Digital transformation at the system level

Centre for Health Technology
D-PACT: Carer and elderly woman communicating remotely on tablet
There is general optimism that the digital future will be one of improved health outcomes, increased efficiency, a more sustainable system and ultimately reduced health-care expenditure. Evidence for these system improvements is currently lacking. Part of the problem is that the uptake of digital health technologies (DHTs) in the NHS and British social care has been relatively slow and uneven. Against this background, an important focus of CHT has been to address implementation barriers to digital acceleration. For example, the aim of the multi-million eHealth Productivity and Innovation in Cornwall and the Isles of Scilly project (EPIC) was to increase demand for, and supply of innovative eHealth & social care products and services. Part of this has involved close work with citizens, who require trust and reassurance about using DHTs; and health and care staff who, due to concerns about increased workload, the ethics of data sharing and the evidence base of new products, may demonstrate cultural resistance to change.

Our projects

Row of diverse young and old people in a gym, Copyright: racorn, courtesy of Shutterstock 244732921

e-coachER

Health Technology Community Pop-up in Stonehouse

Health Technology Community Pop-up in Stonehouse

Elderly person in wheelchair exercising using a virtual reality (VR) headset

Generating Older Active Lives Digitally (GOALD)

COVID-19

Remote-by-Default Care in the COVID-19 Pandemic: addressing the micro, meso-, and macro-level challenges of a radical new service model

Two people sitting down, out of focus, with one hand holding a mobile phone in focus. 

