JMIR Publications

ABSTRACT

Background:

Complex and mixed accounts of the results of large-scale e-health programs are increasing. Questions have also been raised from different stakeholders, about how the wider health political goals and practical goals of quality improvement and equal access, can be obtained along with the necessary digital transformations. A demand is therefore growing for responses to the question of how such processes are governed and should be governed in the future.

Objective:

By investigating how governance has been implemented, described and discussed in connection with digital transformations in health care, the objective is to contribute to the conceptualization and understanding of governance. The end goals are to add to the scientific knowledge-base and contribute to improved governance in order to obtain (e-) health policy goals.

Methods:

We conducted a qualitative systematic review of health sciences literature based upon search in the PubMed database. We summarized existing and emerging models and analyzed them taking into consideration existing theories of governance, empirical experiences and suggestions to improve future governance of e-health.

Results:

The search returned 220 hits and we included 44 papers for full-text screening. Eleven papers were included for the review and analysis. We identified four governance models; political, medical and global internet governance, and self-governance. In all four models, challenges concerning control, trust and judgements of results were described.

Conclusions:

To obtain health policy goals, collective negotiations between nation state and global policy actors, medical- and self-governance actors and global business and industry actors are essential. Technological affordances, including both optimistic and pessimistic visions need to be considered.