Technovation 125 (2023) 102785

Contents lists available at ScienceDirect

Technovation
journal homepage: www.elsevier.com/locate/technovation

Disruptive digital innovations in healthcare: Knowing the past and

anticipating the future
Umesh Bamel a, Shalini Talwar b, Vijay Pereira c, Laura Corazza d, Amandeep Dhir e, f, g, *
a
International Management Institute New Delhi, India
b
S P Jain Institute of Management & Research (SPJIMR), Mumbai, India
c
Neoma Business School, Reims Campus, France
d
Department of Management, University of Turin, Turin, Italy
e
Department of Management, School of Business & Law, University of Agder, Kristiansand, Norway
f
Jaipuria Insitute of Management, Noida, India
g
Optentia Research Focus Area, North-West University, South Africa

A R T I C L E I N F O A B S T R A C T

Keywords: The twin focus on healthcare and digital transformation during the past two decades, which was intensified by
Disruptive digital innovations the COVID-19 pandemic to an unanticipated level, has resulted in the mushrooming of literature in the area.
Healthcare While this has enriched the available insights, it has also created a certain amount of confusion, and there is now
Artificial intelligence
a need to make sense of what has been achieved before undertaking research that contributes more meaningfully
Machine learning
to theory and practice in the area. Motivated by this need, we systematically analyze and evaluate the existing
Blockchain
IoT empirical research on the topic of disruptive digital innovations in healthcare. We followed a five-step approach
E-health to identify and analyze 42 congruent studies spread across domains, publishers, and geographies to achieve our
M-health objective. The outcome of our review is a conceptual framework that could serve to motivate and support future
Digital healthcare research. First, we presented a bibliographic sketch of the literature to clarify the milieu and descriptives. Next,
we performed content analysis to organize the existing evidence into meaningful streams. Towards this end, we
followed a structured approach to the review by defining the scope through a matrix–form conceptual framework
to guide thematic analysis. Accordingly, we reported on the findings from three perspectives—theoretical,
enabler, and barrier—anchoring them in four innovation implementations/outcomes: products, services, pro­
cesses, and business models. Our analysis suggests that existing scholarship has drawn upon various interdis­
ciplinary theories to map the enablers as well as the barriers that may inhibit the adoption and usage of these
disruptive innovations. Based on the findings of our structured approach, we offer useful recommendations to
advance research and practice in this field.

1. Introduction and business models) and help firms in achieving higher performance
through cost-effectiveness, the scope of their use or impact is not limited
With the progression of the digital era, advancements in digital to a particular field or domain (Valmohammadi, 2017). Almost all in­
technology have catalyzed the exponential growth of disruptive digital dustries leverage the benefits of digital innovations (Cohen et al., 2017),
innovations (DDIs). DDIs have become all-pervasive, impacting almost and the healthcare sector is no different (Looman et al., 2021). With
every product, service, and day-to-day organizational routine (Jahanmir sustainable development goals (SDGs; United Nations, n.d.) giving top
and Cavadas, 2018). The growth of these innovations has been largely priority to people and prosperity, and the COVID-19 pandemic pre­
fueled by an intense demand for transforming traditional business senting unforeseen public health challenges, timely healthcare and
models into more agile entities driven by digital technologies (Kohli and continued well-being have emerged as essential areas of focus, now
Melville, 2019). more than ever before. DDIs, with their sweeping transformations,
Since DDIs enable novel outcomes (i.e., products, services, processes, provide a ready platform to make healthcare more inclusive, accessible,

* Corresponding author. Department of Management, School of Business & Law, University of Agder, Kristiansand, Norway.
E-mail addresses: [email protected] (U. Bamel), [email protected] (S. Talwar), [email protected] (V. Pereira), [email protected]
(L. Corazza), [email protected] (A. Dhir).

https://doi.org/10.1016/j.technovation.2023.102785
Received 15 September 2021; Received in revised form 2 May 2023; Accepted 15 May 2023
Available online 11 June 2023
0166-4972/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
U. Bamel et al. Technovation 125 (2023) 102785

