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This short Q and A with Dezan Shira & Associates’ Vietnam Director, Filippo Bortoletti, sheds light on the current state of Vietnam’s sharing economy, where it might be headed next, and what actions need to be taken to ensure it is functional and profitable long into the future.
The sharing economy is a new business model taking advantage of digital technologies and connecting people. It is different from traditional business models because all transactions are carried out online via a third-party multi-dimensional platform. Such multi-dimensional platforms allow direct interaction between different user groups, and the more partners are involved, the more value is created for the entire system.
This new business model offers numerous advantages for the parties involved. The market becomes more competitive and diversified, transaction costs are reduced, and providers have access to a wider consumer base and increased demand. Business opportunities based on digital foundation are multiplied, creating new jobs and increasing incomes, as well as promoting innovation.

Vietnam is well positioned to exploit the growing opportunities in the sharing economy thanks to its well-educated, tech-savvy, and young population. Sharing economies in Vietnam are quite diverse; in recent years, sharing economies have developed in transportation, tourism, and hotels, and they are expected to expand in a variety of other industries as well. At the same time, many new technologies are being applied in the digital payments sector, such as fingerprint authentication, facial recognition, and QR codes.
Digital transformation has also been a driver for change in public administration. Vietnam is an ambitious country with a long-term growth strategy and has demonstrated its willingness to embrace changes by implementing e-government solutions. Such efforts have translated into the formation of an electronic document management system with several national databases and  the introduction of e-invoicing, among others.
While the sharing economy is bringing a lot (and has the potential to bring even more) of positive changes and opportunities, it also threatens the survival of businesses adopting traditional business models. And with fast-developing sharing economy models, the legal framework is lagging.
Specifically, there are some issues to be tackled when embracing the new business model of sharing economies, which are mainly related to: market entry and business conditions, tax collection, users’ interests, workers’ rights, and information security. These issues could create challenges related to uneven competition, economic concentration, the development of informal markets, and a lack of tools to protect users.
One of the issues I have observed is that – within the sharing economy – it is extremely difficult to register a business if it is related to new business lines that are unfamiliar to state management agencies. Due to a lack of definition for such new businesses and clear market entry rules, local officers tend to reject applications or apply unreasonable requirements. The current way of thinking is to ban anything that cannot be managed, thus hindering the development and growth of new businesses.
For example, cryptocurrency trading and peer-to-peer lending are not yet eligible for business registration in Vietnam as they pose high risks for customers, including personal data leakage, cyberattacks, or could involve customers in money laundering and tax evasion.
The absence of a comprehensive and clear legal framework can also result in the proliferation of many black credit loan apps disguised as peer-to-peer lending through leveraging the grey areas of the current legal framework.
A prime example of potential issues that can surface without a clear and flexible legal framework is the controversy between Grab and Vinasun, both directly operating taxis in Ho Chi Minh City. Due to a loophole in the regulations, Vinasun was subject to Government Decree 86/2014 on transport services, while Grab was subject to a different set of regulations. This is an example of unequal competition, as Grab’s operations were not subject to the same requirements and taxes.
This example highlights the importance of having a clear set of rules to define and regulate businesses in the framework of the sharing economy. Indeed, soon after Government Decree 10/2020 was released, many differences between technology providers (like Grab) and transport service providers (like Vinasun) that are providing the same kinds of services were eliminated. For the first time, the concept of electronic contracts as technology vehicles were recognized, and at the same time Decree 10 officially referred to the application software of car booking companies, thus levelling the playing.

Amid a contradictory and unclear legal framework, businesses and users are exposed to increased risks. To this end, Vietnam’s government has actively approached opportunities in the sharing economy. And especially after the COVID-19 period, there is a stronger will to embrace the digital transformation of the local economy.
The government for example has adopted a series of guidelines and policies to catch up with Industry 4.0 and digital transformation – which are considered pillars for the growth of the country – and is now adapting the legal framework to include new flourishing businesses arising from the sharing economy.
For example, the recent Government Decree 85/2021 on e-commerce was aimed at strengthening the responsibility of e-commerce platforms, adding specific regulations on social networks, and improving management of tax collection. The result is a clearer definition of e-commerce, excluding businesses only involved in website and application design (thus not directly participating in the business operations of e-commerce platforms) and including social networks meeting certain conditions – such as Facebook marketplace. Additionally, the decree clarifies market access conditions in compliance with the Law on Investment and mandates a guaranteed payment system.
On the other hand, there are still areas requiring adjustments, for example, the regulations surrounding electronic transactions. Specifically, many provisions have become outdated and could become a barrier to economic activity. There is a lack of clarity around applying electronic signatures and a lack of regulations on electronic contracts as well as on technology measures to ensure data security.
In general, Vietnam’s government should focus on creating a level playing field, encouraging innovation and competition, and improving regulations on transactions, contracts, ownership, property rights, and dispute resolution mechanisms.
Vietnam has made efforts to create a legal framework to guide and promote the development of the digital economy. However, although the government has a vision for sandboxing new businesses in the sharing economy, there is a lack of clear implementation guidelines. A solution could be the creation of working groups that include leaders of different ministries, for coordinating and implementing the sandbox policies. Also, the legislative way of thinking – and the approach of competent state management agencies – should be more flexible when working side-by-side with innovative start-ups.
More from Filippo Bortoletti
About Us
Vietnam Briefing is published by Asia Briefing, a subsidiary of Dezan Shira & Associates. We produce material for foreign investors throughout Eurasia, including ASEAN, China, India, Indonesia, Russia & the Silk Road. For editorial matters please contact us here and for a complimentary subscription to our products, please click here.
Dezan Shira & Associates provide business intelligence, due diligence, legal, tax and advisory services throughout the Vietnam and the Asian region. We maintain offices in Hanoi and Ho Chi Minh City, as well as throughout China, South-East Asia, India, and Russia. For assistance with investments into Vietnam please contact us at vietnam@dezshira.com or visit us at www.dezshira.com
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Want to improve your team’s project management and keep track of requests in real-time? Learn how to create a project request board in Google Sheets.
Perhaps you’re in a position where you need to ask your coworkers for help or send them assignments, but you’re feeling a bit awkward about it—or you just don’t care about all the calls and emails back and forth. Why not create a project request board?
While you could sign up for a project management tool like ClickUp or Asana and get your coworkers to join you, you may already have access to a simple, no-cost solution—Google Sheets. Follow along with this article to learn how you can build a project request board using this common spreadsheet tool.
The goal of creating a project request board is twofold. It serves as a way for you to overcome the friction caused by delegating tasks. Plus, it reduces back-and-forth communication, saving you time.
Essentially, with each assignment you add to the board, you’ll map out everything your coworker needs to know to complete it. So you’ll want to be consistent and create a layout that prompts you to add vital details each time. Details like:
Since every workplace is different, there may be some additional details you can include to tailor it to your team's needs. So, before getting started, take a moment to mull that over. If you can’t think of any now, you can add them later, but remember, less is more. You wouldn't want to add any unnecessary steps.
