EHealth Technologies Integration with Healthcare Work Activities in Public Hospitals: A Critical Realist Perspective

Integration of eHealth technologies with healthcare work activities has seen great advancement in many healthcare systems in developing countries. However, these efforts have been tainted by several challenges such as fragmentation, lack of standardization and co-ordination. Subsequently, the undertakings of eHealth articulated in health strategy/policy documents have not been fully realised. The implications of this has been that the majority of the population still access inadequate healthcare services. The aim of this paper is to explain why the current integration efforts do not adequately facilitate healthcare work activities in public hospitals in under-served contexts of South Africa. A critical realist perspective within a qualitative approach was adopted. A total of 21 participants were purposively sampled and interviewed because of their knowledge and experience in the healthcare service delivery process as well as their involvement in the integration of ehealth. The study applied the Activity Analysis and Development (ActAD) model as a theoretical analytical tool and draws on normalization process theory (NPT) as an explanatory framework. The findings highlight generative mechanisms such as the inadequate analysis of system's fit-for-purpose in healthcare workflows have inhibiting effects in the integration process of eHealth.