I have spent more than 25 years as a clinician and clinical leader in health, now leading an organisation that exists to connect and create meaningful change across Aotearoa New Zealand’s digital health community. The shift from frontline care to health leadership, to a system-wide view has shaped how I view progress in digital change.
From where I sit now, something doesn’t quite add up.
We are investing heavily in digital health. Systems are being rolled out, tools are being implemented, and in many areas, adoption is increasing. Yet the way care is delivered isn’t shifting as we would hope.
Evidence across industry, research, and leadership perspectives reflects this tension. Adoption is increasing, but it is uneven and remains challenging in practice. Integration into routine clinical work is often slower and less complete than anticipated, and across multiple settings, providers report ongoing difficulty embedding digital tools into day-to-day care.
So why is adoption not consistently translating into meaningful change in practice? The answer isn’t simple and isn’t singular, but a key enabler is found when we look closely at clinicians, broadly defined as the health and disability workforce providing direct patient care. This workforce sits at the point where decision, risk, and accountability converge.
A pattern emerges
And that is where a pattern becomes visible. Across international studies since 2023, up to two-thirds of clinicians are either unconvinced about the value of digital tools in their own practice or remain cautiously disengaged. These are people who research shows are largely comfortable and competent users of digital tools in their everyday lives, but choosing not to use digital tools, or at best are reluctantly using digital tools in their clinical practice. This challenges the view that confidence and competence, or digital literacy is the challenge. Looking wider, we start to see a clear pattern of behaviour in clinician’s adoption of digital tools.
When systems are introduced through large-scale or mandated rollout, clinicians will often comply. They log in, enter data, complete required steps. Adoption, by most measures, is achieved. Alongside this, something else has been observed to happen. Documentation is recreated outside formal systems to maintain clarity. Data entry is delayed. Parallel tools are used. Workflows are reshaped so that care can still be delivered safely and effectively. These behaviours can be invisible in standard measures of digital adoption.
That matters, because on the surface it may look like risk disappears, but in reality, risk shifts – into fragmented information, bypassed safety features, and increasing cognitive load as clinicians reconcile multiple systems at once.
From the outside, progress in adoption is achieved. For the clinician, reality can feel like an added layer of complexity in to already complex work.
Digital literacy and digital competence and confidence are important but only solve a small part of the problem for clinical adoption of digital tools. Because from a frontline perspective, the question is not simply “can I use this?”
It is “can I rely on this?”
“Real time decisions”
Clinical practice is grounded in responsibility. Decisions are made in real time, with direct consequences for people and their whānau. When something goes wrong, accountability sits with the person directly making decisions about a person’s care.
Over time, clinical reasoning becomes rapid, internalised, and deeply tied to professional identity. When a digital tool enters that space, it is not adopted automatically, it is tested.
Evidence reflects this as when clinicians cannot see how an output has been generated, they are far more likely to override it. When the logic is visible, when it aligns with workflow and when it reduces effort, engagement increases.
What can look like hesitation is often a careful assessment of whether a tool can be trusted within accountable practice.
It is trust and confidence in the tool that determines whether behaviour actually changes.
The patterns we see – misalignment with workflow, lack of transparency, unclear accountability, increased cognitive load, and tension with professional identity – are more signals of distrust in the solution than they are technical or compliance issues.
This is one lens into a broader system challenge and is also one of the most critical places where change either embeds or quietly unravels.
If trust is critical to digital adoption, then building it becomes a shared responsibility by every person involved in digital transformation.
For those developing and delivering innovation, this means grounding design in real environments and making it possible to understand how tools work and where they do not.
Perspectives
For those in research, it means studying performance in the complexity of real-world care, including where tools are not used and why.
For clinical educators, it means treating digital capability as part of safe and accountable practice, building the ability to critically assess and integrate digital outputs alongside other forms of evidence.
For health workforce champions, it means translating between perspectives – connecting digital capability to the realities of care, risk, and patient outcomes – and creating space for questioning and shared learning.
And for health workforce leaders, it means looking closely at how success is defined. Because the metrics traditionally used to assess adoption may not tell us what we need to know about meaningful, long-term change. Implementation and usage are helpful, but incomplete measures of adoption.
If trust is central to change, then success needs to be reflected in the behavioural signs of change in practice; digital outputs being used in decision-making, tools being discussed as part of clinical conversations, override patterns becoming clinically selective rather than routine, shadow systems reducing, data completeness improving, training demand becoming proactive, and incident reporting signalling refinement rather than avoidance.
Core indicators
These may be harder to measure, but they are core indicators of whether change is sustainable and delivering impact.
If trust is what shapes behaviour, then building it becomes a shared responsibility across the system: in how and who we design digital solutions with, how we measure success of tools, how we educate our future workforce, how we lead, and how we measure success.
It requires us to look beyond whether tools are being implemented and used, and to focus on whether they are being relied on in practice, trusted in the moments that matter and making a meaningful difference to our frontline health and disability workforce.
Meaningful, sustainable change embeds when the frontline workforce can see that what is being introduced strengthens their judgement, supports their responsibility and fits the reality of the clinical care they provide to people and their whānau .
When that happens, we can be confident that adoption will truly lead to digital transformation.
Have your say with our poll: Is lack of trust—not digital literacy—the biggest barrier to digital health adoption?