and effective. Talwar et al., 2020). To summarize, there are gaps in the literature in
To better understand the nature of the present-day healthcare chal­ terms of the contexts and variables examined and the research findings
lenge, the issues and impediments within existing systems need to be available, which severely constrain both theory and practice in the area
thoroughly diagnosed. The scholarly literature has paid close attention (Florian and Hess, 2020). On a positive note, these concerns can be
to some of these issues, enumerating high medical cost, asymmetric easily remedied through motivating research that expands the scope of
access to healthcare, and expensive healthcare infrastructure as some of investigations in the area.
the reasons that are limiting the efficiency of the healthcare system (e.g., One impediment that can hinder the recommendation of future
Paterick et al., 2009). At the same time, academic research suggests that research activity in the area is the lack of a systematic presentation,
the integration and adoption of DDIs and related technologies is one of which is evident in the DDI literature, in general, and is also observed in
the most convenient and cost-effective ways to address the various the case of healthcare research (Ma et al., 2020). To explain the issues
bottlenecks and obstacles in the healthcare system, ensuring healthy further, we observe that the scope of research on DDIs in healthcare is
lives and well-being for citizens (Abdel-Basset et al., 2021; Ienca and spread across multiple verticals such as products, processes, services,
Vayena, 2020; Konstantinidis et al., 2021). Indeed, several DDIs have and business models, including drug development (Afolabi, 2013),
been adopted to counter the challenges faced by the healthcare sector, occupational therapy (Imms et al., 2017), and the training and learning
such as online consultations with patients, 3D printing facilities, online of advance practice nursing (Campbell et al., 2021). Findings related to
care delivery, automated insulin delivery, remote consultation, flexible such diverse issues need structured mapping and consolidation before
operation theatres, home medical ventilation, and e-health records, to they can serve as a robust platform to support further research, which is
name a few (Alves et al., 2020; Jung and Padman, 2015). Past studies possible through rigorous review studies. Appreciating this need,
have determined that these initiatives have reduced the cost of health­ scholars have undertaken reviews in the past to synthesize the literature,
care to an appreciable extent, promoted and supported healthcare but the scope of these reviews is limited to certain niches, such as
infrastructure, and reduced the disparities in access to healthcare fa­ patient-centered digital health applications (Ludewig et al., 2021),
cilities (Jung and Padman, 2015). digital innovation for diet monitoring (Mortazavi and Gutierrez-Osuna,
These findings and observations have been supported by an appre­ 2021), and preventive psychiatry (Reilly et al., 2019). There is no
ciable volume of extant literature, with scholars noting the benefits of existing review that provides an all-inclusive and comprehensive eval­
adopting DDIs in the healthcare sector in terms of improvements in uation of research spanning the application of DDIs in products, services,
access and delivery of healthcare services to patients (e.g., Agarwal processes, and business models in the healthcare sector by following a
et al., 2010), consultative methods (Gupte et al., 2016), patient-centered structured and systematic approach. This is a visible gap that needs to be
care (Donaldson, 2008), patient safety (Jue et al., 2020), patient well­ addressed to energize and expedite future research endeavors. We aim to
being (Di Giacomo et al., 2021), preventive treatments (Paterick et al., fill this gap in the research by systematically reviewing the extant
2009), home-based/remote advisory and treatments (Ramaswamy et al., literature on DDI implementation in the healthcare sector using the
2020), collaborations, including inter-organizational collaborations, (i. popular approach of a systematic literature review (SLR). SLRs are a
e., with hospitals, universities, and other agencies; Secundo et al., 2019), popular approach used by many recent review studies (e.g., Dhir et al.,
telemedicine (Drago et al., 2021), and so on. Recent studies have spe­ 2020; Talwar et al., 2020b). We particularly propose to address the
cifically noted that some key digital innovations that have been instru­ following research questions (RQs): RQ1. How has the research on the
mental in increasing efficiency in the healthcare value chain are those implementation of DDIs in the healthcare sector evolved over the years?
based on disruptive technologies such as blockchain, artificial intelli­ and RQ2. What are the key themes in the congruent scholarly literature
gence (AI), machine learning, and robotics. (Sousa et al., 2019). on the implementation of DDIs in the healthcare sector that can guide
In sum, existing scholarship agrees that the adoption of digital in­ future research and practice?
novations, particularly DDIs in healthcare, has increased the overall To address these questions, we have further funneled them into
efficacy and resilience of the sector, making it more resilient (Cobianchi specific research objectives that are guided by the scope of review and
et al., 2020). The role of DDIs in the sector has become not only visible presented with a description of SLR methodology in the relevant part of
but also more critical during the recent global health crisis caused by the the study.
COVID-19 pandemic as the traditional healthcare system was forced to Our study adds to the current understanding of research on DDI
adapt and evolve (Cobianchi et al., 2020). For example, health surveil­ implementation in the healthcare sector in the following ways: First, to
lance apps are DDIs that significantly helped governments to better our knowledge, this is the maiden SLR synthesizing the research on DDI
manage the challenge of the COVID-19 pandemic around the world by implementation in the healthcare sector from the broad perspective of
providing the public health authorities with relevant details about products, services, processes, and business models. As a result, the
COVID-19 infected patients, their quarantine period, and their location findings offered are relevant to a larger group of researchers and prac­
(Susanto et al., 2020; Zhang et al., 2020). All in all, there is sufficient titioners. Second, the study provides visibility to the existing research in
evidence to support the claim that DDIs can be deployed effectively to the area by contextualizing it, thereby granting it theoretical and con­
help the healthcare sector overcome the ongoing and upcoming global ceptual legitimacy. Third, our SLR provides a balanced view of the
health management challenges. literature by classifying two distinct thematic areas—enabling factors
The preceding discussion confirms that academic research has that have increased the diffusion and effectiveness of DDIs in healthcare
accorded due attention to the diffusion of DDIs in the healthcare sector, in various implementation/outcome categories and inhibiting factors or
both at the administrative and medical service delivery levels. However, barriers and challenges that have obstructed/slowed the seamless
scholars have also been quick to admit that the diffusion of DDIs in implementation and diffusion of DDI in the sector. Such a systematically
healthcare as a research area is not fully developed since it lacks an organized view can serve to guide future researchers to plan their con­
independent body of literature, with the existing work remaining loosely ceptualizations better. Finally, our present research suggests future
connected (Florian and Hess, 2020; Kohli and Melville, 2019). The areas of investigation by identifying certain unanswered research
literature also seems to be skewed, with most of it focused on the ben­ questions in this domain. Knowing specific gaps will encourage focused
efits derived from DDI adoption, while critical issues, such as resistance and effective research capable of enhancing the maturity of knowledge
to technology acceptance, risks, patient-doctor relationships, and so on, in this field.
seem to be underdeveloped and deficient. These aspects may or may not
be serious in this context, but they need to be explored since resistance 2. Conceptual boundary and scope of the review
to innovations, in particular, is a phenomenon well-acknowledged in
other digital contexts (e.g., Sharma et al., 2021; Talwar et al., 2020a; Healthcare activities such as patient consultation and diagnosis,

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diagnostic procedures, sample collection, lab testing, maintaining re­ (Bosler et al., 2021; Ramaswamy and Ozcan, 2018), user-wellbeing
cords, drug development and testing, medical treatment procedures, (Majchrzak and Shepherd, 2021).
surgeries, patient data management, tracking patient history, collabo­ The motivation for our study comes from the fact that while the
rations, and knowledge sharing offer a huge scope for implementing existing insights are exciting, they are lacking from two prominent
digital innovations (Cobianchi et al., 2020; Neumaier, 2019). Due to the perspectives—first, the accumulated literature research has yet to catch
anticipated gains, the healthcare sector has observed an unprecedented up with the practice, and second, there are too many ongoing parallel
and organic adoption of digital technologies (Ienca and Vayena, 2020; conversations, making the existing literature fragmented and difficult to
Keesara et al., 2020). Most of such digital innovations in the sector have absorb. For the literature in the area to be more incisive and attractive
the potential to drastically transform the traditional way of doing things, from a practice perspective, the findings need to be augmented in both
so they are often called DDIs to truly reflect their impact. The planned depth and width, which mandates generating noticeable momentum to
implementation of these DDIs has the potential to develop an effective, conduct research in the area. However, to encourage future research
sustainable, and robust healthcare ecosystem comprising multiple actors endeavors, there is a need to structure the current diverse and loosely
such as healthcare practitioners and professionals, hospitals, pharma­ coupled body of literature to present a more coherent and cohesive
cies, drug companies, R&D labs and universities, and government bodies narrative. We address this need by systematically reviewing the litera­
and departments (Cobianchi et al., 2020; Cohen et al., 2017; Nambisan, ture using the SLR approach.
2017; Rippa and Secundo, 2019; Secundo et al., 2019). Taking the discussion forward, the prior literature on DDIs largely
Such a dynamically evolving ecosystem needs extensive and agrees on two characteristics or features: convergence and generativity
continuous research inputs for it to expand and overcome its challenges. (Nambisan, 2017). Convergence means that information technology
Our study is an attempt in this direction. To better understand the architecture and artifacts enable information and knowledge sharing
context of our study, it is essential to first have a more detailed discus­ among various actors of an ecosystem (Tilson et al., 2012). In compar­
sion on DDIs. To present a clear picture, we begin by focusing first on ison, generativity refers to those features that enable existing informa­
digital innovations and thereafter moving on to the disruptive aspect. tion technology architecture and artifacts to generate new offerings (i.e.,
The term digital innovation has a broad context, and it can be defined as products, services, and processes; Liu et al., 2022; Tilson et al., 2012).
“the creation of (and consequent change in) market offerings (product Since our objective is to examine the literature around disruptive digital
and services), business processes, and business models that result from innovations in the healthcare sector, our review subscribes to this pop­
the use of digital technology” (Nambisan, 2017, p. 224). In comparison, ular and uncontended conceptualization of DDIs and focuses on the four
DDIs have a more specific connotation, referring to innovations such as implementation/outcome categories of DDIs in healthcare—products,
AI, blockchain, virtual/augmented reality, 3D printing, and the Internet services, processes, and business models (Nambisan, 2017; Tilson et al.,
of things (IoT), which are quite drastic in their impact and bring about 2012; Florian and Hess, 2020; Kohli and Melville, 2019).
highly visible changes in the way things are done at work as well as play Towards this end, we propose a framework for guiding our review in
(Harrington, 2023). In other words, DDIs are innovations that involve a structured manner. This framework, in the form of a matrix presented
using digital technologies in innovative and novel ways (Kohli and in Fig. 1, provides the basis for a thematic analysis of the congruent
Melville, 2019; Nambisan, 2017), and their value comes from their literature. On the one hand, it accommodates the conventional imple­
inherent architecture (Kohli and Melville, 2019; Nambisan, 2017). To mentation/outcome categories of DDIs in healthcare, and on the other
elaborate, DDIs enable major business improvements and trans­ hand, it incorporates diffusion-related aspects (theoretical perspectives,
formations across various commercial functions and industries (Khin enablers, and barriers). The idea behind such a conceptualization is to
and Ho, 2020). Importantly, DDIs create value for organizations and bring together the concerns of theory and practice.
their stakeholders by supporting the creation of novel products, services,
processes, and business models (Ciriello et al., 2018; Hinings et al., 3. Methods
2018; Ramaswamy and Ozcan, 2018). Other benefits that can accrue
from adopting DDIs include a higher degree of customer involvement Our study aims to critically examine the past research in the area to
(Shi et al., 2022), enhanced firm performance through rapid innovation set the agenda for future research on the implementation of DDIs in the
and operational efficiency (Liu et al., 2022), entrepreneurship trans­ healthcare sector. To achieve the proposed outcomes of our study, we
formation (Elia et al., 2020; Kitsios and Kamariotou, 2022), digital considered the available literature holistically, reviewing it systemati­
boosts/transformations (Schneckenberg et al., 2021), and value creation cally and comprehensively using the SLR approach. SLR is a suitable

