MODERATING EFFECT OF HEALTHCARE DIGITIZATION ON THE RELATIONSHIP BETWEEN MEDICAL EQUIPMENT PROCUREMENT PRACTICES AND HEALTHCARE SERVICE DELIVERY AMONG REFERRAL HOSPITALS IN KENYA
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Abstract
This study examined the moderating effect of healthcare digitization on the relationship between medical equipment practices and and healthcare service delivery in referral hospitals in Kenya. The study was grounded in the systems theory. A positivist research philosophy was adopted, employing an explanatory cross-sectional research design. Primary data was collected through structured questionnaires administered to 156 key informants from all 52 referral hospitals in Kenya. The findings revealed that healthcare digitization demonstrated a synergistic moderating effect. This study contributes theoretically by extending the application of systems theory in healthcare delivery research, and methodologically by applying SEM with moderation analysis in the context of public healthcare systems. Managerially and policy-wise, the findings offer actionable insights for adopting digital health innovations to improve service quality, accessibility, and efficiency in referral hospitals. Limitations of the study included the use of a cross-sectional design, which restricts causal inference, and reliance on self-reported data, which may introduce response bias. Also, the study focused only on public referral hospitals and excluded private hospitals hence limiting the generalizability of the study findings. Future studies should consider longitudinal designs and incorporate patient-level data to validate and extend the current findings. Furthermore, future studies should consider integrating private hospitals to augment the generalizability of the study outcomes.
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References
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Afwande, M., Mbugua, S., & Kilwake, J. (2021). Framework for Evaluation of Effectiveness of Integrated Financial Management Information Systems Architecture Implemented in Public Hospitals in Kenya. International Journal of Scientific Research in Science Engineering and Technology, 38–41.
Ahmed, I., &Ishtiaq, S. (2021). Reliability and validity: Importance in medical research. Journal of Pakistan Medical Association, 71(10), 2401–2406.
Beaulieu, M., & Bentahar, O. (2021). Digitalization of the healthcare supply chain: A roadmap to generate benefits and effectively support healthcare delivery.
Bouh, M. M., Hossain, F., Paul, P., Rahman, M. M., Islam, R., Nakashima, N., & Ahmed, A. (2024). The impact of limited access to digital health records on doctors and their willingness to adopt electronic health record systems. Digital Health, 10.
Boulding, H., & Hinrichs-Krapels, S. (2021). Factors influencing procurement behaviour and decision-making: An exploratory qualitative study in a UK healthcare provider.
Brownie, S., & Oywer, E. (2016). Health professionals in Kenya: strategies to expand reach and reduce brain drain of psychiatric nurses and psychiatrists. BJPsych International, 13(3), 55–58.
Carini, E., Villani, L., Pezzullo, A. M., Gentili, A., Barbara, A., Ricciardi, W., & Boccia, S. (2021). The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review. Journal of Medical Internet Research, 23(9), e26189.
Cerchione, R., Centobelli, P., Riccio, E., Abbate, S., & Oropallo, E. (2023). Blockchain’s coming to hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem.
Chen, J., Lv, Y., & Fan, T. (2023). Research on the evolution and driving factors of digitalization of energy in China—A new perspective based on coupling coordination. Heliyon, 9(3), e14138.
Chikophe, R. M., Tenambergen, W. M., & Kyalo, C. K. (2024). Influence of procurement process on availability of essential drugs in public health facilities in Mombasa County, Kenya. International Journal of Health Sciences, 7(3), 44-56.
Cresswell, K., & Williams, R. (2024). Essential strategic principles for planning and developing digitally enabled interventions in health and care settings. BMC Health Services Research, 24(1), 11819.
Davis, M. J. (2024). Procurement practices influencing service delivery: A case of Kenya Power. European Journal of Logistics Purchasing and Supply Chain Management, 2(3), 79–137.
Fähndrich, J. (2022). A literature review on the impact of digitalisation on management control. Journal of Management Control, 34(1), 9–65.
Fraser, H. S., Mugisha, M., Bacher, I., Ngenzi, J. L., Seebregts, C., Umubyeyi, A., & Condo, J. (2024). Factors influencing data quality in electronic health record systems in 50 health facilities in Rwanda and the role of clinical alerts: Cross-sectional observational study.
