Sabina De Rosis

Public strategies for improving eHealth integration and long-term sustainability in public health care systems: Findings from an Italian case study

Summary eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes.

Multi-level determinants of tele-healthcare: a case study in Italy

The routine deployment of tele-healthcare solutions in healthcare systems and at the system-level is challenging and often problematic. This article reports the results of a case study in Tuscany (Italy), aimed at investigating the factors that may affect these processes. A multi-level and multi-stakeholder sample of 32 informants were interviewed in-depth about topics based on a previous literature analysis. Crucial determinant factors in the management of tele-healthcare services were identified in relation to technological, individual, organisational and contextual aspects. A reorganisation of healthcare in line with more participatory dynamics of teamwork, and more collaborative relationships within and among healthcare organisations, as well as with other stakeholders could contribute to integrate tele-healthcare into practice. Leadership and a strategic vision could also strongly influence the implementation and deployment of tele-healthcare.