Fig. 1. Framework for thematical analysis of research on disruptive digital innovations in healthcare.

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Fig. 2. The SLR process.

approach for our study due to two main advantages: (i) it provides a Table 1
reproducible and systematic consolidation of the literature (Kaur et al., Inclusion and exclusion criteria.
2021; Kushwah et al., 2019); (ii) it is considered an appropriate method Inclusion criteria Exclusion criteria
for reviews with clear guiding research questions (Talwar et al., 2020b;
(i) only empirical articles (i) articles published in other than English
TM et al., 2021). Following recent studies (e.g., Madanaguli et al., 2021; language
Seth et al., 2020), we used a five-step process for executing the SLR: (a) (ii) only articles published in (ii) research notes, lecture notes, editorials,
defining clear research objectives, (b) identifying relevant keywords for peer-reviewed journals conference papers, proceedings, expert opinions,
a literature search (c) setting distinct inclusion and exclusion criteria, and theses
(iii) review and conceptual articles
(d) sorting and filtering the literature to select congruent studies, and (e) (iv) duplicate articles based on titles/DOIs
conducting content analysis to critically review the selected literature.
This process is exhibited in Fig. 2.
care*” or “health service*” or “public health*” or “health-care*” and
3.1. Research objectives “disruptive technolog*” or “digital innovation*” or “disruptive innova­
tion*.” Thereafter, in concurrence with recent studies (e.g., Kaur et al.,
In alignment with our proposed research questions and the concep­ 2022), we searched these words on two prominent digital data­
tual framework present in Fig. 1, we sought to achieve three research bases—Scopus and Web of Science (WoS). Herein, we searched these
objectives (ROs). keywords in an all fields query in WoS and in a Title-ABS-Key query in
Scopus. Further, to make sure that all potentially relevant studies were
RO.1: What are the various theoretical perspectives used in different identified, we did not limit the search to a specific timeframe of shorter
implementation categories/outcomes of DDIs in healthcare? duration.
RO.2: What are the enabling factors that support the implementation
of DDIs and positive outcomes in different healthcare verticals and 3.3. Inclusion and exclusion criteria
contexts?
RO.3: What are the barriers and challenges that hinder the imple­ Our keyword search across multiple databases resulted in the gen­
mentation of DDIs and positive outcomes in different healthcare eration of a large list of studies that were potentially incongruent with
verticals and contexts? the scope of the review. Hence, these needed to be filtered and refined.
To execute such filtration effectively, we laid down distinct inclusion
3.2. Relevant keywords and exclusion criteria consistent with recent reviews (e.g., TM et al.,
2021); these are presented in Table 1.
To achieve the objectives of the SLR, we needed to select the relevant
studies to be reviewed. The first step in this selection process was the 3.4. Selection of congruent studies
identification of keywords to help search the relevant articles. Towards
this end, we followed the popular practice (e.g., Chaudhary et al., 2022) After an all-inclusive initial keyword search, which was rerun in
of generating an exhaustive list of keywords: “healthcare*” or “health August 2022, we found 1542 articles, of which 887 were from Scopus

