Status of Digital Health Technology Adoption in 5 Vietnamese Hospitals: Cross-Sectional Assessment

Abstract

Background: Digital health technologies (DHTs) have been recognized as a key solution to help countries, especially those in the low- and middle-income group, to achieve the Sustainable Development Goals (SDGs) and the World Health Organization's (WHO) Triple Billion Targets. In hospital settings, DHTs need to be designed and implemented, considering the local context, to achieve usability and sustainability. As projects such as the Vietnam ICU Translational Applications Laboratory are seeking to integrate new digital technologies in the Vietnamese critical care settings, it is important to understand the current status of DHT adoption in Vietnamese hospitals.

Objective: We aimed to explore the current digital maturity in 5 Vietnamese public hospitals to understand their readiness in implementing new DHTs.

Methods: We assessed the adoption of some key DHTs and infrastructure in 5 top-tier public hospitals in Vietnam using a questionnaire adapted from the Vietnam Health Information Technology (HIT) Maturity Model. The questionnaire was answered by the heads of the hospitals' IT departments, with follow-up for clarifications and verifications on some answers. Descriptive statistics demonstrated on radar plots and tile graphs were used to visualize the data collected.

Results: Hospital information systems (HIS), laboratory information systems (LIS), and radiology information systems-picture archiving and communication systems (RIS-PACS) were implemented in all 5 hospitals, albeit at varied digital maturity levels. At least 50% of the criteria for LIS in the Vietnam HIT Maturity Model were satisfied by the hospitals in the assessment. However, this threshold was only met by 80% and 60% of the hospitals with regard to HIS and RIS-PACS, respectively. Two hospitals were not using any electronic medical record (EMR) system or fulfilling any extra digital capability, such as implementing clinical data repositories (CDRs) and clinical decision support systems (CDSS). No hospital reported sharing clinical data with other organizations using Health Level Seven (HL7) standards, such as Continuity of Care Document (CCD) and Clinical Document Architecture (CDA), although 2 (40%) reported their systems adopted these standards. Of the 5 hospitals, 4 (80%) reported their RIS-PACS adopted the Digital Imaging and Communications in Medicine (DICOM) standard.

Conclusions: The 5 major Vietnamese public hospitals in this assessment have widely adopted information systems, such as HIS, LIS, and RIS-PACS, to support administrative and clinical tasks. Although the adoption of EMR systems is less common, their implementation revolves around data collection, management, and access to clinical data. Secondary use of clinical data for decision support through the implementation of CDRs and CDSS is limited, posing a potential barrier to the integration of external DHTs into the existing systems. However, the wide adoption of international standards, such as HL7 and DICOM, is a facilitator for the adoption of new DHTs in these hospitals.

Keywords: Vietnam; clinical decision support; digital health technology; digital infrastructure; digital maturity; electronic health record; electronic medical record; health information technology; low- and middle-income country.

Figure 1

Percentage of HIT criteria satisfied in each domain across the 5 hospitals (IT infrastructure, EMR, LIS, HIS, RIS-PACS, and extra capabilities). EMR: electronic medical record; HIS: hospital information systems; HIT: health information technology; LIS: laboratory information systems; RIS-PACS: radiology information systems–picture archiving and communication systems.

Figure 2

Criteria of IT infrastructure in the Vietnam HIT Maturity Model met by the 5 hospitals in this assessment, where a maximum of level 7 could be obtained. The color coding represents the maturity group that a criterion belongs to, not the entire domain’s maturity level of a hospital. Although for official purposes, a hospital needs to meet all the criteria of a lower level to progress to a higher level, this figure represents any criteria attained. HIT: health information technology; LAN: local area network; NAS: network attached storage; SAN: storage area network.

Figure 3

Criteria of HIS in the Vietnam HIT Maturity Model met by the 5 hospitals in this assessment, where a maximum of level 7 can be obtained. The color coding represents the maturity group that a criterion belongs to, not the entire domain’s maturity level of a hospital. Although for official purposes, a hospital needs to meet all the criteria of a lower level to progress to a higher level, this figure represents any criteria attained. EMR: electronic medical record; HIS: hospital information systems; HIT: health information technology; PACS: picture archiving and communication systems.

Figure 4

Criteria of LIS in the Vietnam HIT Maturity Model met by the 5 hospitals in this assessment, where a maximum of 2 levels can be obtained. The color coding represents the maturity group that a criterion belongs to, not the entire domain’s maturity level of a hospital. Although for official purposes a hospital needs to meet all the criteria of a lower level to progress to a higher level, this figure represents any criteria attained. HIS: hospital information systems; HIT: health information technology; LIS: laboratory information systems.

Figure 5

Criteria of RIS-PACS in the Vietnam HIT Maturity Model met by the 5 hospitals in this assessment, where a maximum of 2 levels can be obtained. The color coding represents the maturity group that a criterion belongs to, not the entire domain’s maturity level of a hospital. Although for official purposes a hospital needs to meet all the criteria of a lower level to progress to a higher level, this figure represents any criteria attained. DICOM: Digital Imaging and Communications in Medicine; HIS: hospital information systems; HIT: health information technology; HL7: Health Level Seven; RIS-PACS: radiology information systems–picture archiving and communication systems.

Figure 6

Criteria of EMRs in the Vietnam HIT Maturity Model met by the 5 hospitals in this assessment, where a maximum of 2 levels can be obtained. The color coding represents the maturity group that a criterion belongs to, not the entire domain’s maturity level of a hospital. Although for official purposes a hospital needs to meet all the criteria of a lower level to progress to a higher level, this figure represents any criteria attained. CCD: Continuity of Care Document; CDA: Clinical Document Architecture; EMR: electronic medical record; HIT: health information technology; HL7: Health Level Seven.

Figure 7

Extra capability criteria in the Vietnam HIT Maturity Model met by the 5 hospitals in this assessment. CDR: clinical data repository; CDSS: clinical decision support systems; HIT: health information technology; HL7: Health Level Seven.