The (O)nline (N)egativity Study

Recent publications

2023

Ahmed H & Joshi LT (2023). Clostridioides difficile spores tolerate disinfection with sodium hypochlorite disinfectant and remain viable within surgical scrubs and gown fabrics. Microbiology 169, (11). https://doi.org/10.1099/mic.0.001418
Anil K, Bird AR, Bridgman K, et al. Telehealth competencies for allied health professionals: A scoping review. Journal of Telemedicine and Telecare. 2023;0(0). , DOI. https://journals.sagepub.com/doi/10.1177/1357633X231201877
Asthana S, Prime S. (2023). The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers. Front Health Serv. 2023 Aug 30;3:1225757. https://doi.org/10.3389/frhs.2023.1225757
Batool A, Yakoob A, Anwar Z, Joshi LT, Lone D, Zikriya M, Ahmed Q & Qamar MU (2023). Outbreak investigation of NDM-producing Burkholderia cepacia causing neonatal sepsis in Pakistan. Future Microbiology. https://doi.org/10.2217/fmb-2023-0063
Bradwell HL, Edwards KJ, Baines R, Page T, Chatterjee A & Jones RB (2023). Facial recognition lock technology for social care settings: A qualitative evaluation of implementation of facial recognition locks at two residential care sites. Frontiers in Digital Health 5:1066327. https://doi.org/10.3389/fdgth.2023.1066327
Bristow IR & Joshi LT (2023). Dermatophyte resistance – on the rise. Journal of Foot and Ankle Research 16 (1). https://doi.org/10.1186/s13047-023-00665-5
Burke RL & Veliz-Reyes A. (2023) Socio-spatial relationships in design of residential care homes for people living with dementia diagnoses: a grounded theory approach, Architectural Science Review, 66:5, 391-405. https://doi.org/10.1080/00038628.2021.1941749
Butler J, Handy RD, Upton M, Besinis A (2023). Review of Antimicrobial Nanocoatings in Medicine and Dentistry: Mechanisms of Action, Biocompatibility Performance, Safety, and Benefits Compared to Antibiotics, ACS NANO,10.1021/acsnano.2c12488. https://doi.org/10.1021/acsnano.2c12488
Collings R, Freeman J, Latour J, Hosking J & Paton J (2023). Insoles to ease plantar pressure in people with diabetes and peripheral neuropathy: a feasibility randomized controlled trial with an embedded qualitative study. Pilot and Feasibility Studies 9. https://doi.org/10.1186/s40814-023-01252-y
Grey B, Upton M & Joshi LT (2023). Urinary tract infections: a review of the current diagnostics landscape. Journal of Medical Microbiology 72 (11). https://doi.org/10.1099/jmm.0.001780
How to involve and engage patients to NHS buyers for free in digital health tech innovation An Evidence Based Guide. https://www.boehringer-ingelheim.co.uk/sites/gb/files/documents/ppie_guide.pdf
Joshi LT (2023). Candida auris: another frontier in the battle against antimicrobial resistance. British Medical Journal. https://doi.org/10.1136/bmj.p1276
Ladds E, Greenhalgh T, Byng R, Rybczynska-Bunt S, Kalin A, Shaw S (2023). A contemporary ontology of continuity in general practice: Capturing its multiple essences in a digital age. Soc Sci Med Sep;332:116112. https://doi.org/10.1016/j.socscimed.2023.116112
Malthouse R, Križaj T, Warren A & Turner K (2023). A scoping review and thematic analysis of the use of technology in everyday occupations amongst adults aged 55 years or older in supported housing. Journal of Housing and the Built Environment. https://doi.org/10.1007/s10901-023-10077-3
Malyshev D, Jones IA, McKracken M, Öberg R, Harper G, Joshi LT & Andersson M (2023). Hypervirulent R20291 Clostridioides difficile spores show disinfection resilience to sodium hypochlorite despite structural changes. BMC Microbiology 23. https://doi.org/10.1186/s12866-023-02787-z
McInroy LB, Beer OWJ, Scheadler TR, Craig SL & Eaton AD (2023). Exploring the psychological and physiological impacts of digital microaggressions and hostile online climates on LGBTQ + youth. Current Psychology, 43, 2586-2596. https://doi.org/10.1007/s12144-023-04435-1
Phillips RJ, Beer OWJ & Maleku A (2023). Conceptualizing and operationalizing community resilience: A scoping review of the social and health sciences literature. Community Development, 55, (2), 174-194. https://doi.org/10.1080/15575330.2023.2225088
Sohrab Almasi, Kambiz Bahaadinbeigy, Hossein Ahmadi, Solmaz Sohrabei, Usability Evaluation of Dashboards: A Systematic Literature Review of Tools, BioMed Research International, Volume 2023. https://www.hindawi.com/journals/bmri/2023/9990933/
Thomas A, Edwards KJ, Bradwell HL, Chatterjee A & Jones RB (2023). E-nursing homes: transforming access to nurses in nursing homes in response to the staffing crisis. British Journal of Nursing 32, (9) 428-432. https://doi.org/10.12968/bjon.2023.32.9.428
Vranopoulos G, Clarke N & Atkinson S (2023). Big Data Confidentiality: An Approach Toward Corporate Compliance Using a Rule-Based System. Big Data 2023. https://doi.org/10.1089/big.2022.0201
Willis K, Gupta A (2023). Place-Keeping in the Park: Testing a Living Lab Approach to Facilitate Nature Connectedness in Urban Greenspaces, Sustainability, 15 Iss.13. https://doi.org/10.3390/su15139930