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and 655 from WoS. Next, we applied the first three exclusion criteria, per the themes presented in the conceptual framework in Fig. 1.
which yielded 783 relevant articles of which 401 were from Scopus and
382 from WoS. 4.1. Research profile
Thereafter, we merged the Scopus and WoS lists and applied the
fourth exclusion criterion, whereby we removed the duplicate articles. We examined the 42 studies to extract descriptive details related to
This step resulted in a joint pool of 580 potentially relevant studies. operational and methodological choices. The yearly trend of publica­
Moving on to a closer evaluation, the author team read the titles and tions, as presented in Fig. 3, reveals that the research on implementa­
abstracts of these articles to confirm their congruence with the topic at tional aspects of DDIs in healthcare has still not gained the desired
hand. This step helped us identify 103 studies to take forward for full- momentum and continues to grow at a tepid pace. However, the existing
text reading. As a result of full-text reading, undertaken independently studies have been published by noteworthy publishers, including
by each author, we excluded 64 articles that were not relevant to our Blackwell Publishing, Cambridge University Press, Elsevier, Emerald
specific context of DDIs in healthcare and shortlisted a data set of 39 Publishing, SAGE Publications Ltd., and Springer.
empirical articles to be included in the SLR. We also undertook a Fig. 4 illustrates the geographical scope of the accumulated research.
citation-chaining search of these 39 articles to find three more relevant The data indicates a noticeable skew of insights from developed coun­
studies, which were also included in the survey. The final data set taken tries, with more than 50 percent of the insights coming from the United
forward for systematic review comprised 42 journal articles published in States and European nations.
English. Coming to methodological choices, the existing scholarship has
shown an inclination to favor qualitative methods, with nearly 74
3.5. Analysis of the literature percent of the studies using methods such as case studies, observations,
interviews, focus group discussions, and Delphi studies (e.g., Khatter
To synthesize and present the findings and relevant details for and Relan, 2022; Kraus et al., 2022). The remaining 26 percent are based
making sense of the fragmented literature field, which at times appears on quantitative approaches, with data collected through cross-sectional
in completely undiscernible silos, we analyzed the shortlisted set of 42 surveys, experiments, secondary data sources, and work-flow analysis
studies from two perspectives: (a) an analysis of bibliographical details (Samonte et al., 2022; Subirats et al., 2015). In addition, most studies
to understand the research profile of the extant literature, and (b) a were conducted at a single point in time, with data collected in a single
detailed qualitative content analysis. The bibliographic profile of the wave, and very few chose to collect data longitudinally (e.g., Shimada
studies is important to motivate future research since it helps in un­ et al., 2013).
derstanding research trends, potential publication targets, geography- To their credit, the reviewed studies have examined diverse target
related scope, and method-related gaps. Similarly, qualitative content groups ranging from single organizations (e.g., Khatter and Relan, 2022)
analysis of the shortlisted congruent literature is important not only to to entrepreneurs (Beaulieu and Lehoux, 2019; Garbuio and Lin, 2019;
synthesize the scattered evidence and present a meaningful narrative Janssen and Moors, 2013), advanced practice nurse faculty and partic­
but also to assess it critically to develop a conceptual framework to guide ipants (Campbell et al., 2021), medical and healthcare professionals
future research on DDIs transforming the face of healthcare. (Bagot et al., 2015; Shah et al., 2019; Zaman et al., 2021), pharmacy
owners and assistants (White, 2009), various cohorts at healthcare fa­
4. Results and discussion cilities (Shimada et al., 2013), patients (Hans et al., 2018; Jung and
Padman, 2014; Kario, 2020; Kraus et al., 2022; Subirats et al., 2015;
The results and discussion section is arranged into two sub-sections. Wong et al., 2017), projects (Evans et al., 2009; Herrmann et al., 2018;
First, we present the research profile details of the eligible data set in Keijser et al., 2016), IoT users (Ben Arfi et al., 2021), and service pro­
terms of publication trends and publishers, geographical context, viders (Veld et al., 2011).
method and research design, sample, and DDI implementation/outcome The final profile-based information that we extracted from the
categories. We also discuss the potential implications of the findings for shortlisted studies concerned the context/categories. Herein, in terms of
future research. In the second sub-section, the findings are discussed as DDI implementation/outcome categories, maximum inquiries (based

Fig. 3. Yearly publication trend.

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Fig. 4. Geographical scope.

solely on one implementation/outcome category) were about processes 4.2.1. Theoretical perspectives on disruptive digital innovations in
(29 percent), and 21 percent of the inquiries considered two or more healthcare
implementation/outcome categories (e.g., services, processes, and The research on DDIs in healthcare is in a nascent state, with scholars
business models). The details are presented in Table 2. still exploring various aspects and outcomes to develop a preliminary
understanding. Despite the exploratory nature of the inquiries, these
4.2. Thematic analysis and discussion initial efforts have appreciable theoretical grounding. Our content
analysis confirmed that diverse theoretical frameworks have been uti­
This section presents a thematic evaluation of the shortlisted studies. lized to ground the conceptualization. Some exemplars include the
With the conceptual framework proposed to guide the scope of our disruptive innovation framework (Afolabi, 2013), top management
analysis as a point of reference, we evaluated and synthesized the full team (Garbuio and Lin, 2019), and simulative learning (Campbell et al.,
text of each study and consolidated the findings into three stream­ 2021). The fine-grained aspects of the application of these theories in the
s—theoretical perspectives, enablers, and barriers, aligning them at the underlying literature become even more clear when seen in the context
same time with the four implementation/outcome categories. of the four implementation/outcome categories. Consequently, we have
divided the discussion into four sub-themes—business models, pro­
cesses, products, and services.

Table 2
DDI implementation/outcome categories.
4.2.1.1. Theoretical perspectives and business models. Insights: The busi­
ness model outcome of DDI implementation in healthcare has received
Implementation/outcome Studies
due attention with discussions focused on AI technology development
categories
strategy, business models for mobile telehealth services, customer
Business models (8) Beaulieu and Lehoux (2019); Garbuio and Lin needs, the development and dissemination of health technologies, the
(2019); Herrmann et al. (2018); Janssen and
Moors (2013); Khatter and Relan (2022); Sterling
implementation of e-health innovations, models for the supply chain,
and LeRouge (2019); van Meeuwen et al. (2015); etc. Specifically, Garbuio and Lin (2019) used the theoretical lens of the
Veld et al. (2011) top management team paradigm to discuss AI-based business models for
Processes (12) Afolabi (2013); Bagot et al. (2015); Campbell et al. healthcare start-ups, and Veld et al. (2011) used the service, technology,
(2021); Garrety et al. (2014); Keijser et al. (2016);
organization, and financing (STOF) framework to discuss trans­
Kraus et al. (2022); Li et al. (2022); Samonte et al.
(2022); Sangal et al. (2022); Shah et al. (2019); formations in telemonitoring and teletreatment models. In other studies
Sharp et al. (2020); Wong et al. (2017) focused on business models, Virtanen et al. (2016) utilized the theo­
Products (5) Evans et al. (2009); Kario (2020); Nguyen et al. retical propositions of service dominant logic for conceptualizing and
(2015); Rushforth and Greenhalgh (2020); explicating customer needs and developing business intelligence,
Subirats et al. (2015)
Services (8) Ben Arfi et al. (2021); Gilbert Hunt (2017); Jung
Beaulieu and Lehoux (2019) employed neo-institutional theory to
and Padman (2014); Looman et al. (2021); Menon investigate the dynamics of how entrepreneurs managed the challenges
et al. (2019); Shimada et al. (2013); Steele Gray of market and healthcare systems and interacted with other actors, and
et al. (2018); White (2009) van Meeuwen et al. (2015) used the design approach and actor per­
Processes and services (4) Abdel-Basset et al. (2021); Hans et al. (2018);
spectives to create a business model toolkit for online pre-care services.
Mukherjee (2021); Sahu et al. (2020)
Products, processes, and Castro e Melo & Araújo (2020); McBee and Wilcox
services (3) (2020); Zaman et al. (2021) 4.2.1.2. Theoretical perspectives and processes. Process outcomes of DDIs
Services, processes, and Sust et al. (2020); Virtanen et al. (2016) that have been examined using a suitable theoretical lens include drug
business models (2)
development, training of advanced practice nursing, health innovation

