Global Digital Transformation in Healthcare: Impact of Connected Healthcare Systems on Patient Safety Open Access

The healthcare industry has undergone a dramatic transformation through technological advancements and changing approaches to patient care. The evolution of connected healthcare systems has significantly transformed patient safety and care delivery.^[1] Advancements in the Internet of Medical Things (IoMT), characterized by real-time patient monitoring, timely interventions, efficient healthcare delivery, and integration of advanced data technologies across healthcare systems, have improved patient safety and quality of care.^[2] Before these technological advancements, healthcare primarily operated on a reactive model, such as a patient relying on self-referral for medical assistance, often resulting in late diagnosis and treatment delays. Technologies like telemedicine and big data analysis facilitate a shift toward a proactive model, emphasizing prevention and personalized treatment; for example, in a recent publication in the Global Journal on Quality and Safety in Healthcare, Mondal and Sameer^[3] reported that connected healthcare systems equipped with computerized physician order entry (CPOE) and clinical decision support systems reduce medical errors and enhance patient safety. This commentary sheds light on the evolution of connected healthcare systems, their impact on patient safety, and barriers to adoption across different economic contexts.

Before using electronic health records (EHRs), paper-based documentation systems were challenged by limited error-tracking capabilities, poor communication, and inaccurate safety checks that impacted patient safety outcomes and healthcare quality. Implementing EHRs provided the basic clinical decision support system, CPOE features, and standardized safety protocols that reduced serious medication errors. Integrated health information systems emerged in the 2000s, which provided web-based healthcare services, initial telemedicine platforms, real-time alert systems, and standardized incident reporting systems that were found to improve quality and patient safety. Healthcare systems have since evolved to connected healthcare, characterized by the IoMT, artificial intelligence (AI) integration, predictive analytics, innovative alert systems, and cloud-based computing.^[4] AI can offer 92% accuracy in diagnostic imaging and improve productivity and workflow by reducing the time required.^[5] Healthcare systems focus on personalized medicine, called “Healthcare 5.0,” characterized by individual risk prediction and patient-specific safety protocols. Personalized medicine integrates genomic modeling and AI with digital health systems to establish personalized patient safety alerts. Abid et al^[6] discussed the importance of AI integration with patient engagement through a patient-centered approach to minimizing diagnostic errors. Personalized medications can reduce healthcare costs and improve patient safety outcomes by reducing dosing errors and adverse drug reactions.^[1] The future of healthcare may be characterized by the integration of Quantum computing for safety analytics, advanced robotics, autonomous monitoring systems, AI-driven preventive measures, and blockchain health records that have the potential to reshape the future of connected hospitals.

The evolution of connected healthcare systems demonstrates how patient safety has moved from reactive to proactive approaches, with each evolutionary phase bringing new tools and methodologies for protecting patients. Connected healthcare systems, primarily driven by the IoMT, have significantly transformed patient care by enhancing monitoring, diagnosis, and treatment processes. Mondal and Sameer^[3] found weak evidence for the efficiency of electronic incident reporting systems (EIRS) in preventing medical errors. In contrast, a Veterans Affairs Medical Center study^[7] demonstrated that implementing EIRS significantly enhances the prevention of medical errors by facilitating documentation, analysis, and learning from adverse events. EIRS fosters a safety culture by encouraging healthcare professionals to report incidents in real time and promoting timely investigations and corrective actions, thereby reducing underreporting and improving patient safety outcomes. Systematic analysis of reported incidents can identify trends and preventive measures, ultimately decreasing medical errors and enhancing overall healthcare quality.

The introduction of AI, blockchain, and wearable devices has provided new opportunities to enhance patient safety through real-time data collection, improved clinical decision support, drug traceability, and increased patient engagement. However, these advancements also bring new challenges that must be addressed. The challenges connected healthcare systems face vary in economic contexts. In high-income countries (HICs), the primary issues revolve around equitable access, privacy, and interoperability. In low- and middle-income countries (LMICs), there are infrastructural deficits, limited funding, lack of expertise, and low digital literacy for both patients and healthcare providers, in addition to the challenges faced by HICs.

Connected healthcare systems in HICs generate vast amounts of sensitive data that require strong protection measures. The large volume of data produced through integrating the IoMT can make healthcare systems vulnerable to cyberattacks and data breaches.^[8] Currently, HICs face data privacy issues, equitable access, and effective interoperability, underscoring the need for robust digital safety protocols in connected health.^[9] Collaboration among stakeholders is essential to maximize the benefits of these technologies. Establishing regulatory standards and oversight is crucial to ensuring the safety and security of connected healthcare systems. In addition, the overwhelming amount of information can influence healthcare providers and patients, potentially leading to misinterpretation or missed critical alerts, hindering their engagement in care.^[10] Therefore, implementing effective digital safety protocols and efficient data management standards is vital for harnessing the full potential of IoMT in healthcare.

LMICs are at a crucial juncture in their healthcare digitization efforts.^[11] Establishing robust legal and regulatory frameworks is essential for supporting this transformation. In addition, improving the computer literacy of healthcare professionals is paramount to successfully integrating digital technologies. Adopting the IoMT in healthcare presents significant opportunities for innovation; however, it necessitates ongoing training and education for the workforce to use these new technologies effectively. By developing IoMT and machine learning skills, healthcare settings can be transformed, leading to enhanced patient outcomes. Nonetheless, LMICs face considerable infrastructural challenges, including inconsistent internet access and limited funding, that can hinder the implementation of digital health solutions, such as telemedicine.^[12] For AI models and other digital health technologies to be effective, they must be customized to fit the local context. Tailoring these technologies to address regional needs is essential for ensuring that digital health initiatives are sustainable and impactful in the long term. This underscores the importance of localized strategies that consider the available resources.

Although healthcare systems in HICs and LMICs encounter different challenges, the ongoing digitization of healthcare opens up new avenues for both contexts. HICs primarily aim to enhance equity and efficiency, whereas LMICs concentrate on building foundational infrastructure and regulatory frameworks. According to the World Health Organization (WHO), the unique needs of HICs and LMICs can be addressed by fostering collaborative efforts and developing solutions tailored to each context. The WHO Digital Health Strategy (2021–2025)^[13] identifies the disparities among countries digitizing their healthcare systems, emphasizing the need to support LMICs in crafting and implementing effective digital health solutions. All member nations are encouraged to formulate national action plans, cultivate a skilled digital health workforce, and invest in leadership and frontline staff capacity-building. A sustainable and equitable health system reinforced by digital technologies can be created by leveraging global partnerships, ultimately enhancing patient safety. Furthermore, the WHO Global Patient Safety Strategy (2021–2023)^[14] highlights the transformative potential of innovative digital health solutions in improving patient safety. Integrating digital technology can be vital in fostering a culture of safety and active patient engagement, paving the way for significant improvements in patient care.

To conclude, improvements in patient safety have been intrinsically linked to the evolution and development of connected healthcare systems, with each new healthcare era bringing opportunities and challenges. Rapid technological advancement across the globe requires collaboration among healthcare providers and administrators, technology developers, and policymakers to overcome hurdles and establish secure, equitable, cost-effective, and connected healthcare systems. The transformation of patient safety through connected healthcare technologies is a continuous journey. HICs and LMICs are at different stages of this journey, with respective contextual challenges, but with the same goal: creating more efficient and fundamentally safer healthcare systems.