Freitas, A. T. (2023). Data-driven approaches in healthcare: Challenges and emerging trends. In Law, Governance and Technology Series (pp. 65–80).
Give, C., Ndima, S., Steege, R., Ormel, H., McCollum, R., Theobald, S., Taegtmeyer, M., Kok, M., &Sidat, M. (2019). Strengthening referral systems in community health programs: A qualitative study in two rural districts of Maputo Province, Mozambique. BMC Health Services Research, 19(1).
Gupta, N., Coates, M. M., Bekele, A., Dupuy, R., Fénelon, D. L., Gage, A. D., … &Bukhman, G. (2020). Availability of equipment and medications for non-communicable diseases and injuries at public first‐referral level hospitals: A cross‐sectional analysis of service provision assessments in eight low‐income countries.
Guyow, H. A. (2021). Factors affecting medical equipment utilization in health service delivery in Mandera County Referral Hospital, Kenya (Doctoral dissertation, KeMU).
Haider, M., & Mohailan, S. (2020). Supply chain operations reference model: An analytical study.
Hair, J. F., Howard, M. C., & Nitzl, C. (2019). Assessing measurement model quality in PLS-SEM using confirmatory composite analysis. Journal of Business Research, 109, 101–110.
Ham, C. (2020). Health policy in Britain: The politics and organization of the National Health Service. Routledge.
Hinrichs-Krapels, S., Ditewig, B., Boulding, H., Chalkidou, A., Erskine, J., & Shokraneh, F. (2022). Purchasing high-cost medical devices and equipment in hospitals.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.
Huang, L., Lv, W., Huang, Q., Zhang, H., Jin, S., Chen, T., & Shen, B. (2024). Transforming medical equipment management in digital public health: A decision-making model for medical equipment replacement.
Justus, M. G., Kinyua, J. M., & Kariuki, S. N. (2021). Effect of system capability on the performance of level four public hospitals in Kenya.
Kabeta, S. H., Chala, T. K., &Tafese, F. (2023). Medical equipment management in general hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia.
Karim, A., de Savigny, D., Awor, P., Muñoz, D. C., Mäusezahl, D., Tshefu, A. K., … & Alegbeleye, A. (2022). The building blocks of community health systems: A systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions.
Kitila, S. B., Tesema, A. A., Bekele, G., Olika, A. K., Terfa, Y. B., Sinkie, S. O., & Olika, A. K. (2022). Average time spent in referral process and its determinants among clients of maternal and child health service in 2 districts of Jimma Zone, Ethiopia. Journal of Patient Experience, 9, 23743735221086757.
Leonardi, P. M., & Treem, J. W. (2020). Behavioral visibility: A new paradigm for organization studies in the age of digitization, digitalization, and datafication. Organization Studies, 41(12), 1601–1625.
Li, M., Zhang, Y., Lu, Y., Yu, W., Nong, X., & Zhang, L. (2017). Factors influencing two‐way referral between hospitals and the community in China: A system dynamics simulation model. SIMULATION, 94(9), 765–782.
Likert Scale in Social Sciences Research: Problems and Difficulties. (2022). FWU Journal of Social Sciences, 89–101.
Lingg, M., Wyss, K., & Durán-Arenas, L. (2016). Effects of procurement practices on quality of medical device or service received: A qualitative study comparing countries. BMC Health Services Research, 16(1).
Liu, Y., Liu, B., & Yang, H. (2024). Optimal pricing and financing strategies for leased equipment considering maintenance and lessees’ options. International Journal of Production Economics, 269, 109157.
Mackey, T. K., & Cuomo, R. E. (2020). An interdisciplinary review of digital technologies to facilitate anti-corruption, transparency and accountability in medicines procurement.
Modi, S., & Feldman, S. S. (2022). The value of electronic health records since the health information technology for economic and clinical health act: Systematic review.
Musiega, A., Tsofa, B., Nyawira, L., Njuguna, R. G., Munywoki, J., Hanson, K., Mulwa, A., Molyneux, S., Maina, I., Normand, C., Jemutai, J., &Barasa, E. (2022b). Examining the influence of budget execution processes on the efficiency of county health systems in Kenya. Health Policy and Planning, 38(3), 351–362.
Mwihia, F. (2020). Performance of public hospitals in Kenya: The essential role of management (Doctoral dissertation, University of Nairobi).