To get started with your project request board, open a blank document in Google Sheets. Write the following titles, and any extras you come up with, across the top of the spreadsheet:
Help your titles stand out by bolding them and adding a background color to the row. You can also freeze the top row of your Google Sheet by highlighting it and going to View in the top menu, Freeze, and then 1 row.
Adding a status button to your project request board gives you and your coworkers a quick way to share progress. It’s also a great way to get a quick overview of everyone’s workload and identify if someone could use an extra hand. Some examples of status you can use are:
You can create a working status button, much like the ones you find in project management software like ClickUp and Asana, by adding a dropdown menu to your sheet. To do this:
Now you’ll have a menu your team can use to show a task's status. There's an edit button at the bottom of the list, but that only works for the selected cell. To change all your status buttons, return to the data validation menu and pick the rule you want to edit from the sidebar.
Repeat these steps to add quick options to your Priority, Assignee, and Created by columns if you want.
If you simply tag or mention someone in the sheet, Google won’t send a notification. When assigning someone to a project, you can give them a heads-up by following these steps:
Now, if your coworker has questions, they can add them as a comment in the same thread. By keeping all of your communications about the task in the same place you assigned it, you’ll both know exactly where to find the conversation again later if someone needs a refresher.
Since there will be more than one person using the sheet, it’s good you have a backup, just in case someone accidentally deletes or writes over important information. At the top of your sheet, you’ll notice a hyperlink that states the most recent edit occurred. Click this, and you’ll see backups from previous work sessions and the changes that took place.
Using version history in Google Sheets is handy because you can see your previous projects and notes if you need a record of them. But you can also revert to a previous version if your sheet gets messed up somehow—it happens.
Note: If you want a more direct record of completed assignments, add another sheet to your document using the plus symbol in the bottom-left of your screen and cut and paste your rows in there once the status changes to Done.
Creating a project request board in Google Sheets is an excellent way to save time when delegating and collaborating on assignments. Not only will there be less back and forth, but everyone will know where to find the information for tasks, having it all in one place.
It also helps you avoid some of the awkwardness you could feel about asking for help or dishing out tasks. You’ll get more comfortable with that as you go.
Autumn Smith is a freelance tech and lifestyle writer from the great Canadian wilderness. She studied graphic design, but marketing kept finding her instead; her passion for writing trying to push its way in. Now she writes full-time.

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by Justin Guinn | Updated Aug. 5, 2022 – First published on May 18, 2022
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You’ve heard it before, and here it is again: Digital transformation is a must.
There are a ton of layers to that statement, and one layer that’s become relatively low-hanging fruit is implementing a paperless office. It’s been apparent for some time that paper-based document management and business dealings are expensive and inefficient.
Put simply, you must commit to going paperless in the office. It’s a move that positively impacts your budget, business efficiency, and brand positioning as well as the world at large.
It’s time to adopt digital document management best practices by implementing communication strategies and productivity apps that eliminate the need for paper.
Regardless of your business, it’s well past time for you to adopt a digital filing system and go paperless. But there are a few critical considerations to keep in mind before implementing your new paperless filing system.
You’ll need to address these key hurdles before working through the best practices highlighted below.

There’s just no need to continue operating so inefficiently. (via CloudPoint Technology) Image source: Author
Going paperless is the right move for all businesses, but you still need to work through how your new paperless operation will uniquely impact your business metrics.
Moving to a paperless, digitally driven organization should definitely save money in your business budget, even after paying for your document management system.
It should also increase efficiency across the board. Two efficiency boosters include reducing human error in lost papers and incorrect filings and decreasing the time between submitting bids to clients and closing deals with e-signing documents.
There are innate technology core competencies that employees and clients will need in order to successfully transition to a paperless operation. The day-to-day experience with your new document management systems will be similar to navigating your business website.
So as long as people are comfortable executing basic online browsing and using websites, they should be fine with the transition.
Still, it’s a good idea to mitigate any issues by building proper instruction documentation to walk clients through the process and provide struggling employees with a guide.
Keep your instructions as simple as possible by incorporating some screenshots and limiting each instructional section to a single task.
For example, you should be able to share instructions on how to upload a file to a particular folder without having to share all the instructions for e-signing and other tasks.
Once you’ve made the switch to digital, you’re going to have a bunch of dormant equipment laying around your office. While this isn’t hugely impactful for your business, you do need to determine what will happen with your retired printers, copiers, fax machines, etc.
You may be able to recoup some money by selling them. If that’s too much hassle, you can probably donante them and have someone come take them off your hands. Just get a plan in place so that you’re not suddenly wondering what to do with a bunch of bulky office equipment.
You’re ready to go paperless in your business. It’s rightfully exciting, as it provides tons of positive impact to your operation, your personal branding, and of course the environment.

Your transition to paperless will be easier than you think. (via Ezop) Image source: Author
Here are five best practices to ensure you have a smooth transition to becoming a paperless business and installing a sustainable operation to take on the future.
A document management system is the foundation on which you’ll operate your paperless business. It is your new digital filing cabinet and file retrieval system, as well as a solution for sharing and collaborating on files.
You’ll use your documentation retention solution as an essential tool to create, secure, and share critical documents, so be sure you take the time to get the system that’s best for your business needs.
And make sure you have the technical ability to operate and manage the system. If you take care of your own website management, you should be fine with managing your new document management system.
Here are a few tips for adopting and implementing a document management system.
A major benefit of a document management system is the ease with which you can find documents. But this search capability doesn’t just happen — it requires tons of organizational effort and detailed tagging inputs.
So before you can bring on your new document management system, you’ll need to account for all the digital and paper-based documents you already have. This means scanning, uploading, organizing, categorizing, tagging, formatting, and much, much more.
This will most definitely be the largest hurdle in transitioning to a paperless office, so start ASAP and work to get ahead of this project so that it costs you less time in the future.
Here are a few tips for organizing your existing documents to ensure a detailed and easily searchable document database.
You must lead by example to make a successful transition to going paperless. Regardless of the new document management software and organization apps you implement, your employees need to see that you’re committed to the paperless cause.
This type of top-down leadership is essential for managing any kind of change in your business.
Here are a few tips to help you lead by example as you go paperless with your business operation.
Employee engagement and buy-in is critical for making a seamless transition to your new paperless office and operating style. You need to focus on ways to engage employees and get them motivated and committed to making the change to paperless.
Leading by example through top-down change management is essential, but you should also consider additional tactics to rally your employees toward the cause, such as gamification and training exercises.
Here are a few tips to ensure your employees become equally as committed to going paperless as you.
Take advantage of employees who are excited about and committed to going paperless by assigning them as paperless champions.
These champions will become quasi-experts on the transition and new systems and provide a helpful and willing resource for any questions that employees have along the journey.