2022

Alami, Hassane, Pascale Lehoux, Sara E. Shaw, Chrysanthi Papoutsi, Sarah Rybczynska-Bunt, and Jean-Paul Fortin (2022) Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients. International Journal of Environmental Research and Public Health 19, no. 17: 10591. https://doi.org/10.3390/ijerph191710591
Baines R, Bradwell H, Edwards K, Stevens S, Prime S, Tredinnick-Rowe J, Sibley M & Chatterjee A (2022) 'Meaningful patient and public involvement in digital health innovation, implementation and evaluation: A systematic review' Health Expectations. https://pubmed.ncbi.nlm.nih.gov/35526274/
Baines R, Hoogendoorn P, Stevens S, Chatterjee A, Ashall-Payne L, Andrews T & Leigh S (2022) Navigating Medical Device Certification: A Qualitative Exploration of Barriers and Enablers Amongst Innovators, Notified Bodies and Other Stakeholders. Therapeutic Innovation & Regulatory Science 57, (2) 238-250. https://doi.org/10.1007/s43441-022-00463-4
Blease C, Torous J, Dong Z, Davidge G, DesRoches C, Kharko A, Turner A, Jones R, Hägglund M & McMillan B (2022) 'Patient Online Record Access in English Primary Care: A Qualitative Study of General Practitioners’ Views (Preprint)' Journal of Medical Internet Research , DOI. https://doi.org/10.2196/43496
Bradwell H, Baines R, Edwards KJ, Stevens S, Atkinson K, Wilkinson E, Chatterjee A & Jones RB (2022) 'Exploring Patient and Staff Experiences With Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data' JMIR Formative Research 6, (3). https://researchportal.plymouth.ac.uk/en/publications/exploring-patient-and-staff-experiences-with-video-consultations--3
Bruder, A.L., Rothwell, C.D., Fuhr, L.I. et al. (2022). The Influence of Audible Alarm Loudness and Type on Clinical Multitasking. J Med Syst 46, 5. https://doi.org/10.1007/s10916-021-01794-9
Greenhalgh T, Shaw SE, Alvarez Nishio A, Booth A, Byng R, Clarke A, Dakin F, Davies R, Faulkner S & Hemmings N (2022). Protocol: Remote care as the ‘new normal’? Multi-site case study in UK general practice. NIHR Open Research 2, 46-46. https://doi.org/10.3310/nihropenres.13289.1
Greenhalgh T, Shaw SE, Alvarez Nishio A, Byng R, Clarke A, Dakin F, Faulkner S, Hemmings N, Husain L & Kalin A (2022). Remote care in UK general practice: baseline data on 11 case studies. NIHR Open Research 2, 47-47. https://doi.org/10.3310/nihropenres.13290.2
Gupta AK, Venkataraman M, Joshi LT & Cooper EA (2022). Potential use of Microwave Technology in Dermatology. Journal of Dermatological Treatment 1-26. https://doi.org/10.1080/09546634.2022.2089333
Halliday B (2022). Evaluating the Management of chronic Pelvic girdle Pain following pregnancy (EMaPP): study protocol for a randomised controlled feasibility trial to compare a customised pelvic orthosis with standard care. BMJ Open 12. https://doi.org/10.1136/bmjopen-2022-063767
