Norwegian Centre for E-health Research, Tromsø, Norway.
J Med Internet Res. 2020 Oct 28;22(10):e17214. doi: 10.2196/17214.
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?
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.
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 from 2010 onwards. We specified the criteria for selection and quality assessment.
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.
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.
大型国家电子卫生政策计划不仅因其益处而受到关注，还因其一些意外后果和未实现的期望而受到关注。鉴于结果的复杂和混合情况，人们对如何管理大型数字化计划以实现质量改进和公平获得医疗服务的卫生政策目标以及必要的数字化转型提出了质疑。在本次定性系统评价中，我们研究了以下问题：在定性评价中包括的研究中，治理是如何实施和考虑的？
本研究旨在对电子卫生相关治理模型的概念化和考虑因素进行深入了解，这些概念化和考虑因素在科学文献中得到了呈现和讨论。反过来，我们希望我们的研究结果将有助于讨论如何管理这些流程以实现共同协商的目标。
定性系统评价是一种整合或比较定性研究结果的方法。它寻找存在于或跨越单个定性研究的“主题”或“构建”。这种类型的综述采用主题分析进行叙述性综合，并包括解释性概念模型。目的是进行解释并拓宽对特定现象的理解。我们使用预定义的搜索词在 PubMed 数据库中进行搜索，并选择了 2010 年以后发表的论文。我们规定了选择和质量评估的标准。
搜索返回了 220 篇论文。我们选择了 44 篇摘要进行全文阅读，有 11 篇论文被纳入全文综述。基于这 11 篇论文，我们构建了四个治理模型来对研究结果进行分类和概念化。这些模型包括政治治理，通常描述自上而下的过程；医疗治理，通常描述自下而上的过程；互联网和全球模型，强调国际商业策略与互联网相结合；自我治理，它建立在互联网和物联网的发展基础上，为个人治理和自己的健康数据沟通铺平了道路。
国家和全球政策行为者、医疗和自我治理行为者以及全球商业和工业行为者之间的集体谈判至关重要。技术赋权既为实现卫生政策目标带来了积极的机会，也带来了消极的机会，未来的研究应该仔细研究这种动态。