Here are two tips for establishing and choosing champions to support the transition to paperless and adoption of new document software.
If you’re serious about going paperless, these considerations and best practices will help you build the path to get there. The technology to do so has been around for a while, and it continues to get more affordable, easier to use, and feature-rich every year.
All the tools are there to take your entire business into the digital realm, but it’s up to you to lead your people through the archaic paper wasteland and show them the ease and efficiency that awaits them in their new paperless business.

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Justin Guinn is an SMB technology expert writing for The Ascent and The Motley Fool.
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Quadintel’s recent global File Sharing and Document Management Software market research report gives detailed facts with consideration to market size, cost revenue, trends, growth, capacity, and forecast till 2030. In addition, it includes an in-depth analysis of This market, including key factors impacting the market growth.
This study offers information for creating plans to increase the market’s growth and effectiveness and is a comprehensive quantitative survey of the market.
Download Free Sample of This Strategic Report :-https://www.quadintel.com/request-sample/global-file-sharing-and-document-management-software-market-1/QI045
For industry executives, marketing, sales, and product managers, consultants, analysts, and stakeholders searching for vital industry data in easily accessible documents with clearly presented tables and graphs, the research contains historical data from 2017 to 2020 and predictions through 2030.
This market report provides accurate market research that can exponentially accelerate the business.
The main location, economic conditions, as well as the item value, benefit, limit, generation, supply, demand, and market growth rate and figure, are provided in the study.
This industry study also includes a new project SWOT analysis, speculation attainability analysis, and venture return analysis.
This market study offers information on segmentation and its subsegments, competitors and their earnings, size, and pricing, among other things.
Request full Report Description, TOC, Table of Figure, Chart, etc :-https://www.quadintel.com/request-sample/global-file-sharing-and-document-management-software-market-1/QI045
Key Segments and leading prominent companies profiled Included in the Report are
Major Players in File Sharing and Document Management Software market are:
Zoho
Google
PDFelement
BizPortals 365
Dropbox
Citrix Systems
WeTransfer
Microsoft
Wrike
Synology
PandaDoc
EFileCabinet
Hightail
Samepage
Bitrix
FileInvite
Backlog
Templafy
Droplr
Most important types of File Sharing and Document Management Software products covered in this report are:
Cloud Based
On-Premise
Most widely used downstream fields of File Sharing and Document Management Software market covered in this report are:
Large Enterprise
SMEs
Top countries data covered in this report:
United States
Canada
Germany
UK
France
Italy
Spain
Russia
China
Japan
South Korea
Australia
Thailand
Brazil
Argentina
Chile
South Africa
Egypt
UAE
Saudi Arabia
Request full Report :-https://www.quadintel.com/request-sample/global-file-sharing-and-document-management-software-market-1/QI045
About Quadintel:
We are the best market research reports provider in the industry. Quadintel believes in providing quality reports to clients to meet the top line and bottom line goals which will boost your market share in today’s competitive environment. Quadintel is a ‘one-stop solution’ for individuals, organizations, and industries that are looking for innovative market research reports.
We will help you in finding the upcoming trends that will entitle you as a leader in the industry. We are here to work with you on your objective which will create an immense opportunity for your organization. Our priority is to provide high-level customer satisfaction by providing innovative reports that enable them to take a strategic decision and generate revenue. We update our database on a day-to-day basis to provide the latest reports. We assist our clients in understanding the emerging trends so that they can invest smartly and can make optimum utilization of resources available.
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Updated : 2023-01-04 09:11 GMT+08:00
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Home » Small Business » Top 7 Best BPM (Business Process Management) Software
The article is checked by our editorial team, Which includes entrepreneurs who are painfully aware of how overwhelming and challenging it is to start a business for the first time.
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As a business expands, the workflow can become complex.  With the expansion, business leaders may find it hard to organize and streamline various departments.  Many companies offer comprehensive process management software to integrate processes and data into an effective system.  We have reviewed the leading competitors and chosen 7 outstanding services. We analyze each to help guide you when selecting the right match for your needs and to optimize your business processes.
Software for business process management assists companies in connecting and synching various siloed aspects of their work. BPM software organizes, manages, and optimizes your business.
Business process management (BPM) software manages workflow, data, business processes, and logistics.  Automated applications analyze your data, forecast, integrate, and streamline applications into enterprise dashboards.  When deployed as part of a comprehensive plan, it takes away hours of manual effort, maximizes efficiency, and gives an organized feel to your business.
Read more: Best CRM Softwares In 2023
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Read Monday.com Reviews
As an elegant and streamlined process management package, Monday offers clients an agile adaptable platform with easy integrations.  Users will find it surprisingly easy to automate business process management. Monday.com is the Best Overall choice for BPM software.
Users find Monday to be a supremely efficient and streamlined single-source workflow product.  Outstanding features include process automation, project management functions, and sales-facing features like CRM and marketing campaigns.  All aspects of the company can be automated and streamlined with process management. These features have helped the company receive over 10,000 reviews with a 5/5 Star average.  Customers praise the features, the 24/7 customer support, and the easy-to-use interface.
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Read Zoho Creator Reviews
As one of the simplest drag-and-drop interface platforms, Zoho Creator is a user-friendly choice with good value in process management software.  Flexible pricing including a surprisingly effective free plan.  Zoho creator is the Most Affordable
This company bills itself as a low-code app development site.  The drag-and-drop functions are truly straightforward and workable, with excellent outcomes for IOS and android.  Though the free service is a draw to smaller businesses, the service does quite a bit including CRM and real-time business analytics.  Any small business can streamline business processes effectively with Zoho Creator. Their free tier offers solid BPM software, so bootstrappers may want to start here.
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Read Kissflow Reviews
With the top case-specific automation, Kissflow provides a simplified workflow with personalization on the internal and customer-facing aspects.  Thus, Kissflow wins our nod for Best Service
This is a great service for simplified workflow and customer responsiveness.  Managers can implement this software with no coding whatsoever with the help of the drag-and-drop studio with prebuilt tools.  Organizations can allow for personalization even within user classes in order to maximize effectiveness. Features such as helpdesks, service desks, and complaint management are effective in boosting satisfaction. Additional highlights include form builder and process modeling and simulation.  However, the internal processes are less comprehensive and fluid than some of the competitors, and the occasional bug is reported on reviews.
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Read Appian Review
Branded as a sort of innovator for innovators, Appian provides low-code business process automation and a mission to respond to changing industry needs. Appian is the Best for Market Demands.
To stay competitive, businesses need software packages that optimize exactly what they do.  Appian understands this and offers tailored solutions.  They adapt to your needs.  Prominent features include data analytics, AI, bot optimization, and third-party automation – all wrapped into a seamless process.  Appian offers trending services such as data fabric architecture, DevOps, and process mining.