Jones RB, Tredinnick-Rowe J, Baines R, Maramba IDC & Chatterjee A (2022). Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England. BMJ Open 12, (3). https://doi.org/10.1136/bmjopen-2021-058247
Khan A, Milne-Ives M, Meinert E, Iyawa GE, Jones RB, Josephraj AN (2022). A Scoping Review of Digital Twins in the Context of the Covid-19 Pandemic. Biomedical Engineering and Computational Biology. 2022;13. https://doi.org/10.1177/11795972221102115
Maramba ID, Jones R, Austin D, Edwards K, Meinert E & Chatterjee A (2022). The Role of Health Kiosks: Scoping Review. JMIR Medical Informatics 10, (3). https://doi.org/10.2196/26511
McInroy LB & Beer OWJ (2022). Adapting vignettes for internet-based research: eliciting realistic responses to the digital milieu. International Journal of Social Research Methodology, 25(3), 335–347. https://doi.org/10.1080/13645579.2021.1901440
McInroy LB, Zapcic I & Beer OWJ (2022). Online fandom communities as networked counterpublics: LGBTQ+ youths’ perceptions of representation and community climate. Convergence, 28(3), 629-647. https://doi.org/10.1177/13548565211032377
Mehmood M, Khan UF, Maka AOM, Akhter J, Chaudhary TN, Masood F, Hasan SA & Lee YC (2022). A review of thermal impact of surface acoustic waves on microlitre droplets in medical applications. Advances in Mechanical Engineering 14 (8). https://doi.org/10.1177/16878132221116481
Milne-Ives M, Fraser LK, Khan A, Walker D, van Velthoven MH, May J, Wolfe I, Harding T, Meinert E (2022). Life Course Digital Twins–Intelligent Monitoring for Early and Continuous Intervention and Prevention (LifeTIME): Proposal for a Retrospective Cohort Study. JMIR Res Protoc 11(5):e35738. https://doi.org/10.2196/35738
Milne-Ives M, Leydon J, Maramba I, Chatterjee A & Meinert E (2022). The potential impacts of a digital preoperative assessment service on appointments, travel-related carbon dioxide emissions, and user experience: a case study. JMIR Perioperative Medicine 16;5(1):e28612. https://doi.org/10.2196/28612
Rosen R, Wieringa S, Greenhalgh T, Leone C, Rybczynska-Bunt S, Hughes G, Moore L, Shaw S, Wherton J & Byng R (2022) 'Clinical risk in remote consultations in general practice: findings from in-Covid-19 pandemic qualitative research' BJGP Open. https://pubmed.ncbi.nlm.nih.gov/35487581/
Scott R, Joshi LT & McGinn C (2022). Hospital surface disinfection using ultraviolet germicidal irradiation technology: A review. Healthcare Technology Letters. https://doi.org/10.1049/htl2.12032
Watanabe K, Wu H-Y, Xavier J, Joshi LT & Vollmer F (2022). Single virus detection on silicon photonic crystal random cavities. Small. https://doi.org/10.1002/smll.202107597
Waterfield S, Ahmed H, Jones IA, Burky R & Joshi LT (2022). Isolation of Clostridioides difficile PCR Ribotype 027 from single-use hospital gown ties. Journal of Medical Microbiology 71 (6). https://doi.org/10.1099/jmm.0.001550

