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.Author summary: This study explored how senior leaders from diverse U.S. health systems view the opportunities and challenges of digital health technologies (DHTs), such as telehealth and remote patient monitoring. Through in-depth interviews, we found that health system leaders see DHTs as promising tools to improve access to care, efficiency, and public health, especially in rural and underserved areas. However, they identified several barriers to successful adoption, including difficulties integrating DHTs with existing workflows and electronic health records, concerns about data privacy and cybersecurity, and the potential for fragmented or inequitable care. Leaders emphasized that factors such as reimbursement policies, regulatory requirements, and investment in digital infrastructure play a crucial role in the long-term sustainability of DHTs. Without coordinated actions across healthcare, policy, and technology sectors, digital health innovation risks exacerbating disparities and failing to be sustainable. The findings highlight that bridging the digital divide and establishing supportive national policies are key to making digital health a lasting part of routine healthcare, rather than isolated pilot programs. This research provides actionable insights for policymakers, healthcare organizations, and technology developers aiming to deliver equitable and effective digital health solutions.