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Read IBM Reviews
With superior features and the connection with IBM’s iconic Watson AI, Cloud Pak is perhaps the most powerful solution in the field.  It offers high scalability on a Kubernetes platform.  Compared to our other selections, IBM offers the most capabilities.  However, it is tailored to larger enterprises. Companies need human and capital resources to make Cloud Pak work to its potential. Therefore, IBM Cloud Pak is Best for Large Enterprises
Watson AI powers state-of-the-art business analytics, data management prediction functions, and app modernization on IBM Cloud Pak. The service also offers an entire Security Pak as one aspect of the Pak solution. It’s hard to compete with IBM’s functions to manage process documentation and business process automation of large volumes of complex data in order to maximize business outcomes.  Cloud Pak deploys on Red Hat Marketplace to integrate more enterprise software tools.  However, there are downsides that make Cloud Pak a poor solution for some circumstances.  It is not a simple process to install the product and train staff to use it.  This is no plug-and-play option and is best for companies with a larger staff where there is technical and data analytic expertise in-house.  Cloud Pak can do more and more on a larger scale than competitors, but its complexity makes it better for larger enterprises.
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Read Nintex Reviews
Nintex is one of the simplest BPM solutions.  Their platform is easy to use and works smoothly for routine needs.  It is not aimed at higher-end complex and customized needs.  We select Best Value Service, as it meets the needs well of its intended users.
Upon relatively easy implementation, Nintex helps users with mapping to identify processes, automate workflow, and optimize all your business apps. Highlights include robotic process automation for paperwork flow such as e-sign,  generating personalized documents, insights, and analytics.  To make the drag-and-drop interface even easier, Nintex provides horizontal offerings with Industry specific workflow templates or vertical categories by the department.  With flexible pricing, it gives a good value for the investment for most small businesses. Its effectiveness appears to break down at more complex levels when Nintex can’t offer the customization and scalable approach that some competitors do better.
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Read ProcessMaker Reviews
If your business needs an easy-to-launch and streamlined BPM, Process Maker is an excellent service. They offer a variety of services and excellent workflow management.  Therefore we judge it Best for Medium to Large Sized Businesses
Look no further for a drag-and-drop business process platform that is easily to set up yet still has good features.  And one bonus – ProcessMaker Integrates legacy systems making a change feasible.  This system works well for medium and large enterprises because it integrates complex business functions into a simple process.  Users cite its business activity monitoring features as a highlight.  Key players are alerted to metrics instead of actively hunting reports and charts.   Additional benefits include excellent robotic process automation out of the box.   The business analytics are excellent, and also Integrate your ERP and CRM for an all-around solution.  On the negative side,  at the smallest size, some of the debugging and integration programming may be too burdensome, while some features become too complicated at the large enterprise level.  Everyone in between should consider ProcessMaker as a straightforward and simple solution.
There is no one “best” BPM solution out there.  The key is to analyze the strengths and limitations compared to the needs of your business. We recommend considering the following factors.
Every platform comes with a different pricing structure.  Most offer flexible fees such as per-user pricing, organizational flat fees, or enterprise pricing.  Businesses need to ask what they really need and what value each potential solution brings to determine ROI.
You have existing business applications and software.  So how easy will your new business process management system integrate with these existing features?  This is key for workflow automation to actually function.  Otherwise, you can be in for a frustrating process.
In larger companies, the ability to create and assign roles to users in a way that helps workflow is necessary.
Some platforms are good for smaller uses while others function well on more complex and robust use cases.  If you are trying to scale quickly, make sure the platform can follow.
The best process automation tool can offer incredibly insightful data analytics with easy-to-access reports.
Automation of paperwork processes is a key efficiency upgrade.  Do you need a platform to send, receive, sign, approve and manage document flow?
Business users can choose from drag and drop, to low code, to complex.  A fast learning curve and smooth user experience are helpful for your staff.  Smaller and medium-sized businesses usually benefit from simplicity while larger and or more complex businesses may have enough IT and coding capacity to get even more out of a different product.
Customer service varies greatly between business process management platforms.  Companies that are responsive and good at troubleshooting are at a premium.
[Almost any company in this space will provide an impressive list of potential features.  We recommend you pay careful attention to customer reviews.  This gives you a good indication of how the actual client experience works out.
Modern business can become complex with the array of data sets, software applications, and business functions to oversee and integrate  Business process management software can save an organization time, money, and energy with streamlined processes and powerful data analytics.  We reviewed 7 entrants who all bring strengths to the table.  We urge business leaders to review the features of each and determine which solution matches their challenges.
Business managers may find it hard to organize and streamline various departments.  Many companies offer comprehensive business process management software to integrate.  These software services optimize business processes and organize workflow.
Use software platforms to integrate various departments, applications, and work functions.  This can take the steps of identifying business processes, automating the functions, integrating applications, and then managing the workflow. 

Yes, cloud-based business process management software has millions of users worldwide.  There are many reputable companies all of whom provide effective and secure platforms.  Use professional reviews, customer ratings, and your own analysis to determine the legitimacy of any particular company.

Bizreport Advisor adheres to strict editorial integrity standards avoids using tertiary references. We have strict sourcing guidelines and rely on peer-reviewed studies, academic research. To ensure the accuracy of articles in Bizreport, you can read more about the editorial process here.

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When implemented in practice, digital technologies have shown improvements in morbidity and mortality outcomes in patients with cardiovascular disease (CVD). For scholars, research into digital technologies in cardiovascular care has been relatively recent, thus it is important to understand the history of digital health technology in cardiovascular research—its emergence, rate of growth, hot topics, and its temporal evolution. The aim of this study was to analyse more than 16,000 articles in this domain based on their scientometric indicators. Web of Science (WoS) Core Collection was accessed and searched at several levels, including titles, abstracts, keywords, authors, sources and individual articles. Analysis examined the temporal shifts in research and scholarly focus based on keywords, networks of collaboration, topical divisions in relation to digital technologies, and influential publications. Findings showed this research area is growing exponentially. Co-citation analysis revealed twenty prominent research streams and identified variation in the magnitude of activities in each stream. A recent emergence of research activities in digital technology in cardiovascular rehabilitation (CR), out-of-hospital cardiac arrest (OHCA), and arrythmia research was also demonstrated. Conversely, wearable technologies, activity tracking and electronic medical records research are now past their peak of reported research activity. With increasing amounts of novel technologies becoming available and more patients taking part in remote health care monitoring, further evaluation and research into digital technologies, including their long-term effectiveness, is needed. Furthermore, emerging technologies, which are evaluated and/or validated should be considered for implementation into clinical practice as treatment and prevention modalities for CVD.