2021

Aguiar Noury G, Walmsley A, Jones RB & Gaudl SE (2021). The Barriers of the Assistive Robotics Market—What Inhibits Health Innovation? Sensors 21, (9) 3111-3111. https://doi.org/10.3390/s21093111
Blease C, Kharko A, Annoni M, Gaab J, Locher C (2021) Machine Learning in Clinical Psychology and Psychotherapy Education: A Mixed Methods Pilot Survey of Postgraduate Students at a Swiss University FRONTIERS IN PUBLIC HEALTH Vol.9 10.3389/fpubh.2021.623088 http://hdl.handle.net/10026.1/17032. https://pubmed.ncbi.nlm.nih.gov/33898374/
Bloor, J., Handy, R. D., Awan, S. A. and Jenkins, D. (2021). Graphene oxide biopolymer aerogels for the removal of lead from drinking water, Ecotoxicology and Environmental Safety, 5 208, 111422. https://doi.org/10.1016/j.ecoenv.2020.111422
Boyd DT, Quinn CR, Jones KV & Beer OWJB (2021). Suicidal ideations and Attempts Within the Family Context: The Role of Parent Support, Bonding, and Peer Experiences with Suicidal Behaviors. Journal of Racial and Ethnic Health Disparities, 9, 1740–1749. https://doi.org/10.1007/s40615-021-01111-7
Bungon T., Haslam C., Damiati S., O’Driscoll B., Whitley T., Davey P., Siligardi G., Charmet J. and Awan S. A. (2021) Graphene FET Sensors for Alzheimer’s Disease Protein Biomarker Clusterin Detection. Frontiers in Molecular Biosciences, 8:651232. DOI: 10.3389/fmolb.2021.651232. https://doi.org/10.3389/fmolb.2021.651232
Collings R, Freeman J, Latour JM, Paton J. (2021). Footwear and insole design features for offloading the diabetic at risk foot—A systematic review and meta-analyses. Endocrinol Diab Metab. 2021; 4:e00132. https://doi.org/10.1002/edm2.132
Edwards KJ, Jones RB, Shenton D, Page T, Maramba I, Warren A, Fraser F, Križaj T, Coombe T & Cowls H (2021). The Use of Smart Speakers in Care Home Residents: Implementation Study. Journal of Medical Internet Research 23, (12). https://doi.org/10.2196/26767
Gartshore A, Kidd M & Joshi LT (2021). Applications of Microwave Energy in Medicine. Biosensors 11, (4) 96-96. https://doi.org/10.3390/bios11040096
Goodman S, Skirton H, Jackson L, Jones RB (2021) Development of a Secure Website to Facilitate Information Sharing in Families at High Risk of Bowel Cancer—The Familyweb Study CANCERS Vol.13 Iss.10 10.3390/cancers13102404. https://pubmed.ncbi.nlm.nih.gov/34065728/
Greenhalgh T, Rosen R, Shaw SE, Byng R, Faulkner S, Finlay T, Grundy E, Husain L, Hughes G & Leone C (2021) 'Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics' Frontiers in Digital Health 3. https://pubmed.ncbi.nlm.nih.gov/34713199/
Jones IA & Joshi LT (2021). Biocide Use in the Antimicrobial Era: A Review. Molecules 26, (8) 2276-2276. https://doi.org/10.3390/molecules26082276
Jones IA, Silver K & Joshi LT (2021). Letter to the Editor. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2021.09.024
Joshi LT (2021) 'The G7 Summit 2021: Time for our world leaders to step up to the challenge of Anti-Microbial Resistance. Access Microbiology 3 (12). https://doi.org/10.1099/acmi.0.000298
Joshi LT (2021). Using alternative teaching and learning approaches to deliver clinical microbiology during the COVID19 pandemic. FEMS Microbiology Letters. https://doi.org/10.1093/femsle/fnab103
Meinert E, Reeves S, Eerens J, Banks C, Maloney S, Rivers G, Ilic D, Walsh K, Majeez A, Car J (2021) Exploring the cost of eLearning within the field of health professions education: Scoping Review JMIR MEDICAL EDUCATION Vol.7 Iss.1 10.2196/13681 http://hdl.handle.net/10026.1/16762. https://mededu.jmir.org/2021/1/e13681/
Milne-Ives M, Swancutt D, Burns L, Pinkney J, Tarrant M, Calitri R, Chatterjee A, Meinert E (2021) The effectiveness and usability of online, group-based interventions for people with severe obesity: Systematic review protocol JMIR RESEARCH PROTOCOLS Vol.10 Iss.6 10.2196/26619 http://hdl.handle.net/10026.1/16920. https://pmc.ncbi.nlm.nih.gov/articles/PMC8280827/
Milne-Ives M, Rehman N, Sharif R, Meinert E (2021) Distributed Ledger Infrastructure to Verify adverse Event Reporting (DeLIVER): Proposal for a proof-of-concept study JMIR RESEARCH PROTOCOLS Vol.10 Iss.6 10.2196/28616 http://hdl.handle.net/10026.1/17058. https://www.researchprotocols.org/2021/6/e28616/
Naqvi, B., Clarke, N. and Porras, J. (2021). Incorporating the human facet of security in developing systems and services. Information and Computer Security, Vol. 29 No. 1, pp. 49-72. https://doi.org/10.1108/ICS-11-2019-0130
Nasiri, S, Farahnaz Sadoughi, Afsaneh Dehnad, Mohammad Hesam Tadayon, Hossein Ahmadi (2021), Layered Architecture for Internet of Things-Based Healthcare System: A Systematic Literature Review, Informatica, Vol 45, No 4. https://doi.org/10.31449/inf.v45i4.3601
Toropov N, Osborne E, Joshi LT, Davidson J, Morgan C, Page J, Pepperell J & Vollmer F (2021) SARS-CoV-2 Tests: Bridging the Gap Between Laboratory Sensors and Clinical Applications. ACS sensors. https://doi.org/10.1021/acssensors.1c00612
Willis K (2021). The social infrastructure of the smart city: How can "Smart Cities" be more inclusive?'. In Topos- The International Review of Landscape Architecture and Urban Design, : Georg GmbH & Co. KG, pp 60-64
Zamir S, Hennessy CH, Taylor AH & Jones RB (2021). Feasibility of school students Skyping care home residents to reduce loneliness. Computers in Human Behavior Reports 3. https://doi.org/10.1016/j.chbr.2021.100053

