Digital health and capability maturity models—a critical thematic review and conceptual synthesis of the literature

Abstract

Abstract Objective A literature review of capability maturity models (MMs) to inform the conceptualization, development, implementation, evaluation, and mainstreaming of MMs in digital health (DH). Methods Electronic databases were searched using “digital health,” “maturity models,” and related terms based on the Digital Health Profile and Maturity Assessment Toolkit Maturity Model (DHPMAT-MM). Covidence was used to screen, identify, capture, and achieve consensus on data extracted by the authors. Descriptive statistics were generated. A thematic analysis and conceptual synthesis were conducted. Findings Diverse domain-specific MMs and model development, implementation, and evaluation methods were found. The spread and pattern of different MMs verified the essential DH foundations and five maturity stages of the DHPMAT-MM. An unanticipated finding was the existence of a new category of community-facing MMs. Common characteristics included: 1. A dynamic lifecycle approach to digital capability maturity, which is: a. responsive to environmental changes and may improve or worsen over time; b. accumulative, incorporating the attributes of the preceding stage; and c. sequential, where no maturity stage must be skipped. 2. Sociotechnical quality improvement of the DH ecosystem and MM, which includes: a. investing in the organization’s human, hardware, and software resources and b. a need to engage and improve the DH competencies of citizens. Conclusions The diversity in MMs and variability in methods and content can create cognitive dissonance. A metamodel like the DHPMAT-MM can logically unify the many domain-specific MMs and guide the overall implementation and evaluation of DH ecosystems and MMs over the maturity lifecycle.