Integration of Digital Health, Telemedicine, and Healthcare Service Management: Implications for Quality of Care and Health System Sustainability – A Scoping Review
DOI:
https://doi.org/10.51574/hayyan.v3i2.5212Keywords:
digital health; telemedicine; healthcare service management; quality of care; health system sustainability; health system innovationAbstract
Background:
Digital health and telemedicine have evolved into structural components of modern healthcare systems, fundamentally transforming how access, service delivery, and care coordination are organized. While their adoption accelerated during the COVID-19 pandemic, their broader implications for healthcare service management, quality of care, and system sustainability remain variably understood.
Aim:
This scoping review aims to synthesize current evidence on the integration of digital health, telemedicine, and healthcare service management, with a focus on their impact on quality of care and health system sustainability.
Methods:
A scoping review design was applied following PRISMA-oriented principles. Literature published between 2020 and 2026 was identified from major scientific databases, including PubMed, Scopus, and ScienceDirect. Studies were included if they examined digital health or telemedicine interventions and reported outcomes related to healthcare access, service quality, patient experience, efficiency, or sustainability. Evidence was synthesized across four domains: digital health ecosystem, access to care, service quality, and efficiency–sustainability.
Results:
The findings indicate that digital health and telemedicine expand healthcare access by reducing geographical and temporal barriers, improve service quality through enhanced coordination and communication, and increase operational efficiency by optimizing resource utilization and reducing unnecessary hospital visits. In addition, digital health contributes to system sustainability by enabling flexible, adaptive service delivery models and improving system resilience. However, these benefits are conditional on factors such as infrastructure readiness, interoperability, governance frameworks, and digital equity.
Conclusion:
Digital health and telemedicine should be conceptualized as healthcare service-management infrastructure rather than standalone technologies. Their impact on quality and sustainability depends on effective integration with clinical workflows, organizational processes, and policy frameworks. Future health systems must focus on governance, equity, and continuous performance evaluation to realize the full potential of digital transformation.
References
Adler-Milstein, J., et al. (2014). Electronic health record adoption. Health Affairs. https://doi.org/10.1377/hlthaff.2013.1279
Ashwood, J. S., et al. (2017). Direct-to-consumer telehealth. Health Affairs. https://doi.org/10.1377/hlthaff.2016.1130
Barbieri, C., Neri, L., Stuard, S., Mari, F., & Martín-Guerrero, J. D. (2023). From electronic health records to clinical management systems: How the digital transformation can support healthcare services. Clinical Kidney Journal, 16(11), 1878–1884. https://doi.org/10.1093/ckj/sfad168
Bashshur, R. L., et al. (2020). Telemedicine effectiveness. Telemedicine Journal. https://doi.org/10.1089/tmj.2020.29183.rb
Bates, D. W., et al. (2014). Big data in healthcare. Health Affairs. https://doi.org/10.1377/hlthaff.2014.0041
Bokolo, A. (2021). Telemedicine adoption. Healthcare. https://doi.org/10.3390/healthcare9020179
Boonstra, A., et al. (2014). EHR barriers. BMC Health Services Research. https://doi.org/10.1186/1472-6963-14-370
Budd, J., Miller, B. S., Manning, E. M., Lampos, V., Zhuang, M., Edelstein, M., McKendry, R. A. (2020). Digital technologies in the public-health response to COVID-19. Nature Medicine, 26(8), 1183–1192. https://doi.org/10.1038/s41591-020-1011-4
Carayon, P., et al. (2019). Health IT workload. BMJ Quality Safety. https://doi.org/10.1136/bmjqs-2018-007148
Chang, J. E., et al. (2021). Telehealth disparities. Health Affairs. https://doi.org/10.1377/hlthaff.2020.01786
Choi, K., Gitelman, Y., Leri, D., Deleener, M. E., Hahn, L., O’Malley, C., Lang, E., Patel, N., Jones, T., Emperado, K., Erickson, C., Rosin, R., Asch, D. A., Hanson, C. W., & Adusumalli, S. (2021). Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care. Healthcare, 9(3), 100568. https://doi.org/10.1016/j.hjdsi.2021.100568
Contreras, C. M., et al. (2020). Telemedicine impact. Surgical Endoscopy. https://doi.org/10.1007/s00464-020-07538-7
Cresswell, K., et al. (2013). EHR implementation. JAMIA. https://doi.org/10.1136/amiajnl-2012-001279