Digital innovation and connection is a vital part of a modern, accessible healthcare system. Digital health is an umbrella term used to describe a range of technologies, including mobile health and applications, electronic medical records (eMRs), telehealth and telemedicine, wearable devices, robotics and artificial intelligence (AI)¹. These technologies have a multitude of uses, including disease detection, aiding patient treatment, ensuring continuity of care, and managing a person’s health information. The 1980s were considered a rapidly progressive time for digital health technologies, with the emergence of professional organisations (e.g. American Telemedicine Association and International Medical Informatics Association) whose goals were to transition from traditional healthcare methods to more advanced, technology driven applications². However, the maturation of digital health technology has occurred in the current century. Access to care and health equity is an international priority³, and is largely a motivating factor for health systems to move towards digital health adoption. The recent World Heart Federation Roadmap for Digital Health in Cardiology highlights the potential for digital health technologies to achieve optimal and universal health coverage (UHC) through empowering patients and providers, promoting UHC, improving long-term patient outcomes and care experience and reducing healthcare costs⁴. In the last five years (especially the COVID-19 pandemic years of 2020–2022) a new imperative has arisen to extend reach of care and achieving even higher standards of healthcare using digital health technology. Digital technology applications in healthcare have developed into a standalone market, and researchers, health professionals and industry now observe and appreciate a promising future.
Implementing best practice care for patients with cardiovascular diseases (CVDs) is one of the greatest challenges for health care providers. CVDs require frequent, continuous, and seamless management. Thus, these diseases continue to be important targets for implementation of digital technologies to enable patients, their families and communities, to manage -and improve- their health¹ through improving quality of care, equity of access, increasing efficiencies and promoting better patient self-management⁵. CVD remains the leading cause of death worldwide with an estimated prevalence of 470 million in 2016⁶. CVD encompasses a wide range of conditions, including ischemic heart disease, cerebrovascular disease, cardiomyopathies, arrhythmias, peripheral vascular disease, rheumatic heart disease, congenital heart disease and hypertensive heart disease, among others. The majority of CVD are accelerated by largely modifiable behavioural and metabolic risks factors (e.g., smoking, physical activity, unhealthy diet), although non-modifiable risk factors (e.g., genetics, age, sex) are also important. To date, the weight of scientific evidence supports the use of digital technologies in CVD care and management⁷.
Detecting and visualizing emerging trends and transient patterns in scientific literature, as achieved by Chen’s methods⁸ is essential for developing sound research rationale and formulating relevant, useful and applicable research questions. Therefore, the aim of this study is to conduct a macro-scale analysis of the scientific literature with a broad scope on digital health innovation. Through this exploration we can grasp the breadth and depth of the knowledge of digital technology applications within the field of cardiovascular medicine.
Using the search strategy, 16,699 documents were identified in the topic of digital health technologies in cardiovascular medicine. The first article on record, published in 1961 in Circulation is titled ‘Electronic device for accurate identification of cardiac conduction system- its use in open-heart surgery’⁹. In the period of 30 years to the early 1990’s only 35 more relevant papers were published. Since the mid-1990’s there has been an accelerating publication trend until 2021, when over 2,300 articles were published in year (Fig. 1a). Within the observable exponential trend in this topic, there are no distinct jumps in research activity. Around 60% of the research output is in the form of original research articles (including case studies), followed by conference proceedings papers (14%), meeting abstracts (13%) and review articles (9%).
a Distribution of digital technology research articles (in cardiovascular medicine) from 1961 to 2021; b Major journals within the topic of digital technology applications in cardiovascular medicine.
The top globally cited articles have quite distinct topics (see Supplementary Table 2). The most cited paper is “Flexible polymer transistors with high pressure sensitivity for application in electronic skin and health monitoring” authored by Schwartz, Tee¹⁰. The paper has received 1,337 citations in WoS provides information on the fabrication of a novel flexible pressure-sensitive sensor that has high pressure and time resolution capabilities to continuously monitor the human radial artery pulse wave. It is a step-change innovation because previously, only complex instruments such as micromanometers could read a pulse with such accuracy. Furthermore, the flexible pressure sensors developed could be used in mobile health monitoring and remote diagnostics in cardiovascular medicine. Other highly cited papers include topics about health-related behaviours such as sedentary lifestyles¹¹, medication adherence¹², robots¹³, and software¹⁴, which highlights the diversity within this topic.
Specific subject areas were identified using WoS Categories. While most of the literature is concentrated in Cardiac and Cardiovascular Systems (n = 4,809, 28%), it reaches across a range of sub-disciplines, including Health Care Science Services (n = 1,643, 10%), Engineering Biomedical (n = 1,449, 9%), Engineering Electrical Electronic (n = 1,255, 8%), Medicine General Internal (n = 1,201, 7%), Peripheral Vascular Disease (n = 1,142, 7%), Medical Informatics (n = 1,118, 7%), Clinical Neurosciences (n = 941, 6%) and Rehabilitation (n = 752, 4%). Circulation and European Heart Journal are the dominant outlets for publications in this area of research (Fig. 1b), with around 700 documents attributed to these two alone.
Over 75,000 authors have contributed to the topic, 2,956 of whom have authored five or more articles. Authors with more than 45 contributions include Giuseppe Boriani (University-Hospital Polyclinic of Modena, Italy), Rizwan Sohail (Baylor College of Medicine, United States of America [USA]), Tiny Jaarsma (Linkoping University, Sweden), Paul Friedman (Mayo Clinic College of Medicine, USA), Bruce Wilkoff (Cleveland Clinic, USA), Larry Baddour (Mayo Clinic, USA), Jinseok Lee (Kyung Hee University, South Korea) Julie Redfern (University of Sydney, Australia) and Jenny Wang (University of Sheffield, England).
Publications originating from the USA have been most frequent (n = 5,493), followed by England (n = 1,494), Italy (1,338), Germany (n = 1,191), China (n = 1047), Canada (n = 1030), and Australia (n = 908) (Fig. 2). There are fewer contributions from Africa and South America (except for Brazil). Authors based in the USA are involved in all the strongest collaborations; with England (n = 260), Canada (n = 248), China (n = 163), Germany (n = 163), Australia (n = 159) and Italy (n = 146) indicating that lingual similarities and geographical proximity do not necessarily foster greater collaboration. Collaborations between researchers from English-speaking countries such as Australia, Canada, England and USA and Middle Eastern countries Iran, Iraq and Saudi Arabia are amongst the newest. Lastly, we can also observe that there are few low and middle-income countries producing scholarly research in this area.
The strength of collaborations between researchers from different countries, defined by number of documents, is indicated by the width of the link.
Table 1 shows the top keywords (see also Supplementary Fig. 1 for density of co-occurrence of keywords in the literature). In just under two years since the term emerged, Covid-19 (and alternatives e.g. sars-cov-2) have already garnered 270 mentions, reflecting the imperative of managing care when physical distancing is demanded. Keywords also provide insight into the temporal shifts in research and scholarly focus. Table 1 also shows the top keywords with the strongest bursts of citation and the keywords with the most recent and strongest bursts of citation. Children and infants, men, youth, and elderly patients are the populations of interest for scholars, as shown by bursts. Children appeared to be a strong research interest for over two decades (1991-2013), in parallel with research topics such as blood pressure, cardiovascular reactivity and family history.
