Anna M. Braspenning

Background: The success of eHealth relies on interorganizational collaboration (IOC) throughout the development, evaluation, and implementation phases of eHealth deployment. This IOC is complex, as it involves a diversity of organizations from different sectors, such as technological, academic, health care, and governmental organizations, collaborating to deploy eHealth. Between these organizations, organizational boundaries, defined as the demarcation of an organization from its environment, arise. When these boundaries are perceived as aligned and enable complementarity, IOC is facilitated. By contrast, misalignment of organizational boundaries can hinder IOC. A dialogical learning mechanism, defined as a learning process that occurs when boundaries hinder IOC, can support learning how to navigate such boundaries. However, it is difficult to determine whether and when organizational boundaries facilitate or hinder IOC, and which dialogical learning mechanisms can be used to address these challenges during eHealth deployment. Previous literature presents the barriers and facilitators of IOC during eHealth deployment only for subsets of organizations or specific phases, leaving their generic versus phase specific applicability uncharted. Objective: This scoping review aims to identify whether, and under what circumstances, organizational boundaries facilitate or hinder IOC during the development, evaluation, and implementation of eHealth. Methods: A scoping review was conducted using searches in the PubMed, PsycINFO, CINAHL, and Web of Science databases. Articles were eligible for inclusion if they were empirical studies written in English or Dutch and contained findings on factors influencing IOC during the development, evaluation, or implementation phases of eHealth deployment. The search yielded 11,867 articles, of which 16 met the inclusion criteria. Open and axial coding of the extracted findings was performed to identify organizational boundaries and dialogical learning mechanisms that hindered or facilitated IOC during eHealth deployment. Results: In each phase, different organizational boundaries either hindered or facilitated IOC. The dialogical learning mechanism identification was crucial for enhancing IOC and was supported by training or by establishing IOC from previous relationships. Additionally, the learning mechanism coordination improved IOC and depended on the involvement of boundary spanners (ie, individuals who span organizational boundaries) and the use of boundary objects (ie, objects which help bridge different social worlds). Furthermore, the mechanism reflection, fostered through open and frequent communication, facilitated IOC. The dialogical learning mechanism transformation did not influence IOC during any phase of eHealth deployment. Conclusions: IOC in eHealth deployment is a dynamic process that depends on the dialogical learning mechanisms identification, coordination, and reflection to navigate organizational boundaries. This review is the first to present organizational boundaries and dialogical learning mechanisms that influence IOC across the different phases of eHealth deployment. However, further research that explicitly considers these phases is needed to deepen the understanding of IOC in eHealth deployment.

BACKGROUND The success of eHealth relies on interorganizational collaboration (IOC) throughout the development, evaluation, and implementation phases of eHealth deployment. This IOC is complex, as it involves a diversity of organizations from different sectors, such as technological, academic, health care, and governmental organizations, collaborating to deploy eHealth. Between these organizations, organizational boundaries, defined as the demarcation of an organization from its environment, arise. When these boundaries are perceived as aligned and enable complementarity, IOC is facilitated. By contrast, misalignment of organizational boundaries can hinder IOC. A dialogical learning mechanism, defined as a learning process that occurs when boundaries hinder IOC, can support learning how to navigate such boundaries. However, it is difficult to determine whether and when organizational boundaries facilitate or hinder IOC, and which dialogical learning mechanisms can be used to address these challenges during eHealth deployment. Previous literature presents the barriers and facilitators of IOC during eHealth deployment only for subsets of organizations or specific phases, leaving their generic versus phase specific applicability uncharted. OBJECTIVE This scoping review aims to identify whether, and under what circumstances, organizational boundaries facilitate or hinder IOC during the development, evaluation, and implementation of eHealth. METHODS A scoping review was conducted using searches in the PubMed, PsycINFO, CINAHL, and Web of Science databases. Articles were eligible for inclusion if they were empirical studies written in English or Dutch and contained findings on factors influencing IOC during the development, evaluation, or implementation phases of eHealth deployment. The search yielded 11,867 articles, of which 16 met the inclusion criteria. Open and axial coding of the extracted findings was performed to identify organizational boundaries and dialogical learning mechanisms that hindered or facilitated IOC during eHealth deployment. RESULTS In each phase, different organizational boundaries either hindered or facilitated IOC. The dialogical learning mechanism identification was crucial for enhancing IOC and was supported by training or by establishing IOC from previous relationships. Additionally, the learning mechanism coordination improved IOC and depended on the involvement of boundary spanners (ie, individuals who span organizational boundaries) and the use of boundary objects (ie, objects which help bridge different social worlds). Furthermore, the mechanism reflection, fostered through open and frequent communication, facilitated IOC. The dialogical learning mechanism transformation did not influence IOC during any phase of eHealth deployment. CONCLUSIONS IOC in eHealth deployment is a dynamic process that depends on the dialogical learning mechanisms identification, coordination, and reflection to navigate organizational boundaries. This review is the first to present organizational boundaries and dialogical learning mechanisms that influence IOC across the different phases of eHealth deployment. However, further research that explicitly considers these phases is needed to deepen the understanding of IOC in eHealth deployment.

A variety of technologies classified as lifestyle monitoring (LM) allows, by unobtrusive monitoring, for supporting of living alone at home of vulnerable older adults, especially persons with neurocognitive disorders such as dementia. It can detect health deterioration, facilitate early intervention, and possibly help people avoid hospital admission. However, for LM to redeem its intended effects, it is important to be adopted by involved stakeholders such as informal and formal caregivers and care managers. Therefore, the aim of this qualitative study is to understand factors that drive or impede successful implementation of LM for vulnerable older adults, specifically using infrared sensors to record movements, studied from a multiple stakeholder perspective. An open coding process was used to identify key themes of the implementation process. Data were arranged according to a thematic framework based on the normalization process theory (NPT). All stakeholders agreed that LM could lead to various health benefits for older adults using LM. However, some did not perceive the LM system to be cost-efficient and expressed a need for more flexible health care structures for LM to be successfully implemented. All stakeholders acknowledged the fact that LM requires a transition of care and responsibilities, a clear eligibility strategy for clients, and a clear ambassador strategy for health care professionals, as well as reliable technology. This study highlights the complex nature of implementing LM and suggests the need for alignment within constructs of the NPT among stakeholders about new ways of collaboration in supporting living alone at home.