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systems, the adoption of mobile technologies, and participation in 4.2.2.1. Enablers and business models. DDIs bring with them multiple
telemedicine. More specifically, Afolabi (2013) used a disruptive inno­ changes for business models, and enablers play the role of motivating
vation framework for conceptualizing varied nuances of indigenous stakeholders to make the changes required to adjust to the new reality.
medicine research, and Li et al. (2022) employed complex system theory In this regard, the reviewed studies identified several enablers that
to discuss 5G-enabled COVID-19 prevention and control. Resonating support business model outcomes. These include customer value prop­
with the disruptive nature of the innovations being examined, Bagot ositions, customer needs, and customer acquisitions (Herrmann et al.,
et al. (2015) and Garrety et al. (2014) utilized disruptive innovation 2018; Sterling and LeRouge, 2019), key resources such as technology
theory to examine the use of telemedicine in acute health settings and and venture capital providers (Garrety et al., 2014; Herrmann et al.,
healthcare. Existing scholarship has drawn upon some novel theoretical 2018; Sterling and LeRouge, 2019), the brand extension and profit for­
lenses to examine the process outcomes of DDIs. For instance, Mukherjee mula (Herrmann et al., 2018; Sterling and LeRouge, 2019), opportunity
(2021) used a health technology assessment framework to examine the identification (Beaulieu and Lehoux, 2019), and the involvement of
process outcomes of integrating technology to manage the COVID-19 experts from health sectors, strategic collaborations, and
pandemic, and Sangal et al. (2022) employed swift trust and organiza­ service-dedicated experts (van Meeuwen et al., 2015). These enablers
tion information theory to investigate blockchain adoption in the can further be contextualized by classifying them under the broad types:
omnichannel healthcare sector. Interestingly, acknowledging that DDIs institutional (brand extension, profit formulas, and opportunity identi­
brought various coping challenges, Shah et al. (2019) invoked the fication); actor-related (customer value propositions, customer needs,
change management perspective for explicating the process-related as­ and customer acquisitions); infrastructure/resource-related (technology
pects of transitioning to a mobile-first culture of work. and venture capital providers); products/services-related (service dedi­
cated experts); and partnership-related (involving experts from health
4.2.1.3. Theoretical perspectives and products. In comparison to business sectors and strategic collaborations).
models and processes, fewer product-related outcomes of DDIs have
been examined using a theoretical lens. In fact, only three such con­ 4.2.2.2. Enablers and processes. Next, we synthesized and classified the
texts—personalized medicine, an antiaging drug, and electronic nursing enablers of the process outcomes (such as drug development, COVID-19
documents—were examined through theoretical frameworks. Admit­ management, e-learning in APN, cost management processes, policy
tedly, scholars have used uniquely befitting theoretical frameworks in formulation, the adoption of mobile technologies, clinical information
this regard. In the case of personalized medicine, Rushforth and systems rollout, remote patient monitoring, medical imaging record
Greenhalgh (2020) utilized the strong structuration theory to examine management, and knowledge transformation and learning). The key en­
the issues related to the failure of personalized medicine in the UK. To ablers in this regard include collaboration and knowledge sharing (Afo­
contribute meaningful insights on the development of an antiaging drug, labi, 2013; Virtanen et al., 2016), trainers’ ability and leadership support
Evans et al. (2009) used the programmed and error theory of aging, and (Campbell et al., 2021; Shah et al., 2019; Wong et al., 2017), organiza­
Nguyen et al. (2015) used the actor-network approach to examine the tional culture (Shah et al., 2019), user engagement and user-centric ser­
transition of patient records in Australia from paper versions to elec­ vice production (Shah et al., 2019; Virtanen et al., 2016), staff training
tronic form. and engagement (Hans et al., 2018; Wong et al., 2017), individual and
relational capabilities (Sharp et al., 2020), change management and
4.2.1.4. Theoretical perspectives and services. As in the case of product- disruptive business models (Keijser et al., 2016), and technological
related outcomes, where the theoretical perspectives were quite nar­ development and adoption (Abdel-Basset et al., 2021). These process
row, past studies have examined only a limited variety of service-related outcome enablers can be classified under the five broad types as follows:
outcomes of DDIs, such as e-healthcare, management of COVID-19, and institutional (leadership support, organizational culture, change man­
community-based primary healthcare. Specifically, Ben Arfi et al. agement, and knowledge sharing); actor-related (trainers’ ability, staff
(2021) used a common-yet-popular technology adoption theory, the training and engagement, individual and relational capabilities, and user
unified theory of acceptance and use of technology, to examine the engagement); infrastructure/resource-related (disruptive business models
factors driving the acceptance of e-healthcare services, and Abdel-Basset and technological development and adoption); products/services-related
et al. (2021) utilized neutrosophic theory to propose a framework based (user-centric service production); and partnership-related (collaboration).
on disruptive technologies for COVID-19 analysis. In another study,
Steele Gray et al. (2018) used service-dominant logic to examine the role 4.2.2.3. Enablers and products. Analysis of the short-listed studies sug­
of ubiquitous revolutions in clinical care, remote monitoring, etc. and gests that factors such as stakeholder engagement (Evans et al., 2009;
the diffusion of innovation and normalization process theory for Rushforth and Greenhalgh, 2020), and employee training (Nguyen et al.,
examining integrated community-based primary healthcare. 2015), and features such as reliability, accuracy, and flexibility (Kario,
2020) promote product-related outcomes of DDI implementation.
4.2.2. Enablers of disruptive digital innovations in healthcare Within the broad categories, the types of enablers include the
Diffusion and sustained use of any innovation in any setting, following: institutional (organizational culture), actor-related (employee
particularly in the digital domain, is driven or impeded by certain en­ training and stakeholder engagement), products/services-related (fea­
ablers of adoption. It is no different for the healthcare sector. Content tures such as reliability, accuracy, and flexibility), and infrastructure/
analysis of the short-listed studies confirmed that the existing scholar­ resource-related (system integration).
ship had indeed noted various enablers that support the diffusion of
DDIs. The reviewed studies discussed a number of enablers, ranging 4.2.2.4. Enablers and services. Offering the deepest insights among the
from organizational factors to resource availability. The majority of four outcome categories, the enablers of service-related outcomes of
studies included in the review have discussed various enablers; however, DDIs identified by the reviewed studies include partnerships (Gilbert
the narratives are confusing. To make sense of the enablers discussed in Hunt, 2017), infrastructure and policy (Menon et al., 2019), leadership
the literature, we have not only divided the discussion into four sub- (Shimada et al., 2013), employee involvement, technology adoption,
themes—business models, processes, products, and services—but also training, reorganization of the work process, and vendor support (White,
coded them and clubbed them under five aggregate dimensions repre­ 2009), knowledge management and user-centered production (Virtanen
senting broad types of enablers—institutional, actor-related (users, et al., 2016), staff competencies (Shimada et al., 2013), service pro­
providers, other stakeholders), infrastructure/resource-related, prod­ viders’ training and the availability of and access to relevant informa­
ucts/services-related, and partnership-related as presented in Table 3. tion (Hans et al., 2018), resources such as technological infrastructure

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U. Bamel et al. Technovation 125 (2023) 102785

Table 3
Enablers of disruptive digital innovation outcomes in healthcare.
Type of enabler Enablers Business Processes Products Services
models

Institutional Leadership Y Y – Y
Organizational culture – Y Y Y
Information and knowledge sharing Y Y – Y
Reorganization of work process – – – Y
Strategic orientation Y Y – Y
Actor-related (users, providers, other Training, trainers’ ability – Y Y Y
stakeholders) Employee involvement Y Y Y
End-user engagement Y Y – Y
Stakeholder engagement – – Y –
End users’ expectations Y Y – Y
Skills and competencies of service providers (individual and relational – Y – Y
capabilities)
Customer retention and customer value proposition Y – – –
Infrastructure/resource-related Technological infrastructure such as IoMT, drones, and robots – Y – Y
Financial provisions Y – – Y
Technology development Y Y Y Y
Information availability – – Y
Products/services-related Features such as accuracy, flexibility – – Y –
Partnership-related Partnership – – – Y
Vendor support – – Y
Institutional collaboration Y Y – Y
Collaborative governance – – – Y

