hospitals that were digitally advanced and hospitals with underdeveloped digital maturity. Data from The Leapfrog Group's Hospital Safety Grades report published in spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospital beds were obtained from the CMS database. Results The results revealed that the odds of achieving a higher Leapfrog Group Hospital Safety Grade was statistically significantly higher, by 3.25 times, for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7; odds ratio 3.25, 95% CI 2.33-4.55). Conclusions Hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes. The study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity compared with hospitals with underdeveloped digital maturity.
Prior to and during the COVID-19 pandemic, Canadian provincial health systems and governments did not sufficiently consider healthcare supply chain in their crisis preparedness plans, leading to an exposed and vulnerable healthcare system. There have been many opportunities to learn from past Canadian and global crises, which have emphasized the importance of healthcare supply chain resilience in providing essential care to patients; however, considerations of healthcare supply chain resilience remain a significant gap in preparedness planning. Illustrated through the Canadian response to COVID-19 pandemic, this article will explore how healthcare supply chain resilience should be a necessary consideration in any crisis preparedness plans. Further, without this consideration of healthcare supply chain resilience, it is the person (the patient and healthcare worker), and especially vulnerable populations, that are most put at risk in the event of a future crisis.
This provincial case study, one of seven conducted as part of a national research program on healthcare supply chain management during COVID-19, focuses on Alberta. With a history of emergency preparedness, Alberta’s unique context, one that includes having an already established, centralized, and digital healthcare supply chain strategy, sets this case apart from the others in terms of pandemic responses. A key challenge navigated by Alberta was the inadequacies of traditional sourcing and procurement approaches to meet surges in product demand, which was overcome by the implementation of unique procurement strategies. Opportunities for Alberta included the integration of supply chain teams into senior leadership structures, which enabled access to data to inform public health decision-making. This case demonstrated how Alberta’s healthcare supply chain assets—its supply chain infrastructure, data, and leadership expertise, especially—contributed to resilient supply chain capacity across the province.
RÉSUMÉLa pandémie du COVID-19 a affecté les chaînes logistiques de presque toutes les industries. Cette affirmation est encore plus vraie pour un secteur aussi névralgique que celui de la santé. Cette pandémie ramène à l'avant-plan le concept de résilience de la chaîne logistique. À cet effet, la présente étude entend répondre à cette question de recherche : quelles sont les initiatives qui pourraient être déployées à la lumière des leçons de la gestion des équipements de protection individuelle afin d'accroître la résilience de la chaîne logistique de la santé ? Pour répondre à cette question, une étude de cas sera menée auprès de deux provinces du Canada. L'exercice permettra de comparer les décisions qui ont été prises lors de la première vague de la pandémie et de suggérer des mesures qui pourront non seulement soutenir la résilience de cette chaîne logistique, mais aussi améliorer sa performance au quotidien.
The COVID-19 pandemic exposed significant fragilities in the configuration of global healthcare supply chains. This was felt acutely by citizens, patients and healthcare workers across Canada. As demand for critical medical products surged in Canada, and globally, provincial healthcare supply chain teams worked to rapidly stabilize their supply chains. These efforts indicate the emerging features of healthcare supply chain resilience. Results suggest that there are five emerging features: (1) redundancy of supply inventory; (2) diversification of suppliers across geographies; (3) maturity of digital infrastructure to create transparency; (4) proactivity; and (5) equity of distribution to protect the lives of all.
This provincial case study, one of seven conducted as part of a national research program on healthcare supply chain management during COVID-19, focuses on Ontario. The context of significant restructuring of health organizations and regions in Ontario challenged the province’s capacity to respond to COVID-19. A complex leadership structure, led by political leaders, with limited healthcare supply chain expertise at decision-making tables and a prioritization of “hospitals first” early in the first wave were described as challenges Ontario faced in managing the pandemic. A lack of supply chain digital infrastructure—and consequently, lack of available data—meant informed decision-making regarding supply utilization and demand forecasting was not possible. The Ontario case presents key lessons learned regarding the unintended consequences of lack of supply chain coordination across organizations, and the prioritization of hospitals and allocation strategies on Canada’s most vulnerable population segments.
Provincial health systems have been challenged by the surge in healthcare demands caused by the COVID-19 pandemic; the COVID-19 vaccine rollout across the country has further added to these challenges. A successful vaccination campaign is widely viewed as the only way to overcome the COVID-19 pandemic, placing greater urgency on the need for a rapid vaccination strategy. In this paper, we present emerging findings, from a national research study, that document the key challenges faced by current vaccine rollout strategies, which include procurement and leadership strategies, citizen engagement and limitations in supply chain capacity. These findings are used to inform a scalable vaccine strategy comprising collaborative leadership, mobilization of an integrated workforce and a digitally enabled supply chain strategy. The goal of vaccinating the entire Canadian population in the next few months can be achieved when supported by such a strategy.
The COVID-19 pandemic has highlighted the many challenges that provincial health systems have experienced while scaling health services to protect Canadians from viral transmission and support care for those who get infected. Supply chain capacity makes it possible for health systems to deliver care and implement public health initiatives safely. In this paper, we present emerging findings from a national research study that documents the key features of the fragility of the health supply chain evident across the seven Canadian provinces. Results suggest that the fragility of the health supply chain contributes to substantive challenges across health systems, thus limiting or precluding proactive and comprehensive responses to pandemic management. These findings inform strategies to strengthen supply chain capacity and performance in order to enable health systems to effectively respond to pandemic events.
This case study provides empirical evidence of the effect of implementing an integrated supply chain strategy province-wide to improve the safety, quality and performance of Alberta Health Services (AHS). AHS implemented a transformational supply chain strategy, enabled by GS1 standards, to achieve traceability of all products, equipment and patient safety events across the health system. Key features of the AHS strategy include strong vision and leadership, price harmonization, a provincial item master and integrated data infrastructure and a centralized warehouse and distribution strategy. Outcomes to date demonstrate a 7:1 return on investment, automated recall and traceability of patient safety events province-wide.
