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Peer-reviewedCC BYJournal of medical Internet research

Extent of Digital Health Fragmentation and Potential Implications for Antimicrobial Prescribing: Rapid Evidence Review.

  • Verena Schneider1
  • Akish Luintel2
  • Bethan Balch3
  • Shivani Gangadia3
  • Grainne Brady1
  • Emma McGuire2
  • Gwenan M Knight4
  • Laura Shallcross5
  • Steve Harris2
  • Cecilia Vindrola-Padros1
5 affiliations
  1. 1Department of Targeted Intervention, University College London, London, England, United Kingdom.
  2. 2University College London Hospitals NHS Foundation Trust, London, England, United Kingdom.
  3. 3Division of Psychiatry, University College London, London, England, United Kingdom.
  4. 4London School of Hygiene & Tropical Medicine, London, England, United Kingdom.
  5. 5Institute of Health Informatics, University College London, London, England, United Kingdom.
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Abstract

Background

Prior microbiology results, resistance patterns, and antimicrobial exposure are central to safe and effective antimicrobial prescribing. Digital health fragmentation refers to the dispersal of patient data across multiple electronic systems and the associated challenge of accessing complete information at the point of care. Antimicrobial prescribing for infections represents a critical use case to investigate the impact of digital health fragmentation on patient care. While interoperability has been studied in the context of patient safety, no review has described digital health fragmentation within the United Kingdom and examined its impact on antimicrobial prescribing and antimicrobial stewardship (AMS).Objective

This study aimed to (1) characterize the extent of digital health fragmentation in the United Kingdom, (2) summarize the available evidence on its impact on AMS and prescribing practices in high-income countries, and (3) identify potential solutions.Methods

A rapid review of the peer-reviewed literature was conducted following published guidance for rapid reviews and the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) statement. MEDLINE ALL and PsycInfo were searched on August 19, 2025, using search terms relating to digital health fragmentation or interoperability, patient safety, and antimicrobial use. Searches were limited to English-language publications from 2015 (for characterizing the recent trends or current state of digital health fragmentation in the United Kingdom) or 2010 onward (for AMS-related impacts and solutions). Screening was conducted by 4 researchers following predefined inclusion and exclusion criteria. Extracted data were synthesized narratively through framework analysis. Study quality was appraised using the Mixed Methods Appraisal Tool.Results

Fourteen studies met the inclusion criteria. Ten studies described the extent and nature of digital health fragmentation in the United Kingdom. Digital health fragmentation affects a large number of patients and is linked to clinical care efficiency, quality, and safety risks, including limited access to external clinical records, missing or incomplete information, duplicate investigations, delays in decision‑making, and substantial time spent searching for data. Evidence specific to antimicrobial prescribing was limited (4 studies) but indicated that AMS relies on information spread across multiple systems, with poor interoperability disrupting workflows, hindering communication, and undermining stewardship activities. Only 1 study reported the development of a digital tool designed to address digital health fragmentation and support AMS.Conclusions

Digital health fragmentation negatively affects patient care across the United Kingdom, yet evidence on how it impacts AMS remains scarce. Given the urgency of the global antimicrobial resistance crisis, future research should therefore quantify the scale and impact of digital health fragmentation for AMS to inform investment and innovation in digital infrastructure and clinical-supportive solutions.Trial registration

PROSPERO CRD420251126067; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251126067.

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Cite

BibTeXRIS
BibTeX
@article{schneider2026extent,
  title = {{Extent of Digital Health Fragmentation and Potential Implications for Antimicrobial Prescribing: Rapid Evidence Review.}},
  author = {Verena Schneider and Akish Luintel and Bethan Balch and Shivani Gangadia and Grainne Brady and Emma McGuire and Gwenan M Knight and Laura Shallcross and Steve Harris and Cecilia Vindrola-Padros},
  journal = {Journal of medical Internet research},
  year = {2026},
  month = oct,
  doi = {10.2196/94014},
  url = {https://europepmc.org/article/MED/42837652},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Extent of Digital Health Fragmentation and Potential Implications for Antimicrobial Prescribing: Rapid Evidence Review.
AU  - Verena Schneider
AU  - Akish Luintel
AU  - Bethan Balch
AU  - Shivani Gangadia
AU  - Grainne Brady
AU  - Emma McGuire
AU  - Gwenan M Knight
AU  - Laura Shallcross
AU  - Steve Harris
AU  - Cecilia Vindrola-Padros
PY  - 2026
DA  - 2026/10/06
JO  - Journal of medical Internet research
DO  - 10.2196/94014
UR  - https://europepmc.org/article/MED/42837652
AB  - Background  Prior microbiology results, resistance patterns, and antimicrobial exposure are central to safe and effective antimicrobial prescribing. Digital health fragmentation refers to the dispersal of patient data across multiple electronic systems and the associated challenge of accessing complete information at the point of care. Antimicrobial prescribing for infections represents a critical use case to investigate the impact of digital health fragmentation on patient care. While interoperability has been studied in the context of patient safety, no review has described digital health fragmentation within the United Kingdom and examined its impact on antimicrobial prescribing and antimicrobial stewardship (AMS).Objective  This study aimed to (1) characterize the extent of digital health fragmentation in the United Kingdom, (2) summarize the available evidence on its impact on AMS and prescribing practices in high-income countries, and (3) identify potential solutions.Methods  A rapid review of the peer-reviewed literature was conducted following published guidance for rapid reviews and the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) statement. MEDLINE ALL and PsycInfo were searched on August 19, 2025, using search terms relating to digital health fragmentation or interoperability, patient safety, and antimicrobial use. Searches were limited to English-language publications from 2015 (for characterizing the recent trends or current state of digital health fragmentation in the United Kingdom) or 2010 onward (for AMS-related impacts and solutions). Screening was conducted by 4 researchers following predefined inclusion and exclusion criteria. Extracted data were synthesized narratively through framework analysis. Study quality was appraised using the Mixed Methods Appraisal Tool.Results  Fourteen studies met the inclusion criteria. Ten studies described the extent and nature of digital health fragmentation in the United Kingdom. Digital health fragmentation affects a large number of patients and is linked to clinical care efficiency, quality, and safety risks, including limited access to external clinical records, missing or incomplete information, duplicate investigations, delays in decision‑making, and substantial time spent searching for data. Evidence specific to antimicrobial prescribing was limited (4 studies) but indicated that AMS relies on information spread across multiple systems, with poor interoperability disrupting workflows, hindering communication, and undermining stewardship activities. Only 1 study reported the development of a digital tool designed to address digital health fragmentation and support AMS.Conclusions  Digital health fragmentation negatively affects patient care across the United Kingdom, yet evidence on how it impacts AMS remains scarce. Given the urgency of the global antimicrobial resistance crisis, future research should therefore quantify the scale and impact of digital health fragmentation for AMS to inform investment and innovation in digital infrastructure and clinical-supportive solutions.Trial registration  PROSPERO CRD420251126067; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251126067.
SN  - 1439-4456
SN  - 1438-8871
ER  -