Background Large-scale national eHealth policy programs have gained attention not only for benefits but also for several unintended consequences and failed expectations. Given the complex and mixed accounts of the results, questions have been raised on how large-scale digitalization programs are governed to reach health policy goals of quality improvement and equal access along with necessary digital transformations. In this qualitative systematic review, we investigate the following question: How is governance implemented and considered in the studies included in the qualitative review? Objective The aim of this study is to arrive at informed and recognizable conceptualizations and considerations of models of governance connected to eHealth, as presented and discussed in the scientific literature. In turn, we hope our results will help inform the discussion of how to govern such processes to obtain collectively negotiated objectives. Methods A qualitative systematic review is a method for integrating or comparing with the findings from qualitative studies. It looks for “themes” or “constructs” that lie in or across individual qualitative studies. This type of review produces a narrative synthesis with thematic analysis and includes interpretive conceptual models. The goal is an interpretation and broadens the understanding of a particular phenomenon. We searched the PubMed database using predefined search terms and selected papers published in 2010. We specified the criteria for selection and quality assessment. Results The search returned 220 papers. We selected 44 abstracts for full-text reading, and 11 papers were included for full-text synthesis. On the basis of the 11 papers, we constructed four governance models to categorize and conceptualize the findings. The models are political governance, normally depicting top-down processes; medical governance, which normally depicts bottom-up processes; the internet and global model, emphasizing international business strategies coupled with the internet; self-governance, which builds upon the development of the internet and Internet of Things, which has paved the way for personal governance and communication of one’s own health data. Conclusions Collective negotiations between the nation-state and global policy actors, medical and self-governance actors, and global business and industry actors are essential. Technological affordances represent both positive and negative opportunities concerning the realization of health policy goals, and future studies should scrutinize this dynamic.

Artificial intelligence (AI) for radiology has the potential to handle an ever-increasing volume of imaging examinations. However, the implementation of AI for clinical practice has not lived up to expectations. We suggest that a key problem with AI projects in radiology is that high expectations associated with new and unproven AI technology tend to scale the projects in ways that challenge their anchoring in local practice and their initial purpose of serving local needs. Empirically, we focus on the procurement of an AI solution for radiology practice at a large health trust in Norway where it was intended that AI technology would be used to process the screening of images more effectively. Theoretically, we draw on the information infrastructure literature, which is concerned with scaling innovative technologies from local settings, with a limited number of users, to broad-use contexts with many users.

Introduction:Globally, countries are investing substantially in e-health. Failures of programs to achieve valuable economic, clinical and societal outcome are increasingly reported. Unsuitable governance models may be one explanation. Research on governance models’ usefulness for realization of valuable outcomes is incomplete and scattered. Our goal is to fill this gap by producing knowledge on e-governance in Norway. Our hypotheses are: i) Co-governance and Relational Coordination will positively impact the realization of valuable outcome; and, ii) Multilateral stakeholder dialogue and collaboration, including health service delivery perspective, have been proposed to innovate health technology assessment (HTA). This will improve the relevance of HTA e-governance research.Methods:We undertook the following: i) Systematic Review of e-governance in healthcare ii) Participatory observations, in depth interviews/focus groups iii) Document retrieval and analyses iv) Creation and support of arenas for dialogue between stakeholders on values and governance v) Analyses of co-produced value adjustments vi) Analyses of the usefulness of the Scientific Dialogue Approach for changing HTA paradigms. The study populations were: i) Governmental bodies responsible for innovation of the electronic health record (EHR) in Norway; ii) Regional and municipal authorities and management responsible for implementation of her; and, iii) The leaders of different levels at a municipal “Health House” established as a hybrid between primary and specialist health servicesResults:The project runs between January 2018–2022. Expected findings are: i) Diverging and common values; ii) Diverging governance models; iii) Diverging attitudes towards “best governance practices”; iv) Diverging levels of trust; v) Different world views, belief-systems and individual values; vi) Attitudes towards consensus building or conflict; and, vii) Experiences to feed into the discussion of stakeholder dialogue as an HTA approach.Conclusions:We expect: i) To present results from the systematic review and preliminary findings from the first phases of participatory observations; ii) That results from the overall project will have high impact on the Norwegian governance models of e-health; and, iii) Publications in high impact scientific journals.

Background Research has shown that national large-scale e-health projects are rarely defined as successful. Methods We have conducted a search in the PubMed database on governance models. Results Our search resulted in 220 hits, 11 papers included. We sorted these in four health systems Governance takes three different paths. 1) governance of e-health - how governments govern e-health programs through national and regional strategies, standards, incentives, legislation 2) governance through e-health - e-health as a strategic tool to obtain national health policy goals 3) governance in e-health - governance in medical networks initiated bottom-up and run by clinicians. In the Single-Payer we find two papers. Both these describe governance of e-health. When the processes had been running for a period of time it shifted to governance through e-health. Two papers from New Zealand describe top-down governance model of e-health. Under the Multi-Payer health system we find a paper that describes the experiences of realizing a national telehealth network in Australia through a governance model in e-health. Under Unknown health system and national governance models, we include a paper that describes a governance model of e-health in Haiti. Two other papers describe the tension between non-profit and for-profit organizations on access to health data and domain names. The authors questions how governments shall realize governance models which captures these new aspects in healthcare. The second paper describes the challenges faced by the authorities’ governance of the purchase and sale of health domains when public health institutions do not have an overview of this. The papers in this category may question if there is a need for a fourth governance model in e-health on the global level. Conclusions The development of governance models are not static but part of processes and context dependent. Need for a fourth governance model on the global level. Key messages Research has shown that national large-scale e-health projects are rarely defined as successful. Currently scattered knowledge on how large-scale e-health projects that bring economic, clinical and societal benefits are governed.

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