(Abdel-Basset et al., 2021), finance, multidisciplinary teams, feedback, privacy); ecosystem-related (lack of process standardization); strategic
and governance mechanisms (Looman et al., 20201), expected outcomes orientation-related (identification of suitable disruptive technology,
such as performance and efforts (Ben Arfi et al., 2021), and demographic misalignment, scalability, and issues in the implementation of e-health
features of the users (van Meeuwen et al., 2015). innovations); and resource/infrastructure constraints-related (asymme­
These enablers can be further classified under four of the five broad try of resources and technologies).
types: institutional (leadership, multi-disciplinary team, feedback,
governance mechanism, knowledge management, and reorganization of 4.2.3.2. Barriers and processes. The process outcome-related barriers
work process); actor-related (expected outcomes, employee involve­ and challenges are well considered in the past literature on DDI imple­
ment, service providers’ training, user-centered production, staff com­ mentation in the healthcare sector, with scholars identifying the
petencies, and training); infrastructure/resource-related (technology following impediments: poor linkage among various stakeholders
adoption, finance, technological infrastructure, availability and access (Afolabi, 2013), lack of users’ acceptance and anxiety (Afolabi, 2013;
to relevant information, and ecosystem integration); and partnership- Sharp et al., 2020), technical, operational, and legal issues (Sangal et al.,
related (partnership, vendor support, policy, and ecosystem 2022), perceived cost in terms of time and effort, poor fit with existing
integration). work schedule, and care givers’ resistance (Hans et al., 2018), role
clarity among teams and accountability (Sharp et al., 2020), training of
4.2.3. Barriers impeding disruptive digital innovations in healthcare trainer, lack of administrative support, and lack of approval from
Coming to the final theme, content analysis of the retrieved studies accreditors (Campbell et al., 2021), data quality, privacy, and gover­
helped us in consolidating insights related to various barriers identified nance (Garrety et al., 2014), lack of in-person contact (Castro e Melo &
by the existing scholarship. As in the case of enablers, the discussion on Araújo, 2020), and lack of regulations on various aspects such as drug
barriers is also fragmented and siloed in past studies. To make the testing (Afolabi, 2013). Factors such as poor change management,
content more useful and discernible, we have not only divided the clinical factors, expertise of staff, and staff-to-patient ratio (Wong et al.,
barriers into four sub-themes—business models, processes, products, 2017), political, economic, and institutional context (Mukherjee, 2021),
and services—but also coded them to club them under seven aggregate social and cultural factors (Castro e Melo & Araújo, 2020; Mukherjee,
dimensions representing broad types of barriers: data-related, user- 2021), complexity and dynamics of service space (Virtanen et al., 2016),
related, organizational, ecosystem-related, policies and regulations- cost-effectiveness and patient convenience (Kraus et al., 2022), tech­
related, strategic orientation-related, and resource/infrastructure nological constraints and sample biasness (Sahu et al., 2020), gover­
constraints-related, as presented in Table 4. nance models (Keijser et al., 2016), unknown patient outcomes and lack
of follow up communication (Bagot et al., 2015), and handling real-time
4.2.3.1. Barriers and business models. We analyzed the content of the big data and diverse devices (Li et al., 2022) also impede the success of
retrieved studies to understand the barriers that the existing scholarship DDI process outcomes.
had observed as impediments to business model outcomes of DDI In terms of the seven broad types, these barriers may be categorized
implementation in the healthcare sector. The main barriers and chal­ as follows: data-related (data quality, privacy, handling real-time big
lenges enumerated in the literature were related to the identification of data); user-related (perceived cost in terms of time and effort, sample
suitable disruptive technology, data security, and trust (Garbuio and Lin, biasness, lack of users’ acceptance and anxiety, patient convenience, not
2019), lack of process standardization (Sterling and LeRouge, 2019), knowing the patient outcome, caregivers’ resistance); organizational
misalignment and asymmetry of resources and technologies (Beaulieu (training of trainer, poor fit with existing work schedule, role clarity
and Lehoux, 2019), scalability (Khatter and Relan, 2022), data quality among team and accountability, lack of follow up communication, lack
and patient privacy (Garrety et al., 2014), and issues in the imple­ of administrative support, cost-effectiveness, poor change manage­
mentation of e-health innovations (van Meeuwen et al., 2015). These ment); ecosystem-related (clinical factors, lack of in-person contact,
barriers can be further classified under five of the seven broad types: poor linkage among various stakeholders, political, economic, institu­
data-related (data security and trust, data quality); user-related (patient tional, social and cultural factors); policies and regulations-related (legal

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U. Bamel et al. Technovation 125 (2023) 102785

Table 4 Table 4 (continued )

