JMIR Publications

ABSTRACT

Background:

Healthcare organisations increasingly work with eHealth. However, the integration of eHealth into regular healthcare is challenging. It requires organisations to change the way they work. The organisation’s structure and care processes need to be adapted to ensure that eHealth supports the attainment of the desired outcomes.

Objective:

The aims of this study were to investigate whether there are identifiable indicators in the structure, process and outcome categories related to a successful integration of eHealth in regular healthcare, and to investigate which indicators of structure and process are related to outcome indicators.

Methods:

A systematic literature review was conducted, using Donabedian’s Structure-Process-Outcome framework (SPO), to identify indicators that are related to the integration of eHealth into healthcare organisations. Data extraction sheets were designed to provide an overview of the study characteristics, the eHealth characteristics, and the indicators. The extracted indicators were organised into themes and subthemes of the structure, process and outcome categories.

Results:

Eleven studies were included, covering a variety of study designs, diseases and eHealth tools. All studies identified structure, process and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in structure, process, outcomes was respectively 175, 84, and 88. The themes with the most-noted indicators and their mutual interaction were the inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions) and technology (38 indicators, 12 interactions) themes, all three in the structure category, the healthcare actions theme (38 indicators, 15 interactions) in the process category and the efficiency theme (30 indicators, 15 interactions) in the outcome category. In-depth examination showed four most-reported indicators, namely indicator ‘deployment of human resources’ (n=11) of the inner setting theme in the structure category, the ‘ease of use’ (n=16) and ‘technical issue’ (n=10) indicators, both in the technology theme within the structure category, and the ‘health logistics’ (n=26) indicator in the efficiency theme within the outcome category.

Conclusions:

This study showed that three principles are important for the successful integration of eHealth into healthcare. First, the role of the care receiver needs to be incorporated into the organisational structure and daily care process. Second, the technology must be well attuned to the organisational structure and daily care process. Third, the deployment of human resources in the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organisation, daily process, or the end results.