2020

Asthana S, Sheaff R, Jones R & Chatterjee A (2020). eHealth technologies and the know-do gap: exploring the role of knowledge mobilisation. Evidence & Policy 16, (4) 687-701. https://doi.org/10.1332/174426420x15808912803267
Austin D, Andrade J, May J & Jones R (2020). Delivering digital health: The barriers and facilitators to University-Industry Collaboration. Health Policy and Technology. https://doi.org/10.1016/j.hlpt.2020.10.003
Baines R, Tredinnick-Rowe J, Jones R, Chatterjee A (2020) Barriers and Enablers in Implementing Electronic Consultations in Primary Care: Scoping Review. Journal of Medical Internet Research Vol.22 Iss.11 10.2196/19375. https://pubmed.ncbi.nlm.nih.gov/33035177/
Carter H, Hanks S, Gale T (2020) A qualitative study using hybrid simulation to explore the impacts of human factors e-learning on behaviour change ADVANCES IN SIMULATION Vol.5. https://dspace.plymouth.ac.uk/handle/10026.1/16376
McKracken M, Garner C & Joshi LT (2020). COVID-19 and antibiotic resistance – The calm before the storm. AMRC Open Research. https://doi.org/10.21955/amrcopenres.1114927.1
Meinert E, Milne-Ives M, Surodina S & Lam C (2020). Agile Requirements Engineering and Software Planning for a Digital Health Platform to Engage the Effects of Isolation Caused by Social Distancing: Case Study. JMIR public health and surveillance 6, (2). https://doi.org/10.2196/19297
Milne-Ives M, Lam C, Van Velthoven MH & Meinert E (2020) 'Mobile Apps for Health Behavior Change: Protocol for a Systematic Review' JMIR Research Protocols 9, (1) e16931-e16931 , DOI. https://www.researchprotocols.org/2020/1/e16931/
Milne-Ives M, Lam C, van Velthoven M, Meinert E (2020) The Impact of Brexit on the Pharmaceutical Supply Chain of the United Kingdom: Scoping Review Protocol JMIR RESEARCH PROTOCOLS Vol.9 Iss.9 10.2196/17684. https://www.researchprotocols.org/2020/9/e17684/
Nelis JLD, Tsagkaris AS, Dillon MJ, Hajslova J, Elliott CT (2020) Smartphone-based optical assays in the food safety field TRAC TRENDS IN ANALYTICAL CHEMISTRY Vol.129 10.1016/j.trac.2020.115934 http://hdl.handle.net/10026.1/17801. https://pubmed.ncbi.nlm.nih.gov/32904649/
Ollevier A, Aguiar G, Palomino M & Simpelaere IS (2020). How can technology support ageing in place in healthy older adults? A systematic review. Public Health Reviews 41, (1). https://doi.org/10.1186/s40985-020-00143-4
Petersen, A., Schermuly, A. and Anderson, A. (2020). Feeling less alone online: patients’ ambivalent engagements with digital media. Sociol Health Illn, 42: 1441-1455. https://doi.org/10.1111/1467-9566.13117
Williams M, Barclay Y, Harper L, Marchant C, Seamark L, Hickson M (2020) Feasibility, acceptability and cost efficiency of using webinars to deliver first‐line patient education for people with Irritable Bowel Syndrome as part of a dietetic‐led gastroenterology service in primary care JOURNAL OF HUMAN NUTRITION AND DIETETICS Vol.33 Iss.6 10.1111/jhn.12799 http://hdl.handle.net/10026.1/16368 https://pubmed.ncbi.nlm.nih.gov/32816367/
Wright H, Martin F, Clyne W, Clark CCT, McGillion M, Matouskova G, Turner A (2020) A Digital Program (Hope) for People Living With Cancer During the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial JMIR RESEARCH PROTOCOLS Vol.9 Iss.12 10.2196/24264 http://hdl.handle.net/10026.1/17982. https://www.researchprotocols.org/2020/12/e24264/
Zamir S, Hennessy C, Taylor A & Jones R (2020). Intergroup ‘Skype’ Quiz Sessions in Care Homes to Reduce Loneliness and Social Isolation in Older People. Geriatrics 5, (4) 90-90. https://doi.org/10.3390/geriatrics5040090

2019

Asthana, S. Jones, J. Sheaff, R. (2019). Why does the NHS lag behind other health care systems with respect to eHealth? A review of macro, meso and micro factors. BMC Health Services Research 19, Article number: 984. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4790-x
Farahnaz Sadoughi, Taleb Khodaveisi, Hossein Ahmadi, The used theories for the adoption of electronic health record: A systematic literature review, Health and Technology, Volume 9, pages383–400, 21 November 2019. https://link.springer.com/article/10.1007/s12553-018-0277-8. https://link.springer.com/article/10.1007/s12553-018-0277-8

2018

Hossein Ahmadi, Mehrbakhsh Nilashi, Leila Shahmoradi, Othman Ibrahim, Farahnaz Sadoughi, Mojtaba Alizadeh, Azadeh Alizadeh, Moderating effect of hospital size on inter and intra-organizational factors of hospital information system adoption, Technological Forecasting and Social Change. Volume 134, September 2018, Pages 124-149. https://www.sciencedirect.com/science/article/pii/S0040162517303001