Ndlovu, K., Scott, R. E., & Mars, M. (2021, December). Interoperability opportunities and challenges in linking mHealth applications and eRecord systems: Botswana as an exemplar. BMC Medical Informatics and Decision Making, 21(1), 246.
Ngenzi, J. L., Scott, R. E., & Mars, M. (2021). Information and communication technology to enhance continuing professional development (CPD) and continuing medical education (CME) for Rwanda: A scoping review of reviews.
Nguru, K., & Ireri, L. (2022). Challenges influencing proper implementation of quality health care referral system in Kaloleni Sub-county, Kilifi County in Kenya.
Njanwe, P. J., Marete, I., & Ayaya, S. (2021). Adherence to national healthcare referral guidelines and its effect on the management outcomes among children seen at a teaching hospital in western Kenya.
Nyawira, L., Tsofa, B., Musiega, A., Munywoki, J., Njuguna, R. G., Hanson, K., Mulwa, A., Molyneux, S., Maina, I., Normand, C., Jemutai, J., & Barasa, E. (2022). Management of human resources for health: Implications for health systems efficiency in Kenya. BMC Health Services Research, 22(1).
Ohando, E. O., Minja, D., & Muna, W. (2024). Health infrastructure and implications on provision of health care services to nurses and medium level bureaucrats in health facilities in Siaya County and nationally, Kenya.
Okoroafor, S. C., Kwesiga, B., Ogato, J., Gura, Z., Gondi, J., Jumba, N., Ogumbo, T., Monyoncho, M., Wamae, A., Wanyee, M., Angir, M., Almudhwahi, M. A., Evalyne, C., Nabyonga-Orem, J., Ahmat, A., Zurn, P., & Asamani, J. A. (2022). Investing in the health workforce in Kenya: trends in size, composition and distribution from a descriptive health labour market analysis. BMJ Global Health, 7(Suppl 1), e009748.
Putri, Y. D., Huda, L. N., & Sinulingga, S. (2019, May). The concept of supply chain management performance measurement with the supply chain operation reference model (Journal review). In IOP Conference Series: Materials Science and Engineering, 505(1, p. 012011). IOP Publishing.
Rahmani, K., Karimi, S., Raeisi, A. R., & Rezayatmand, R. (2022). Comparative study of medical equipment procurement in selected countries. Medical Journal of the Islamic Republic of Iran, 36.
Schwen, L. O., Kiehl, T.-R., Carvalho, R., Zerbe, N., & Homeyer, A. (2023). Digitization of pathology labs: A review of lessons learned. Laboratory Investigation, 103(11), 100244.
Sepúlveda, M. B., Molina, C. E. Z., & Salazar, E. a. G. (2022). Validity of the general systems theory for applications in management. Revista En-contexto, 11(18).
Simon, D. A., Raza, S., Shachar, C., & Cohen, I. G. (2024). Using digital technologies to diagnose in the home: Recommendations from a Delphi panel. npj Digital Medicine, 7(1), 18.
Simeoni, C., & Kinoti, W. (2023). Medical equipment leasing in Kenya: Neocolonial global finance and misplaced health priorities. In C. Rodríguez Enríquez & M. Llavaneras Blanco (Eds.), Corporate capture of development: Public-private partnerships, women’s human rights, and global resistance (pp. 19–44).
Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital transformation in healthcare: Technology acceptance and its applications. International Journal of Environmental Research and Public Health, 20(4), 3407.
Verhoef, P. C., Broekhuizen, T., Bart, Y., Bhattacharya, A., Dong, J. Q., Fabian, N., & Haenlein, M. (2019). Digital transformation: A multidisciplinary reflection and researchagenda. JournalofBusinessResearch,122,889901.
Villalobos-Quesada, M., Ho, K., Chavannes, N. H., & Talboom-Kamp, E. P. (2023). Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics. European Journal of General Practice, 29(1), 2273615.
Von Bertalanffy, L. (1951). Problems of general system theory. Human Biology, 23(4), 302.
Wachira, B. W., & Mwai, M. (2021). A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients. African Journal of Emergency Medicine, 11(2), 213–217.
Yadav, P. (2024). Digital transformation in the health product supply chain: A framework for analysis. Health Systems & Reform, 10(2).