In the early 1990s, when digital health innovations were rapidly accelerating in cardiovascular medicine research in the early 1990s, the keyword bursts were generally associated with cardiovascular risk factors (e.g. blood pressure, exercise). More recently, bursts of activity are related to modern terminology affiliated with complex data and sensors, including ‘IoT’ (internet of things), ‘neural network’ and ‘photoplethysmography’.
Additional insight into topic structure of the topic was found by completing an analysis of the occurrence of terms in the title and abstracts of articles. Figure 3 shows the frequency of the co-occurrence of terms and is complimented by the averaged publication year of articles containing these terms and the average number of citations articles with these terms receive. The analysis revealed that there are five major divisions. Table 2 shows the top terms, most cited terms, and youngest terms for each cluster.
Bottom left: map of average publication year; Bottom right: map of average number of citations. An interactive online map is available here: https://app.vosviewer.com/?json=https://drive.google.com/uc?id=1wo3ylYehGisHVX0CLM49voNitTjKsYOW.
Cluster 1 (Fig. 3; purple, 491 items) focusses on Cardiac electronic implantable devices (CIEDs), including pacemakers, implantable cardioverter-defibrillators and other devices used to help control of monitor heartbeats in individuals with health rhythm disorders and heart failure (HF).
Cluster 2 (orange, 474 items) represents the area of Mobile health technology for secondary prevention of CVD. This includes methods of measuring risk factors and modes for intervention designed to affect the actions that individuals take regarding their health. This division is saturated with terms such as physical activity, healthy lifestyle, Fitbit and step count, and is associated with clinical trials.
Cluster 3 (grey, 441 items) consists of terms related to Wearable technologies. A large focus of this clusters is using photoplethysmography – or sensor-technology to measure physiological parameters.
The last of the major divisions, Cluster 4 (yellow, 195 items) is concerning Technology applications in stroke rehabilitation. Possible interventions for post-stroke rehabilitation have included use of immersive technologies and gamification such as Virtual Reality and robotics for increasing movement.
Using the interactive link to the visual representation (see caption of Fig. 3), it is determined that some of the newest terms in Cluster 1 are related to the Covid-19 pandemic (‘lockdown’, ‘pandemic’, ‘sars cov’). Throughout the clusters, there is reduced occurrence of terms related to minority populations such as ‘disability’, ‘rural’ and ‘culturally diverse’.
The smaller division, Cluster 5 (red, 57 items) consists of terms related to Emergency cardiovascular care. The care and management of out-of-hospital cardiac arrest (OHCA) is evolving and is strongly influenced by emerging digital technologies. Examples include wearable life detection technologies to improve survival, drones delivering automated defibrillators to the scene of the arrest, and advancements in mobile and digital technology used to leverage bystander response¹⁵.
Examining collaboration, Fig. 4 shows clusters of authors who frequently work together to produce scholarly research. This figure does not represent all 75,000 authors who have contributed to this topic overall, only those who have contributed to the central network of research (see Supplementary Table 1 for details of each cluster). There are ten clusters with ten or more authors.
Co-authorship link strength is used to provide an indication of how many publications two researchers have co-authored. Interactive map available here: https://app.vosviewer.com/?json=https://drive.google.com/uc?id=129YuMxn-9sn-ht5mCd88-ADpbh6nX0v5.
Clusters 1, 2, 3, 6, and 10 are groups of scholars researching cardiac electrophysiology. However, there are some minor variations in research topic, for example, clusters 3 and 6 is focused on cardiac resynchronisation therapy, whilst clusters 2 and 6 are looking at lead extraction and management, and cluster 10 is associated with research in infections associated CIEDs. Cluster 1 is very homogenous and based in Western Europe, with few exceptions. Similarly, Cluster 6 is based in North America, with several authors affiliated with Cleveland Clinic. Cluster 5, another group researching thromboembolic diseases and telecardiology, is exclusive to Italian affiliations. Aside from topics related to CIEDs, four of the other major collaborative groups are researching cardiopulmonary resuscitation (cluster #4), telemonitoring in HF and stroke prevention (cluster #7), mHealth and telemonitoring in HF (cluster #8) and secondary prevention of coronary heart disease (CHD) (cluster #9).
The strongest links within this central author network are between Ewa Piotrowicz and Ryszard Piotrowicz (cluster 7, link strength = 23.73), Friedrich Koehler and Kerstin Koehler (cluster 18, 13.50), and Clara Chow and Julie Redfern (cluster 9, 13.78). Almost all the strongest links are between authors in the same cluster, except for frequent collaboration between Julie Redfern and Lis Neubeck (cluster 9 and 15 respectively, link strength = 7.33), which links two groups of multidisciplinary clinician researchers who are focussed on secondary prevention of CHD and CR.
Influential articles relevant to the specific topic, ranked by local citation count, are listed in Supplementary Table 3. This metric considers the reference lists of documents in the overall dataset and how many citations the references receive. Based on this metric, ‘Telemonitoring in Patients with Heart Failure’¹⁶ is the most influential study in this field. The study indicated that the application of telemonitoring for patients recently hospitalized for HF did not improve outcomes. The other two most influential papers within this topic are ‘2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure’¹⁷ and ‘Update on Cardiovascular Implantable Electronic Device Infections and Their Management: A Scientific Statement From the American Heart Association’¹⁸. The last of which provides an important update on recommendations for the care of patients with infections due to CIEDs, as well as highlighting the research gaps. Studies, reviews, and guidelines focussed on HF, telemonitoring and CIEDs dominate the list of top ten locally cited articles.
Additionally, we can observe the articles that have had the strongest burst of citations since publication (see Supplementary Table 4). The subjects of all of articles with the strongest bursts are related to telemonitoring or remote monitoring. The top two are ‘Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study’ (strength = 36.55)¹⁹ and ‘Structured telephone support or telemonitoring programmes for patients with chronic heart failure’ (strength = 31.81)²⁰.
The growth and temporal evolution of this topic was visualized using document co-citation methodology. Figure 5 shows a birds-eye view of the twenty major divisions – or research streams – in which digital technologies have been applied in cardiovascular research (Supplementary Fig. 2 shows the research streams in a timeline format).
A dynamic visualisation of the interplay between the research areas (from 1990 to 2021) is accessible via this link Temporal map_digital health_CVD.mp4.
