Bente B E, Beerlage-de Jong N, Verdaasdonk R M, van Gemert-Pijnen J E W C
Centre for eHealth and Wellbeing Research, Section of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands.
Section of Health, Technology and Implementation, Technical Medical Centre, University of Twente, Enschede, Netherlands.
Front Digit Health. 2025 Aug 14;7:1575620. doi: 10.3389/fdgth.2025.1575620. eCollection 2025.
The implementation of eHealth technologies can improve healthcare efficiency, accessibility, and affordability. However, it involves complex legal, ethical, financial, and technological (LEFT) challenges that can impede success. While our previous scoping review identified barriers such as balancing compliance with innovation, funding gaps, and unclear business models, there remains a significant gap in understanding how these challenges manifest in real-world settings. This study uses grey literature to explore practical experiences and strategies in addressing LEFT challenges during eHealth implementation.
This study aims to explore real-world experiences and perspectives on the legal, ethical, financial, and technological (LEFT) challenges encountered during eHealth implementation.
A grey literature review was conducted by querying databases BASE and Policy Commons, consulting expert references for relevant reports, and using snowball sampling to identify additional relevant grey literature.
While the aim of this study was to explore practical experiences, the grey literature mainly reflects policy-level concerns, including strategic and regulatory challenges, with limited insight into how organizations navigate eHealth implementation in practice. Legal barriers include navigating complex regulatory frameworks, interpreting regulations, and concerns about data privacy. Facilitators focus on centralized governance and Europe's role in the global data market. Ethical barriers address inequalities in access, while facilitators emphasize patient autonomy, clear consent processes, and digital literacy. Financial barriers stem from inadequate funding structures and unclear financial requirements, with public-private partnerships as facilitators. Technological barriers revolve around interoperability issues due to national IT infrastructure limitations, with facilitators working to improve data exchange.
This study highlights a disconnect between the strategic focus of available grey literature and the need for actionable, practice-based insights. The limited presence of real-world implementation experiences underscores the necessity for more operational documentation to support stakeholders facing interrelated LEFT barriers. Key challenges include the need for actionable legal and ethical frameworks, clearer ethical discussions aligned with legal requirements, sustainable financial infrastructures, and enhanced stakeholder involvement to address interoperability challenges. These challenges require cross-sector investment in IT infrastructures, harmonized data standards, and stronger collaboration among stakeholders. Coordinated efforts across all LEFT domains are crucial for effective eHealth implementation.
电子健康技术的实施可以提高医疗保健的效率、可及性和可承受性。然而，它涉及复杂的法律、伦理、财务和技术（LEFT）挑战，可能阻碍其成功实施。虽然我们之前的范围审查确定了一些障碍，如平衡合规与创新、资金缺口和商业模式不明确等，但在理解这些挑战在现实世界中的表现方面仍存在重大差距。本研究利用灰色文献来探索在电子健康实施过程中应对LEFT挑战的实际经验和策略。
本研究旨在探索电子健康实施过程中遇到的法律、伦理、财务和技术（LEFT）挑战的现实世界经验和观点。
通过查询数据库BASE和政策共享库、查阅相关报告的专家参考文献，并使用滚雪球抽样法来识别其他相关灰色文献，进行了一项灰色文献综述。
虽然本研究的目的是探索实际经验，但灰色文献主要反映了政策层面的问题，包括战略和监管挑战，对于组织在实践中如何推进电子健康实施的见解有限。法律障碍包括应对复杂的监管框架、解释法规以及对数据隐私的担忧。促进因素侧重于集中治理以及欧洲在全球数据市场中的作用。伦理障碍涉及获取方面的不平等，而促进因素强调患者自主权、明确的同意程序和数字素养。财务障碍源于资金结构不足和财务要求不明确，公私伙伴关系是促进因素。技术障碍围绕国家信息技术基础设施限制导致的互操作性问题，促进因素致力于改善数据交换。
本研究强调了现有灰色文献的战略重点与对可操作的、基于实践的见解的需求之间的脱节。现实世界实施经验的有限性凸显了需要更多操作文档来支持面临相互关联的LEFT障碍的利益相关者。关键挑战包括需要可操作的法律和伦理框架、与法律要求相一致的更清晰的伦理讨论、可持续的财务基础设施，以及加强利益相关者参与以应对互操作性挑战。这些挑战需要跨部门对信息技术基础设施进行投资、统一数据标准，并加强利益相关者之间的合作。所有LEFT领域协调一致的努力对于有效的电子健康实施至关重要。
