Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on five databases; PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening and full-text filtering, 86 articles were included from 8276 search results. We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance amongst users, reconciling the system with legal requirements and ensuring an adaptable technical platform. Results revealed support for decentralised implementations because they carry less implementation and engagement challenges than centralised ones. Simultaneously, due to decentralised systems interoperability issues, federated implementations (with a set of national standards) might be preferable. This study identifies the primary socio-technical, legal and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and surmises suggested guidance for resolving the identified challenges.
翻译:我们的范围界定审查旨在评估哪些法律、伦理和社会技术因素有助于或抑制国家电子卫生系统实施的成功。此外,我们的审查还力求描述电子卫生系统的特点和好处。我们利用五个数据库的关键词搜索,对2000年1月至2020年期间以英文出版的文献进行了范围界定审查;PubMed、Scopus、Scopus、Sweb of Science、IEEEXplore和ProQuest。在消除了重复、抽象筛选和全文过滤之后,8276项搜索结果中包括86项文章。我们查明了17个利益攸关方群体、6个电子卫生系统领域和15种法律制度和标准。深入的文字分析揭示了主要在执行方面的挑战,其次是道德法律和数据方面。影响成功的关键因素包括促进系统的信任,确保用户更广泛地接受系统,使系统与法律要求相协调,并确保一个适应性的技术平台。结果显示对分散执行的支持,因为其执行和参与挑战比集中化。同时,由于分散的系统互操作性问题、联合实施(有一套国家标准)以及15种法律制度和标准执行(这套国家标准),因此显示执行方面的挑战。影响执行中存在的挑战和现有道德原则的复杂程度。这项研究可能更可取。本研究报告还说明了现有社会主义制度的执行。