Equity Readiness Index for Digital Health Organizations

Objective As healthcare becomes increasingly digitalized, new challenges and opportunities arise for advancing health equity. In response, a broad range of frameworks and recommendations have emerged to guide equitable innovation. Yet despite this momentum, real world progress remains limited and many digital health organizations (DHOs) struggle to translate health equity principles into concrete, actionable strategies. One promising avenue for closing this implementation gap lies in the use of organizational readiness assessments that not only diagnose current capacity but also help to define a roadmap for improvement. In response, this study introduces the Health Equity Readiness Index and a supporting novel self-assessment tool designed to support DHOs in evaluating and advancing their readiness to act on health equity.

Drawing on established frameworks from health equity, responsible AI, digital innovation, and organizational change, we created a five-dimensional Health Equity Readiness Index, encompassing strategy, governance, culture, data, and community collaboration. Each dimension was operationalized into 15 readiness indicators across four levels. A corresponding digital self-assessment tool was developed and refined through user testing and a structured online survey targeting DHOs.

The resulting tool provides a structured, low-barrier mechanism for DHOs to assess their current equity capacity and identify priority areas for improvement. Survey results (N = 124) showed broad applicability across diverse organizational contexts, with respondents spanning regions, service types, and roles. Participants rated the tool highly across all constructs (M ≥ 4.39/5). Qualitative feedback highlighted five overarching strengths (clarity, diagnostic value, actionability, useability, awareness) and three areas for future improvement (examples, customization, additional features). Overall, respondents perceived the tool as both relevant and actionable for guiding equity-oriented strategy.

This study contributes a novel framework and diagnostic tool for advancing organizational readiness for health equity in digital health, supporting DHOs in moving from intention to implementation. It also offers potential utility for funders, regulators, and health systems seeking to institutionalize equity through incentives or benchmarking. Competing Interest Statement All authors are affiliated with the Centre for Digital Health Interventions (CDHI), a joint initiative of the Institute for Implementation Science in Health Care, University of Zurich, the Department of Management, Technology, and Economics at ETH Zurich, and the Institute of Technology Management and School of Medicine at the University of St. Gallen. CDHI is funded in part by CSS, a Swiss health insurer, the Swiss growth-stage investor MTIP, and the Austrian health provider Mavie Next. TK was also a co-founder of Pathmate Technologies, a university spin-off company that creates and delivers digital clinical pathways. However, CSS, Mavie Next, or Pathmate Technologies were not involved in this research. Funding Statement This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was exempt from a formal review and approval by the Ethics Committee of the University of St. Gallen in August 2025. Informed consent was obtained from all panelists before assessment. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵* shared senior authors Data Availability All data produced in the present study are available upon reasonable request to the corresponding author