Yao, L., Shang, D., Zhao, H., & Hu, S. (2021). Medical equipment comprehensive management system based on cloud computing and internet of things. Journal of Healthcare Engineering, 2021, 1–12.
Zaagsma, G. (2022). Digital history and the politics of digitization. Digital Scholarship in the Humanities, 38(2), 830–851.
Zhang, Y., Hou, Z., Yang, F., Yang, M. M., & Wang, Z. (2021). Discovering the evolution of resource-based theory: Science mapping based on bibliometric analysis. Journal of Business Research, 137, 500-516.
Adjagba, A. O., Oguta, J. O., Akoth, C., Wambiya, E. O. A., Nonvignon, J., & Jackson, D. (2024). Financing immunisation in Kenya: examining bottlenecks in health sector planning and budgeting at the decentralised level. Cost Effectiveness and Resource Allocation, 22(1).
Afwande, M., Mbugua, S., & Kilwake, J. (2021). Framework for Evaluation of Effectiveness of Integrated Financial Management Information Systems Architecture Implemented in Public Hospitals in Kenya. International Journal of Scientific Research in Science Engineering and Technology, 38–41.
Ahmed, I., &Ishtiaq, S. (2021). Reliability and validity: Importance in medical research. Journal of Pakistan Medical Association, 71(10), 2401–2406.
Beaulieu, M., & Bentahar, O. (2021). Digitalization of the healthcare supply chain: A roadmap to generate benefits and effectively support healthcare delivery.
Bouh, M. M., Hossain, F., Paul, P., Rahman, M. M., Islam, R., Nakashima, N., & Ahmed, A. (2024). The impact of limited access to digital health records on doctors and their willingness to adopt electronic health record systems. Digital Health, 10.
Boulding, H., & Hinrichs-Krapels, S. (2021). Factors influencing procurement behaviour and decision-making: An exploratory qualitative study in a UK healthcare provider.
Brownie, S., & Oywer, E. (2016). Health professionals in Kenya: strategies to expand reach and reduce brain drain of psychiatric nurses and psychiatrists. BJPsych International, 13(3), 55–58.
Carini, E., Villani, L., Pezzullo, A. M., Gentili, A., Barbara, A., Ricciardi, W., & Boccia, S. (2021). The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review. Journal of Medical Internet Research, 23(9), e26189.
Cerchione, R., Centobelli, P., Riccio, E., Abbate, S., & Oropallo, E. (2023). Blockchain’s coming to hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem.
Chen, J., Lv, Y., & Fan, T. (2023). Research on the evolution and driving factors of digitalization of energy in China—A new perspective based on coupling coordination. Heliyon, 9(3), e14138.
Chikophe, R. M., Tenambergen, W. M., & Kyalo, C. K. (2024). Influence of procurement process on availability of essential drugs in public health facilities in Mombasa County, Kenya. International Journal of Health Sciences, 7(3), 44-56.
Cresswell, K., & Williams, R. (2024). Essential strategic principles for planning and developing digitally enabled interventions in health and care settings. BMC Health Services Research, 24(1), 11819.
Davis, M. J. (2024). Procurement practices influencing service delivery: A case of Kenya Power. European Journal of Logistics Purchasing and Supply Chain Management, 2(3), 79–137.
Fähndrich, J. (2022). A literature review on the impact of digitalisation on management control. Journal of Management Control, 34(1), 9–65.
Fraser, H. S., Mugisha, M., Bacher, I., Ngenzi, J. L., Seebregts, C., Umubyeyi, A., & Condo, J. (2024). Factors influencing data quality in electronic health record systems in 50 health facilities in Rwanda and the role of clinical alerts: Cross-sectional observational study.
Freitas, A. T. (2023). Data-driven approaches in healthcare: Challenges and emerging trends. In Law, Governance and Technology Series (pp. 65–80).
Give, C., Ndima, S., Steege, R., Ormel, H., McCollum, R., Theobald, S., Taegtmeyer, M., Kok, M., &Sidat, M. (2019). Strengthening referral systems in community health programs: A qualitative study in two rural districts of Maputo Province, Mozambique. BMC Health Services Research, 19(1).