Figure 6 provides a visual representation of the extent of research activity within each stream of digital health applications within cardiovascular medicine (1990-2021) (see Supplementary Fig. 3 for deeper insight into the twenty research streams). It is evident that within the major streams, blood pressure reactivity, bypass surgery, cardiac reactivity to gaming and gamification are no longer active research areas in digital health applications. We can clearly see that there are emerging and heightened research activities in the areas of cardiac rehabilitation and out-of-hospital cardiac arrest. Research in remote monitoring, Virtual Reality, HF, transvenous lead extraction, remote monitoring, and arrythmias emerged between 2000-2010 and have maintained a high level of scholarly interest since. Research into the application of wearables (smartwatches, body sensors etc.) and activity tracking for cardiovascular care, and eMRs, appeared to peak between 2015-2020 but are now showing signs of slowing down. The oldest clusters, as determined by the mean year of article publication are Cardiac reactivity (1981), and similarly Blood pressure reactivity (1984), and Software analysis of cardiac output (1989). The average year the citing articles are 1991, 1993 and 2007 respectively, showing that there is little or no modern research being conducted in these areas. Contrastingly, looking at research activity we can see that the most modern topics are Cardiac rehabilitation (mean citing year 2018), Activity tracking (2018), Radiology in patients with CIEDs, (2018), Arrythmias (2019) and Out-of-hospital cardiac arrest (2020).
Left axis: total number of citations; Right axis: total number of citing articles. Note: scale is different for each cluster.
Cardiac rehabilitation is an interesting cluster in that it has some of oldest articles, dating from 1954, but it still a modern-day research area. The earlier papers from mid-1970’s-1980’s have a focus on behavioural change and self-efficacy^21,22.
A paper by Chow, Redfern²³, titled ‘Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease A Randomized Clinical Trial’ has received the most local citations (n = 131, and globally n = 554) as well as having the strongest burst of citation (13.05) between 2017-2021. Chow, Redfern²³, whose focus is secondary prevention of CHD, shows that using a text-message intervention may improve cardiovascular risk factors such as blood lipids, physical activity, blood pressure, BMI and tobacco intake; a clear example of a simple digital health application for improving cardiovascular care outcomes. Lastly, research related to HF, CIEDs and remote monitoring make an appearance in more than half of the research.
For scholars, research into digital health technologies in cardiovascular care has been relatively recent, thus it is important to understand the history of digital health technology in cardiovascular research—when it emerged, the rate of growth, hot topics, and its temporal evolution—to ensure clarity and direction when formulating research questions. Previous studies using a similar method have provided insight into the evolution of digital medicine and digital health research^24,25. Other studies, including a systematic review have shown how digital health interventions can have a positive effect on CVD outcomes²⁶. However, no other paper has completed a macro-scale analysis of the relevant research. The results of this analysis will help inform scholars of any significant developments in the research area, identify gaps in the literature, and make informed predictions about the future directions of the topic.
One notable omission relevant to digital health applications in cardiovascular care is the absence of no major or frequent keywords associated with co-design research (e.g ‘patient-centred’, ‘user’, ‘consumer-led’). Patient-centered co-designs are important in terms of implementation factor so researchers can see how new devices are accepted and effectively used by patients in a home-based environment²⁷. In cardiovascular research, large-scale and long-term user involvement through a co-design process, can support adaption and lead of quicker adoption of digital health technologies²⁸. Research groups are working and publishing in the human-centered design space²⁹, thus, terminology related to co-design frameworks will likely emerge should this topic be re-analysed in the near future. On the other hand, with the global burden of CVD showing no signs of slowing, it is promising to see the frequency of clinical trials utilised in secondary prevention of CVD. Data from clinical trials are consistently proving the efficacy of interventions in reducing the risk of cardiovascular events in secondary prevention patients³⁰, however, there are still issues with poor adherence to therapies³¹.
Researchers from North America, Australia, and parts of Western Europe appear to be most active in this area with strong focus on CIEDs and secondary prevention of CVD. There are multiple author networks whose work focusses solely on CIEDs and electrophysiology. It could be argued that this is one of the most influential digital technologies in contemporary cardiovascular science as around three million people worldwide have a pacemaker³² and many more have an implantable cardioverter-defibrillator. Remote monitoring has significantly transformed the standard of care for people with CIEDs³³. The pandemic has forced reorganisation of healthcare delivery, and has led to significant increase in remote monitoring of CIEDs³⁴.
The diversity and extensive communication between the central groups of scholars in this space highlight the collective efforts towards understanding how digital technologies can impact cardiovascular care. Many opportunities exist in the digital technology space for health system reform, and this requires a united and interdisciplinary effort³⁵. Collaborative research networks, such as the American Heart Association’s new Strategically Focused Research Network on Health Technologies and Innovation are moving towards³⁶, SOLVE-CHD³⁷ and AF-Screen³⁸, are other examples of advocacy groups who are promoting discussion and unification of research towards digital technology innovation and capacity building in the CVD care area.
Emerging research areas, including telemedicine and remote monitoring have seen widespread adoption over the past few decades, with the Covid-19 pandemic forcing current healthcare delivery to adapt and change more rapidly than ever before. It is expected that telemonitoring will now shift to include mainstream management of cardiovascular disease care in the coming years. Studies have shown that the digital divide is persistent^39,40,41, meaning that chasm between those who have access to technologies and the digital literacy to work them, and those who do not, remains a challenge for cardiovascular researchers and practitioners who care for people with CVD. From this review, we saw that research central to digital health in cardiovascular care was conducted in the context of high-income countries only, similar to telemedicine⁴² and digital literacy research⁴³. We also observed that there is not a large amount of research being conducted in some minority populations (e.g culturally diverse, disability, low-income). It is noteworthy, however, that there are robust and frequent studies including children, the elderly and rural populations.
It is important to note that digital health innovations in cardiovascular care are not without their challenges, including issues with data ownership, interoperability, and data excess^44,45. Also, evidence demonstrates that digital technologies are not at the stage of being standalone treatment options and should be integrated into an overall care model. However, the pandemic has enabled the rapid and wide implementation of telehealth and forced us to address any existing gaps and create long-term strategies to close them²⁷.
Due to the size of the body of literature included in this analysis, the gaps that have been identified are of a large-scale. Minor gaps in each research stream are not discernible. Additionally, it was not possible to seek causality of why individual papers have become influential or why individual streams have become hot topics. Thus, a scientometric review of a research sub-division or a systematic review should be conducted to identify these. Future research opportunities also exist for a sub-analysis of the metrics used in digital health studies, including patient outcomes (e.g. complication), resource utilization (e.g. rehospitalizations), patient or clinician satisfaction (e.g. QoL questionnaires) or metrics in access or equity. This is an important area to consider, however, outside of the scope of this broader scale analysis. Another limitation is the possibility of a delay in the emergence of a research stream. For example, the OHCA cluster shows distinct characteristics of an emerging research area. While the activities of this cluster were detectable since 2016, this does not indicate that the stream was only introduced to the literature at this time. It may simply mean that it takes some time for literature on this topic to accumulate and become a prominent research stream. With time, we may also see digital technology evolution related to COVID-19 and the impact it has had in CVD care. A repeat analysis in the coming years will likely reveal what the popular research topics and practices were during the pandemic years. Lastly, the definition of digital health technologies is not uniform, and it was initially unclear whether CIEDs fall under this broad category; hence it was not included in the search strings. However, a significant amount of literature regarding CIED research was found (related to keywords such as “remote monitoring” and “digital healthcare”). Therefore, this work was included for completeness.
