Abstract Background The implementation of digital technologies within health services promises increased performance, quality, and efficiency. However, evidence is limited regarding the application and outcomes of digital technologies implemented at the level of health services (meso-level) or health systems (macro-level), rather than those evaluated solely as patient-level clinical interventions (micro-level). We systematically review state-of-the-art digital technologies and their applications in healthcare systems and conduct a framework synthesis to review outcomes related to maturity and implementation. Methods Eleven databases were searched (Embase, HMIC, Medline, PsycInfo, SPP, AgeLine, AMED, CDAS, CINAHL, SCOPUS, WoS) on 4th November 2024 for systematic and non-systematic reviews published within the previous five years that provided an overview of digital technologies applied at a systems/service-level (macro/meso-level) in healthcare or evidence for their outcomes. Studies into individual interventions (micro-level) were excluded. Risk of bias/quality assessment tools used in the reviews were recorded. We review types and applications of technology, then use a framework synthesis methodology to assess outcomes relating to digital transformation awareness/maturity, implementation, UK context, and challenges. Results Our searches identified 1423 records, with 1011 remaining after deduplication. Of these, 131 were assessed for eligibility, with 28 reviews reporting on 1606 individual studies (with an additional 2437 included in a bibliometric analysis) included in the final analysis. We identified five main groups of technology in healthcare: Integrated Technology/Industry 4.0, Artificial Intelligence (AI), Big Data, Internet of Things (IoT), and Blockchain. Our framework synthesis revealed recent conceptual recognition of digital transformation, and variability across regions with regards to the sophistication and maturity of uptake of technologies. We report on four reviews which provided quantitative evidence on the impact of digital technologies in health services. Barriers included major concerns related to data privacy and trust, equity, ethics, and implementation logistics. UK frameworks exist for implementation of technologies, but do not focus exclusively on the systems-level. Conclusions Digital technologies are increasingly integrated into health service delivery, yet the maturity and evaluation of these tools vary across regions. More robust implementation research is needed for advanced systems. Our synthesis provides a framework for healthcare leaders to assess digital readiness and prioritise technologies aligned with service transformation goals. Limitations of evidence include the heterogeneity of technologies, settings, and outcomes across included reviews. Trial Registration The review was not part of a trial and was not registered.
Richards et al. (Sat,) studied this question.