Gupta, N., Coates, M. M., Bekele, A., Dupuy, R., Fénelon, D. L., Gage, A. D., … &Bukhman, G. (2020). Availability of equipment and medications for non-communicable diseases and injuries at public first‐referral level hospitals: A cross‐sectional analysis of service provision assessments in eight low‐income countries.
Guyow, H. A. (2021). Factors affecting medical equipment utilization in health service delivery in Mandera County Referral Hospital, Kenya (Doctoral dissertation, KeMU).
Haider, M., & Mohailan, S. (2020). Supply chain operations reference model: An analytical study.
Hair, J. F., Howard, M. C., & Nitzl, C. (2019). Assessing measurement model quality in PLS-SEM using confirmatory composite analysis. Journal of Business Research, 109, 101–110.
Ham, C. (2020). Health policy in Britain: The politics and organization of the National Health Service. Routledge.
Hinrichs-Krapels, S., Ditewig, B., Boulding, H., Chalkidou, A., Erskine, J., & Shokraneh, F. (2022). Purchasing high-cost medical devices and equipment in hospitals.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.
Huang, L., Lv, W., Huang, Q., Zhang, H., Jin, S., Chen, T., & Shen, B. (2024). Transforming medical equipment management in digital public health: A decision-making model for medical equipment replacement.
Justus, M. G., Kinyua, J. M., & Kariuki, S. N. (2021). Effect of system capability on the performance of level four public hospitals in Kenya.
Kabeta, S. H., Chala, T. K., &Tafese, F. (2023). Medical equipment management in general hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia.
Karim, A., de Savigny, D., Awor, P., Muñoz, D. C., Mäusezahl, D., Tshefu, A. K., … & Alegbeleye, A. (2022). The building blocks of community health systems: A systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions.
Kitila, S. B., Tesema, A. A., Bekele, G., Olika, A. K., Terfa, Y. B., Sinkie, S. O., & Olika, A. K. (2022). Average time spent in referral process and its determinants among clients of maternal and child health service in 2 districts of Jimma Zone, Ethiopia. Journal of Patient Experience, 9, 23743735221086757.
Leonardi, P. M., & Treem, J. W. (2020). Behavioral visibility: A new paradigm for organization studies in the age of digitization, digitalization, and datafication. Organization Studies, 41(12), 1601–1625.
Li, M., Zhang, Y., Lu, Y., Yu, W., Nong, X., & Zhang, L. (2017). Factors influencing two‐way referral between hospitals and the community in China: A system dynamics simulation model. SIMULATION, 94(9), 765–782.
Likert Scale in Social Sciences Research: Problems and Difficulties. (2022). FWU Journal of Social Sciences, 89–101.
Lingg, M., Wyss, K., & Durán-Arenas, L. (2016). Effects of procurement practices on quality of medical device or service received: A qualitative study comparing countries. BMC Health Services Research, 16(1).
Liu, Y., Liu, B., & Yang, H. (2024). Optimal pricing and financing strategies for leased equipment considering maintenance and lessees’ options. International Journal of Production Economics, 269, 109157.
Mackey, T. K., & Cuomo, R. E. (2020). An interdisciplinary review of digital technologies to facilitate anti-corruption, transparency and accountability in medicines procurement.
Modi, S., & Feldman, S. S. (2022). The value of electronic health records since the health information technology for economic and clinical health act: Systematic review.
Musiega, A., Tsofa, B., Nyawira, L., Njuguna, R. G., Munywoki, J., Hanson, K., Mulwa, A., Molyneux, S., Maina, I., Normand, C., Jemutai, J., &Barasa, E. (2022b). Examining the influence of budget execution processes on the efficiency of county health systems in Kenya. Health Policy and Planning, 38(3), 351–362.
Mwihia, F. (2020). Performance of public hospitals in Kenya: The essential role of management (Doctoral dissertation, University of Nairobi).
Ndlovu, K., Scott, R. E., & Mars, M. (2021, December). Interoperability opportunities and challenges in linking mHealth applications and eRecord systems: Botswana as an exemplar. BMC Medical Informatics and Decision Making, 21(1), 246.
Ngenzi, J. L., Scott, R. E., & Mars, M. (2021). Information and communication technology to enhance continuing professional development (CPD) and continuing medical education (CME) for Rwanda: A scoping review of reviews.