Barriers impeding disruptive digital innovations in healthcare. Type of barrier Barriers Business Process Product Service
Type of barrier Barriers Business Process Product Service model
model
Boundary Y – – –
Data-related Data security Y Y Y Y misalignment
and privacy Innovation Y Y – –
Data quality Y Y – – implementation
Information – – – Y Resource/ Poor resource Y – – –
access barriers infrastructure asymmetry
Data governance – Y – constraints- Technological – Y – Y
and related constraints
accountability Skilled staff – Y Y –
Data breach and – Y – Y Limited – – – Y
data safety functionality of
regulation technology
User-related User acceptance – Y – – Inter-operability – Y –
Uncertainty – Y – – Lack of funding – – – –
about patient
outcomes
Perceived cost – Y – Y issues, lack of regulations on various aspects such as drug testing, lack of
and risk approval from accreditors); strategic orientation-related (governance
Care-giver Y
model, complexity and dynamics of service space); and resource/infra­
resistance
Patient anxiety – Y – – structure constraints-related (technological constraints, diverse devices,
Patient privacy Y Y – – operational issues, expertise of staff and staff-to-patient ratio).
Patient profile – – – Y
Product efficacy Y
4.2.3.3. Barriers and products. Our analysis revealed several barriers
– – –
(drug)
Sample biasness – Y – Y and challenges that the existing scholarship identified as the key im­
Organizational Lack of – Y – – pediments to product-related outcomes of DDI implementation in
leadership healthcare. Specifically, the reviewed studies identified the following
support barriers: the complexity of service space, privacy, speed, and security
Organizational – – – Y
and provider
(McBee and Wilcox, 2020), overdiagnosis and poor tailoring of treat­
inertia ment and pushback from primary care professional bodies (Rushforth
Poor change and – Y Y Y and Greenhalgh, 2020), poor change management (Nguyen et al., 2015),
project and lack of in-person contact and socio-cultural factors (Castro e Melo &
management
Araújo, 2020).
Traditional work – Y Y
model These barriers can be placed under five of the seven aggregate di­
Communication – Y – – mensions as follows: data-related (privacy, speed, and security); orga­
Lack of Y nizational (poor change management); ecosystem-related (pushback
customization from primary care professional bodies, lack of in-person contact, socio-
Training of – Y – –
trainer
cultural factors); strategic orientation-related (complexity of service
Lack of shared Y space); and resource/infrastructure constraints-related (overdiagnosis
commitment and poor tailoring of treatment).
Clearly defined Y
roles
Ecosystem- Macro-business – Y Y Y
4.2.3.4. Barriers and services. Moving further, we evaluated the studies
related factors to synthesize the barriers that past studies had identified in the context
Lack of in-person – Y Y Y of service-related outcomes of DDI implementation in the healthcare
contact space. The key barriers observed to exist were time, effort, and lack of
Stakeholder Y
– – –
shared commitment (Gilbert Hunt, 2017; Hans et al., 2018), political,
resistance
(professional economic, institutional, and socio-cultural factors (Castro e Melo &
bodies) Araújo, 2020; Mukherjee, 2021), lack of in-person contact (Castro e
Resistance from – Y – Melo & Araújo, 2020), information access barriers, limited functionality
service provider of technology, and organizational and provider inertia (Steele Gray
Lack of Y – – –
standardization
et al., 2018), poor change and project management and a lack of cus­
Policies and Judicial aspects – Y – tomization in services (White, 2009), complexity and dynamics of the
regulations- concerning service space (McBee and Wilcox, 2020; Virtanen et al., 2016), privacy,
related system failures security and speed (McBee and Wilcox, 2020; Garrety et al., 2014),
Lack of Y
patient profiles (Jung and Padman, 2014), perceived financial cost and
regulations
Approval from – Y – – risk (Ben Arfi et al., 2021), poor fit with existing work schedule and care
accreditors givers’ resistance (Hans et al., 2018), and technological constraints and
Strategic Technology Y – – sample biasness (Sahu et al., 2020).
orientation- development From the perspective of the seven broad types of barriers, the iden­
related strategy
Complexity and Y Y Y Y
tified challenges can be thus classified: data-related (information access
dynamics of barriers, privacy, security, and speed); user-related (sample biasness,
service space time, effort, patient profile, perceived financial cost and risk, and care
Governance – Y – – givers’ resistance); organizational (poor fit with existing work schedule,
model
lack of shared commitment, lack of customization in services, organi­
zational and provider inertia, and poor change and project manage­
ment); ecosystem-related (political, economic, institutional, socio-

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U. Bamel et al. Technovation 125 (2023) 102785

cultural factors, and lack of in-person contact); policy and regulations/ looking at all four or at least two categories (e.g., services and business
strategic orientation-related (complexity and dynamics of service models) in tandem. This has resulted in linear insights that can make
space); and resource/infrastructure constraints-related (limited func­ limited contributions to practice. A summary of research profile-based
tionality of technology, technological constraints). gaps is presented in Fig. 5.

5. Gaps and the path ahead 5.2. Research gaps and the path ahead from the thematic perspective

We undertook research profiling and thematic analysis of the iden­ The findings of our thematic analysis confirm that the reviewed
tified studies as guided by the research objectives, research questions, literature has reasonable coverage in terms of the four DDI imple­
and the conceptual framework defining the scope-related boundaries of mentation/outcome categories—business models, processes, products,
our study. Such close analysis not only allowed us systematically to and services. However, from the perspective of all three thematic
synthesize the state-of-the-art in the area, but also helped us form a dimensions—theories, enablers, and barriers—the insights are limited,
critical view of its limitations and how, going forward, the visible gaps in offering testimony of an under-explored area and exploratory
the amassed knowledge can be addressed to make the literature robust beginnings.
and useful. We discuss here the said gaps and suggest potential paths to First, from the theoretical perspective, while it is evident that several
address them. The recommendations are in no way exhaustive, but they theories have been utilized to explain and describe the four DDI
are sufficiently comprehensive to motivate and support research in the implementation/outcome categories in healthcare, the theorization is
area. Since there are visible gaps in the research from both profile and very fragmented, lacking generalization, robustness, and contextual
thematic perspectives, we have bifurcated the discussion accordingly: continuity. One of the key issues is that none of the studies in the area
(a) research gaps and the path ahead from the profile perspective and (b) have tried to build upon prior findings or extend the insights generated
research gaps and the path ahead from the thematic perspective. using a particular theory. The resultant evidence is, thus, a disconnected
set of findings, which does little to guide further research or practice.
5.1. Research gaps and the path ahead from the methodological The gaps exist in the extent of theorization within the four categories
perspective as well, which warrants a deeper discussion of each of the categories
separately. To begin with, in the case of business model-related out­
From the perspective of profiles, as evidenced by the limited number comes, at a glance, the available insights appear to be rich and spread
of studies shortlisted for review, research on implementational aspects across varied contexts. However, when juxtaposed with the size of the
of DDIs in the healthcare sector is scarce and narrow, supporting our sector and the variety of healthcare verticals, not to mention the pace of
contention that the area needs additional impetus to accelerate aca­ digital transformation observed in recent times in the healthcare sector
demic research, not only to keep it apace with practice but also to (e.g., Iyanna et al., 2022), the lens used and the contexts covered can be
support it with novel inputs for future expansion. A look at the list of easily called limited and rather narrow. Several visible gaps persist in
publishers reveals that congruent studies included in the review have this regard. For instance, certain business model aspects that have
been published in journals from leading houses as well as standalone remained unaddressed by a sound grounding in theory are the medical
bodies/associations. Such expression of interest by prominent pub­ supply chain, health solutions for health policy, digital transformation,
lishers confirms the relevance of the topic, encouraging future research and emerging business models for early adopters.
in the area. The diversity of geographies covered is also a cause for Similar gaps are observable in the case of the other three categories,
concern, with most of the studies remaining focused on developed where insights were quite limited to begin with. In the case of process-
countries, resulting in an unequal representation of economies. One of related outcomes, our analysis suggests outcomes such as care de­
the reasons for the inclination of scholars to examine developed coun­ livery, cost minimization, clinical system information rollout, collabo­
tries could be that these are the countries that would have taken the ration and knowledge transfer, information sharing, and e-health record
pioneering initiative to implement DDIs in healthcare. Nonetheless, keeping in particular have remained unaddressed so far from a theo­
there are many other countries where DDIs are being implemented at an retical perspective. In a similar vein, product-related outcomes such as
appreciable pace, such as India, and there is an exigent need for scholars drugs for different specialties, patient-care products for critical care,
to examine such developing geographies with their unique challenges, imaging, and wearable devices to name a few pertinent ones have also
opportunities, and cultural moorings. not been considered. Finally, a lack of theorization is apparent in
It is also obvious from the research profile details that the area is still service-related outcomes as well. To identify some crucial ones, there is
in a state of methodological nascency as it is largely focused on a lack of theory-driven research on service outcomes such as occupa­
exploratory investigations. Thus, there is a need to stimulate methodo­ tional therapy, outpatient diabetes care, automated drug dispensing
logical maturity of research in the area, such that robust and deeper system, tracking of medical devices, nutrition care, and patient data
insights are made available. For example, researchers can use mixed- sharing.
method approaches to collect longitudinal data for analysis to better Coming to the second theme, a similar narrowness is observed, as is
explicate the changes in perception about enablers and/or barriers. evident from Table 3. To begin with, the enablers of business model-
To its credit, the existing scholarship has sampled an appreciable related outcomes identified and the types they can be categorized into
variety of units of analysis, which can serve to guide future researchers are limited, with the literature ignoring a large set of enablers. We
quite meaningfully as they conceptualize their study and research de­ suggest that future studies should take into consideration the role of
signs. However, a closer look reveals that the sample size in most cases, institutional enablers such as leadership and organizational culture,
particularly in the studies that employed a qualitative approach, is quite infrastructure-related enablers, and product/service-related enablers
small, raising concerns about the universality and robustness of the that can directly impact business model outcomes. Moving on to the
findings. There is, therefore, a specific need for future inquiries to draw enablers of process-related outcomes, while the reviewed studies have
larger, more representative samples to offer robust findings that can identified one or more enablers under each of the five broad type­
make the literature in the area more useful for theory and practice. The s—institutions, actors, infrastructure/resources, products/services, and
last aspect that we examined as a part of our research profiling was the partnerships—the enablers attributed to each type are very small in
spread of the reviewed studies across the four DDI implementation/ number and do not provide much input for practice. Further studies are
outcome categories. Our analysis revealed that, while the authors have required, with an intense focus on one of the five categories such that
attempted to examine all four categories, most of them have focused on more fine-grained insights are generated. The gaps are even more
only one, whereas business complexity can be better captured by noticeable in the case of product-related outcomes, where enablers

