Measuring information technology expenditures of hospitals for cross-institutional comparisons: A scoping review.

Abstract

Information technology (IT) expenditure is a structural prerequisite for digital transformation in hospitals. Despite increasing research into the level of digital maturity and increased political initiatives to finance hospital digitalization, this financial dimension remains methodologically unexplored. It can be assumed that one reason for this is the inconsistency of definitions, fragmented data and a lack of standardized reporting, which hinders cross-institutional comparisons. This makes it difficult to evaluate investments in digitalization, especially in the context of national funding programs. At the same time, the scientific investigation of the effects of IT expenditure on the success of digital transformation in comparison to other influencing factors is difficult to answer. This review takes a methodological perspective and aims to (I) provide an overview of how hospital IT expenditures of hospitals are measured in the context of cross-institutional comparisons, (II) identify methodological challenges and (III) propose a conceptual framework that enables cross-institutional comparisons and thus helps future evaluation and research projects. This scoping review followed Arksey and O'Malley's framework and adhered to PRISMA-ScR guidelines. Relevant studies were systematically identified through PubMed, Web of Science and Scopus. Analysis was based on a standardized scheme capturing data sources, IT-related metrics, control variables and methodological challenges. Ten studies were identified that measure IT expenditures in hospitals for cross-institutional comparison. Three main metrics were used, IT capital (n=9), IT personnel (n=6) and IT operating expenses (n=4), but with inconsistent definitions. Most studies relied on secondary data, often outdated and difficult to access, while primary or mixed-methods approaches were rare. Structural control variables were commonly applied; macroeconomic and regulatory factors were seldom considered. A conceptual framework was developed to address three main challenges: limited data availability, heterogeneous metrics and inconsistent use of contextual variables. This scoping review highlights considerable methodological heterogeneity in the cross-institutional measurement of IT expenditures of hospitals, particularly concerning data sources, expenditure metrics and control variables. The findings emphasize the need for theory-informed, empirically feasible and context-sensitive approaches to ensure valid cross-institutional comparisons. The conceptual framework proposed in this review provides methodological guidance for future research and contributes to the standardization of IT expenditure measurement in the context of cross-institutional comparisons.