Nguru, K., & Ireri, L. (2022). Challenges influencing proper implementation of quality health care referral system in Kaloleni Sub-county, Kilifi County in Kenya.
Njanwe, P. J., Marete, I., & Ayaya, S. (2021). Adherence to national healthcare referral guidelines and its effect on the management outcomes among children seen at a teaching hospital in western Kenya.
Nyawira, L., Tsofa, B., Musiega, A., Munywoki, J., Njuguna, R. G., Hanson, K., Mulwa, A., Molyneux, S., Maina, I., Normand, C., Jemutai, J., & Barasa, E. (2022). Management of human resources for health: Implications for health systems efficiency in Kenya. BMC Health Services Research, 22(1).
Ohando, E. O., Minja, D., & Muna, W. (2024). Health infrastructure and implications on provision of health care services to nurses and medium level bureaucrats in health facilities in Siaya County and nationally, Kenya.
Okoroafor, S. C., Kwesiga, B., Ogato, J., Gura, Z., Gondi, J., Jumba, N., Ogumbo, T., Monyoncho, M., Wamae, A., Wanyee, M., Angir, M., Almudhwahi, M. A., Evalyne, C., Nabyonga-Orem, J., Ahmat, A., Zurn, P., & Asamani, J. A. (2022). Investing in the health workforce in Kenya: trends in size, composition and distribution from a descriptive health labour market analysis. BMJ Global Health, 7(Suppl 1), e009748.
Putri, Y. D., Huda, L. N., & Sinulingga, S. (2019, May). The concept of supply chain management performance measurement with the supply chain operation reference model (Journal review). In IOP Conference Series: Materials Science and Engineering, 505(1, p. 012011). IOP Publishing.
Rahmani, K., Karimi, S., Raeisi, A. R., & Rezayatmand, R. (2022). Comparative study of medical equipment procurement in selected countries. Medical Journal of the Islamic Republic of Iran, 36.
Schwen, L. O., Kiehl, T.-R., Carvalho, R., Zerbe, N., & Homeyer, A. (2023). Digitization of pathology labs: A review of lessons learned. Laboratory Investigation, 103(11), 100244.
Sepúlveda, M. B., Molina, C. E. Z., & Salazar, E. a. G. (2022). Validity of the general systems theory for applications in management. Revista En-contexto, 11(18).
Simon, D. A., Raza, S., Shachar, C., & Cohen, I. G. (2024). Using digital technologies to diagnose in the home: Recommendations from a Delphi panel. npj Digital Medicine, 7(1), 18.
Simeoni, C., & Kinoti, W. (2023). Medical equipment leasing in Kenya: Neocolonial global finance and misplaced health priorities. In C. Rodríguez Enríquez & M. Llavaneras Blanco (Eds.), Corporate capture of development: Public-private partnerships, women’s human rights, and global resistance (pp. 19–44).
Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital transformation in healthcare: Technology acceptance and its applications. International Journal of Environmental Research and Public Health, 20(4), 3407.
Verhoef, P. C., Broekhuizen, T., Bart, Y., Bhattacharya, A., Dong, J. Q., Fabian, N., & Haenlein, M. (2019). Digital transformation: A multidisciplinary reflection and researchagenda. JournalofBusinessResearch,122,889901.
Villalobos-Quesada, M., Ho, K., Chavannes, N. H., & Talboom-Kamp, E. P. (2023). Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics. European Journal of General Practice, 29(1), 2273615.
Von Bertalanffy, L. (1951). Problems of general system theory. Human Biology, 23(4), 302.
Wachira, B. W., & Mwai, M. (2021). A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients. African Journal of Emergency Medicine, 11(2), 213–217.
Yadav, P. (2024). Digital transformation in the health product supply chain: A framework for analysis. Health Systems & Reform, 10(2).
Yao, L., Shang, D., Zhao, H., & Hu, S. (2021). Medical equipment comprehensive management system based on cloud computing and internet of things. Journal of Healthcare Engineering, 2021, 1–12.
Zaagsma, G. (2022). Digital history and the politics of digitization. Digital Scholarship in the Humanities, 38(2), 830–851.
Zhang, Y., Hou, Z., Yang, F., Yang, M. M., & Wang, Z. (2021). Discovering the evolution of resource-based theory: Science mapping based on bibliometric analysis. Journal of Business Research, 137, 500-516.