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U. Bamel et al. Technovation 125 (2023) 102785

Fig. 5. Research profile-based gaps.

coming under the partnership category have not been examined at all, analysis, to address the research questions. Our analysis yielded many
and others, such as those under the infrastructure/resource category, are interesting findings that can help accelerate the pace of research in the
examined in a very narrow manner. In a similar vein, the enablers of area. Particularly, the critical analysis of the findings helped identify
service-related outcomes under all five categories remain under- visible gaps in the amassed evidence and set future research agendas.
examined, with the product/service-related enablers remaining The study offers many interesting theoretical and practical implications,
completely ignored. Furthermore, since human behavior is a key aspect which are discussed below.
of enablers, more behavioral studies examining how various stake­
holders perceive and respond to the changes in the business models, 6.1. Theoretical implications
processes, products, and services brought about by DDI implementation
in the healthcare sector can be useful for managers to increase the The first contribution of our analysis is the consolidation of theori­
diffusion of these innovations. zation of the DDIs in healthcare (i.e., tracing and locating the theoretical
The third and last theme/perspective was related to the barriers frameworks relevant to this field of research). For example, our analysis
impeding the implementation of DDIs in the healthcare sector. As in the has determined that many theories—strong structuration, the pro­
case of the preceding two themes, we examined the conceptualizations grammed and error theory of aging, the actor-network approach, the
and insights by dividing them across the four outcomes and further unified theory of acceptance and use of technology, neutrosophic the­
classified the barriers under seven broad categories. Some key obser­ ory, the technology adoption model, service-dominant logic, the diffu­
vations in this regard are that the business model outcomes-related sion of innovation and normalization process theory, the disruptive
challenges are the second least examined challenges after product innovation framework, simulation learning, the health technology
outcome-related barriers, as is evident from the entries in Table 4. Going assessment framework, change management theory, top management
into further detail, it is evident that barriers to business model outcomes team theory, the STOF framework, neo-institutional theory, and the
coming under the organizational, and policies and regulations-related design perspective—have been used while studying DDIs in healthcare.
categories have not been examined at all, revealing a visible gap in These findings indicate the existence of theoretical diversity in the field
the literature. Next, we critically evaluated the barriers inhibiting as is evident from the fact that the different innovation outcomes have
process-related outcomes and observed that the majority of barriers used different theories; for example, service outcomes used the tech­
coming under the identified seven categories have been examined to an nology acceptance model, the products category used the actor-network
appreciable extent. However, the existing scholarship has left the bar­ approach, and business models used the top management teams theory.
riers inhibiting product-related outcomes noticeably underexplored, This conclusion from our study will help future researchers in selecting
with barriers under the two categories, user-related and policy and the relevant theories for studying various outcomes of digital in­
regulation-related, remaining completely ignored, and those under novations. Also, it is interesting to note that service-dominant logic and
three categories—organizational, strategic orientation-related, and the technology acceptance model were used repetitively in one inno­
resource/infrastructure constraints-related—considered only superfi­ vation outcome—services. This suggests that, at least in the service
cially. Similarly, the barriers obstructing service-related outcomes have outcomes of digital innovations, some degree of generalization exists,
been examined in a very limited manner, with policy and regulation- which provides an avenue for theoretical generalizations in other
related barriers remaining totally unexplored. innovation outcomes, too.
Conclusively, research on the implementation of DDIs in the Second, our review identified the enablers of DDIs in healthcare and
healthcare sector is still in its early phase, and impetus is required to also structured the identified enablers in a typology: institutions, actors
spur its growth organically by highlighting the visible gaps. (users, providers, other stakeholders), infrastructure/resources, prod­
ucts and services, and partnerships/collaborations. This finding may
6. Conclusion help future researchers to design their research inquiries in a more
focused and clearer way. Our analysis specifically linked the typology of
Using a structured and systematic approach to review congruent enablers with the innovation outcomes; for example, institutional
literature on the diffusion of DDIs in the healthcare sector, our SLR is category enablers are found to be linked strongly with process outcomes.
among the pioneering efforts to synthesize, consolidate, and critically This clustering consolidates the key enablers and their roles in various
evaluate the available studies. The primary objective of our study was to outcomes of DDIs in healthcare and provides a guiding structure for
review the congruent research base in the area to provide a sound further inquiries.
platform for potential future extension of insights. To present our find­ Third, our study also clustered various barriers and challenges of
ings systematically and reproducibly, we sought to address two specific disruptive digital innovations in healthcare. These categories of barriers
research questions, one related to the evolution of research from an and challenges are data-related, user-related, organizational-related,
operational perspective, and the second related to the conceptual ecosystem-related, policy and regulation-related, strategic orientation-
orientation of the underlying literature. We employed the SLR approach related, and resource/infrastructure constraints-related. This know-
to address these research questions. Before applying the approach, we how may be helpful for scholars in selecting the category of barriers
set the scope and conceptual boundary of our study by proposing a and challenges with a particular digital innovation’s outcome. For
conceptual framework comprising four outcomes—business models, example, the policy and regulations-related category of barriers is linked
processes, products, and services—and three themes: theoretical per­ strongly with processes, and there is a need to test these with product
spectives, enablers, and barriers. We executed our SLR by following five outcomes, too.
distinct steps, including the definition of research objectives, identifi­
cation of keywords for literature search, specification of inclusion and
exclusion criteria, short-listing of congruent studies, and their content

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