The advancement of digital health technologies in cardiovascular care, is for some, a solution to many of the medical and public health challenges that are faced every day. Novel technologies are increasingly becoming available and more patients taking part in remote healthcare monitoring, hence, further evaluation and research into digital health technologies, including their long-term effectiveness, is needed. Furthermore, emerging technologies, which are evaluated and/or validated should be considered for implementation into clinical practice as treatment and prevention modalities for CVD. The current study provides a bridge between different segments of digital technology and CVD research, its major research streams and trends within those streams, and provides broader insight that may otherwise not be obtainable from smaller-scale counterpart studies. Outcomes inform future research directions and facilitate collaborations across various sectors of this field to further facilitate the advancement of CVD knowledge.
Scientometric methods are increasingly being used to quantitatively measure research metrics and trends within fields and topics across disciplines (e.g. medicine, engineering, science). Traditionally, systematic reviews are used in medicine and healthcare to determine efficacy, effectiveness and other outcomes due to their rigorous and specific nature. However, scientometrics can complement systematic reviews by summarising the overall trends of an entire field, sub-field or targeted topic, with virtually no limit on the size of the scholarly literature.
To retrieve the data for this study, the Web of Science (WoS) Core Collection was accessed and searched in January 2022. A search query was formulated that included terms relevant to digital health technologies and cardiovascular medicine (see Supplementary Methods). The terms were searched in the titles (Field tag: TI), abstracts (AB) and author keywords (AK) of articles indexed across the WoS Core Collection. Terms were separated from each other using the Boolean operator (OR) and in the case of multiple words within a term, quotation marks were placed around the term. Asterisks were used to allow for term variation (for example, plurals).
Given that the description of the research methodology is included in the abstracts of these articles, we excluded “electronic medical records” (and its variations) from the abstract search string to avoid false positives. However, the term was included in title and author keyword search strings to ensure the inclusion of electronic medical record research. No restrictions were set on the document type or other subcategory. The maximum year was set to December 31, 2021, with no restriction on the minimum. Full bibliographic details of the documents were exported from WoS as text files. Details include the document title, authors, author affiliations, year of publication, source (journal) title, citation count, document type, abstract, author keywords, keywords plus, funding source, full list of document references and conference information, if relevant.
Keyword analysis were conducted using VOSviewer 1.6.15. Keywords provide insight into the temporal shifts in research and scholarly focus. A citation burst indicates a sudden increase in the number of citations an article with mentioned keywords receives⁴⁶, the strength or duration, and the start and end year of the peak activity. Bursts of citation with a minimum of four years in duration, aggregated at the level of keywords, were calculated and sorted based on start year. For this analysis, only bursts that occurred after 1990 were included, as in the years prior, publications were scattered and sparse, making it difficult to calculate a burst. and abstract analysis were also conducted using VOSviewer 1.6.15. Clusters of terms are formed by the frequency they occur in the title and abstracts of the articles to provides an objective overview about the structure and divisions within this research topic. The frequency of occurrence of the term was set to a minimum of 15.
Analysis of author networks were conducted using VOSviewer 1.6.15. Each author is represented by a node. The link strength, as shown by the thickness of the links between author nodes, represents the number of co-authored documents.
CiteSpace 5.7.R1⁴⁶ was used to complete the document co-citation and citation burst analyses. Using the concept of document co-citation, a methodology developed by Chen⁴⁷, we can obtain a different perspective of the most influential studies within the topic. When two articles appear in the reference list of a third article, they are co-cited by that third article. Essentially, two articles that are frequently co-cited are likely related or are similar in subject. Document co-citation analysis results in a new set of documents, which include valuable knowledge sources for digital technology applications in cardiovascular medicine that are instrumental in the development of this literature but were not captured by the WoS search query.
From document co-citation we can find (i) references with the most local citations (citations from within the literature exclusively relevant to this topic), (ii) references with the strongest citation burst and, 3) references with the highest centrality (document co-citation across multiple clusters). The second of which indicates a heightened attention to an individual article within the field, representing a temporal component of the research topic.
CiteSpace 5.7.R1⁴⁶ is used to generate the dynamic visualisation, which shows insight into the emergence of each research stream since 1990. In the visualisation, parts of the network that have been most active during each year appear more striking, representing co-citation instances during that year. Influential references are identified using the three metrics (local citations, bursts, centrality) However, these metrics are measuring articles that may or may not be about digital health applications, so we must also look at the citing articles with the highest coverage to determine which digital health-related articles are citing the most references within the specified research stream.
Digital technologies have increasingly been adopted in the past few decades, hence, for heightened relevance, the time period for the analysis was set for 1990-2021 (at one-year intervals) and the number of look-back years was set to 50, meaning that articles in the reference lists had to be published less than 50 years ago to be included in the analysis. Each individual reference is represented by a node. The relative size of the node is proportional to the number of local citations identified to that reference, and the nodes are connected by links to create a network of major research streams, all contained within the topic of digital health applications in cardiovascular medicine. Links indicate the occurrence of co-citation. Each stream has been provided with a descriptor based on the contents of the cluster. Furthermore, CiteSpace analysis also provides a timeline view of the evolution of research streams. The references of each stream are visualised and aligned across the timeline based on the year of publication from 1950 to 2021.
All data is available upon reasonable request to the corresponding author.
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This research was funded by NHMRC Synergy Grant SOLVE-CHD [GNT1182301], School of Health Sciences, University of Sydney, Australia JR is funded by a NHMRC Investigator Grant [GNT2007946].
School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
Clara C. Zwack, Matthew Hollings & Julie Redfern
School of Civil and Environmental Engineering, University of New South Wales, Sydney, Australia
Milad Haghani
Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
Ling Zhang & Robyn Gallagher
Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
Sarah Gauci
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C.Z. and M.Haghani led the conception of the study. C.Z. and M.Haghani developed the review protocol. C.Z. conducted the literature search. C.Z. conducted data extraction, with M.Haghani’s support in coordination. M.Hollings, S.G., L.Z., R.G. and J.R. provided support to refining the results. C.Z. drafted the manuscript, with M.Haghani’s support in the Methods section. All authors provided substantial suggestions and edits for the writing of the paper. All authors approved the submission of this paper.
Correspondence to Clara C. Zwack.
The authors declare no competing financial interests but the following Competing Non-Financial Interests: Author Julie Redfern is an Associate Editor of npj Digital Medicine but played no role in the assessment or peer review of this manuscript.
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Zwack, C.C., Haghani, M., Hollings, M. et al. The evolution of digital health technologies in cardiovascular disease research. npj Digit. Med. 6, 1 (2023). https://doi.org/10.1038/s41746-022-00734-2
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Received: 24 July 2022
Accepted: 29 November 2022
Published: 03 January 2023
DOI: https://doi.org/10.1038/s41746-022-00734-2
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