Digital Health Ecosystem Governance: Practices, Processes, and Policies

Permanent URI for this collectionhttps://hdl.handle.net/10125/112476

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    From Breakdown to Breakthrough: An Integrated Framework for Analysing Activity Contradictions in Digital Health Ecosystems
    (2026-01-06) Chu, Joyce; Liu, Na; Thomas, Manoj; Pramartha, Cokorda Rai Adi; Lesmana, Cokorda Bagus Jaya; Aryani, Putu
    Health Information Systems (HIS) governance literature has struggled to explain how coordination is achieved in complex ecosystems marked by institutional voids and technological scarcity. This study addresses this challenge by developing an integrated analytical framework that systematically links process-level bottlenecks, identified through Business Process Model and Notation (BPMN), to their underlying systemic contradictions, analysed through Cultural-Historical Activity Theory (CHAT). Drawing on an in-depth case study of community mental healthcare in remote Indonesia, our analysis offers a counterintuitive theoretical argument: coordination breakdowns are not simply process failures, but catalysts for expansive learning and transformation. We demonstrate how stakeholders’ improvisations in response to these contradictions constitute a form of emergent, bottom-up governance. Our study contributes a new perspective on IS governance as a learning-oriented process.
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    Does Private Equity Hurt or Improve Healthcare Value? New Evidence and Mechanisms
    (2026-01-06) Yuan, Minghong; Wen, Wen; Bardhan, Indranil
    What is the impact of private equity (PE) investment on healthcare value? Does such investment hurt care value, and if so, can this effect be mitigated through the adoption of health IT systems? These are important questions given the growing presence of PE firms in the healthcare sector. Stakeholders, including policy makers, care providers, and patients, need to understand the likely impact and whether PE ownership aligns well with their interests. This study examines the impact of PE investment on healthcare value, focusing on the complex interplay between cost reduction and patient care quality. Using hospital-level data in the U.S. from 2008-2020, we estimate changes in healthcare value, defined as the balance between clinical resource use and patient outcomes, following PE acquisition. We find that overall healthcare value declines after PE investment. However, our empirical evidence also reveals that IT-enabled health information sharing plays a mitigating role. Hospitals with strong information-sharing capabilities experience both greater cost efficiencies and improvements in care quality, ultimately leading to higher healthcare value after PE investment. Moreover, we find that the type of information sharing matters: improvements in care quality are primarily driven by hospital-to-ambulatory provider information sharing.
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    AI with a Heart: THE Pillars of Technology, Humanity and Environment for Responsible Integration of AI along the Patient Journey
    (2026-01-06) Papst, Alexander; Maschewski, Jan; Lemmer , Kristina
    Artificial Intelligence (AI) holds great promise for transforming patient care, yet its integration often neglects the lived experiences of patients. This paper explores how AI can be responsibly applied to support patient-centered care across the patient journey. Drawing on twelve expert interviews with researchers and practitioners from the fields of AI and healthcare, we identify both critical potentials and challenges of AI deployment across care phases – as from symptom awareness to aftercare. Findings reveal three foundational pillars – Technology, Humanity, and Environment (THE) – that frame responsible AI use. Results emphasize the importance of explainability, human-in-the-loop systems, inclusive design, and institutional alignment. We develop a conceptual framework that maps context-specific AI applications along the patient journey and derive guiding principles for their responsible use. The study contributes by complementing socio-technical perspectives with relational and ethical dimensions, and offers practical orientation for aligning AI deployment with clinical realities and infrastructural constraints in healthcare.
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    How Do Cybersecurity Breaches Affect Hospital Survival? Evidence from the U.S. Hospital Industry, 2008–2017
    (2026-01-06) Yang, Xiaoxuan (Stephen); Tanriverdi, Huseyin
    Cybersecurity breaches in U.S. hospitals are becoming more frequent and severe, posing growing threats to hospital survival. Yet, empirical research on their long-term effects remains limited. Theoretical perspectives diverge: while breaches can disrupt operations and erode trust—heightening the risk of closure—they may also spur organizational learning and renewal, potentially enhancing survival. This study examines the impact of cybersecurity breaches on hospital survival using panel data from U.S. hospitals between 2008 and 2017. Contrary to common assumptions, we find that breaches are, on average, associated with improved hospital survival. However, this effect is strongly moderated by the hospital’s level of digitalization: low-digitization hospitals are more likely to survive after a breach, while highly digitalized ones face increased closure risk. These findings shed light on the complex interplay between digital maturity and cyber resilience, with important implications for both research and hospital management.
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    Introduction to the Minitrack on Digital Health Ecosystem Governance: Practices, Processes, and Policies
    (2026-01-06) Winkler, Till J.; Davidson, Elizabeth; Tremblay, Monica; Kwon, Juhee