Dorsey, E. R., & Topol, E. J. (2020). Telemedicine future. NEJM. https://doi.org/10.1056/NEJMp2003539
Drury, P., et al. (2017). Telehealth cost-effectiveness. BMJ Open. https://doi.org/10.1136/bmjopen-2017-016242
Evans, R. S. (2016). Electronic health records. JMIR. https://doi.org/10.2196/jmir.6207
Fagherazzi, G., et al. (2020). Digital health. Journal of Medical Internet Research. https://doi.org/10.2196/16915
Gagnon, M. P., et al. (2016). Telehealth adoption. JMIR. https://doi.org/10.2196/jmir.3662
Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits. Primary Care. https://doi.org/10.1016/j.pop.2021.02.005
Golinelli, D., Boetto, E., Carullo, G., Nuzzolese, A. G., Landini, M. P., & Fantini, M. P. (2020). Adoption of digital technologies in health care during the COVID-19 pandemic: Systematic review of early scientific literature. Journal of Medical Internet Research, 22(11), e22280. https://doi.org/10.2196/22280
Hollander, J. E., & Carr, B. G. (2020). Telemedicine COVID-19. NEJM. https://doi.org/10.1056/NEJMp2003539
Iyengar, K., Upadhyaya, G. K., Vaishya, R., & Jain, V. (2020). COVID-19 and applications of digital health. Journal of Clinical Orthopaedics and Trauma, 11(4), 611–615. https://doi.org/10.1016/j.jcot.2020.04.015
Keesara, S., Jonas, A., & Schulman, K. (2020). Covid-19 and health care’s digital revolution. New England Journal of Medicine, 382(23), e82. https://doi.org/10.1056/NEJMp2005835 [colab.ws]
Kickbusch, I., et al. (2021). Digital health governance. Lancet. https://doi.org/10.1016/S0140-6736(21)00361-1
Kruse, C. S., & Heinemann, K. (2022). Facilitators and barriers to the adoption of telemedicine during the first year of COVID-19: Systematic review. Journal of Medical Internet Research, 24(1), e31752. https://doi.org/10.2196/31752
Kruse, C. S., Molina-Nava, A., Kapoor, Y., Anerobi, C., & Maddukuri, H. (2023). Analyzing the effect of telemedicine on domains of quality through facilitators and barriers to adoption: Systematic review. Journal of Medical Internet Research, 25, e43601. https://doi.org/10.2196/43601
Lennon, M. R., et al. (2017). EHR challenges. BMJ Health Informatics. https://doi.org/10.1136/bmjinnov-2017-000151
Mann, D. M., Chen, J., Chunara, R., Testa, P. A., & Nov, O. (2020). Telemedicine transformation during COVID-19. Journal of the American Medical Informatics Association, 27(7), 1132–1135. https://doi.org/10.1093/jamia/ocaa072
Mehrotra, A., et al. (2020). Telemedicine utilization. NEJM. https://doi.org/10.1056/NEJMp2005835
Mesko, B., et al. (2020). Digital health future. npj Digital Medicine. https://doi.org/10.1038/s41746-020-00323-1
Monaghesh, E., & Hajizadeh, A. (2020). Telehealth review. BMC Public Health. https://doi.org/10.1186/s12889-020-09301-4
Omboni, S., Ballatore, T., Rizzi, F., & Tomassini, F. (2022). Telemedicine and healthcare system sustainability. Telemedicine and e-Health, 28(6), 737–747. https://doi.org/10.1089/tmj.2021.0095
Rahimi, A. K., Pienaar, O., Ghadimi, M., Canfell, O. J., Pole, J. D., Shrapnel, S., van der Vegt, A. H., & Sullivan, C. (2024). Implementing AI in hospitals to achieve a learning health system: Systematic review of current enablers and barriers. Journal of Medical Internet Research, 26, e49655. https://doi.org/10.2196/49655
Sheikh, A., Anderson, M., Albala, S., Casadei, B., Franklin, B. D., Richards, M., Taylor, D., Tibble, H., & Mossialos, E. (2021). Health information technology and digital innovation for national learning health and care systems. The Lancet Digital Health, 3(6), e383–e396. https://doi.org/10.1016/S2589-7500(21)00005-4
Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), e17298. https://doi.org/10.2196/17298
Vidal-Alaball, J., Acosta-Roja, R., Pastor Hernández, N., Sanchez Luque, U., Morrison, D., Narejos Pérez, S., Pérez-Llano, J., López Seguí, F., & Salvador Vèrges, A. (2020). Telemedicine in the face of the COVID 19 pandemic. Atención Primaria, 52(6), 418–422. https://doi.org/10.1016/j.aprim.2020.04.003
Whitelaw, S., Mamas, M. A., Topol, E., & Van Spall, H. G. (2020). Digital technology and COVID-19. The Lancet Digital Health, 2(8), e435–e440. https://doi.org/10.1016/S2589-7500(20)30142-4
World Health Organization. (2021). Ethics and governance of artificial intelligence for health. World Health Organization.
Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., Curtis, S., Roman, M., Poon, E. G., Ferranti, J., Katz, J. N., & Tcheng, J. (2020). Telehealth transformation: COVID 19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957–962. https://doi.org/10.1093/jamia/ocaa067
