Digitally delivered, systemically challenged: A qualitative study of health system readiness for digital care

Digital health technologies (DHTs) expand healthcare access, improve care coordination, and reduce costs. However, integrating these tools into care faces complex barriers. Understanding the perspectives of health system leaders is essential for developing sustainable DHTs. The objective of this project is to explore the experiences and priorities of health system stakeholders regarding the implementation of DHTs. The study team conducted semi-structured interviews with 12 stakeholders from diverse U.S. health systems, including clinical, operational, and executive leadership. Interviewees were selected using purposeful and snowball sampling. Interviews were transcribed and analyzed thematically using the Consolidated Framework for Implementation Research (CFIR). A constant comparative coding process was used to identify and organize key themes. Participants viewed DHTs as a way to enhance healthcare access and efficiency and improve public health operations, especially in rural or underserved settings. However, several major adoption challenges emerged: (1) integrating DHTs into existing workflows and electronic health records is operationally burdensome; (2) digital care can introduce risks to quality, continuity, and equity; and (3) external factors (reimbursement policy, regulatory constraints, infrastructure investment) are critical to long-term adoption. Digital health is seen as essential to the future of healthcare delivery, but meaningful integration requires alignment across clinical, operational, and policy domains. Coordinated investment, regulatory reform, and robust data infrastructure are needed to ensure DHTs are scalable and sustainable.