Five Pillars of EHealth Development
EHealth has many proven and potential benefits, but there are still many barriers that need to be overcome. One way to overcome these barriers is to employ a holistic approach towards eHealth development and evaluation.
In 2011, a review on the potential and limitations of existing eHealth frameworks was conducted to find their value in overcoming these barriers (van Gemert-Pijnen et al., 2011). A main outcome was that these kinds of issues are expected to be avoided by applying a participatory development process that creates a good fit between technological, human and contextual factors. However, most existing frameworks were found to have a rather conceptual approach instead of practical guidelines, and lacked the stakeholder-driven approach that is required in eHealth development (van Gemert-Pijnen et al., 2011).
Based on this review and prior research, a holistic approach was proposed. Holism in general refers to the notion that individual elements in a complex system are determined by the relations they bear to the other elements. This means that all aspects of a larger whole are interrelated, and separate analysis of its parts should be avoided (James, 1984). For eHealth development, this means that constructs as technology, people and context are all interrelated and interdependent, and are all part of one whole instead of separate elements (Van Gemert- Pijnen et al., 2011).
Such a holistic approach is required since eHealth is much more than a thing or tool. It entails creating an infrastructure for supporting health, organizing care, disseminating knowledge and communication via technology. eHealth developers should be aware of the impact that technology can have on people (patients, citizens, healthcare professionals, policy makers) and their socio-cultural context (healthcare organization, homes). Approaches such as participatory development, human centred design, business modelling and persuasive design can be combined into a framework that supports the developers in this. The CeHRes Roadmap does just that: it combines these approaches and thus provides a framework to develop a technology that fits the human and contextual perspective. The Roadmap is underpinned by five pillars of eHealth development, which are based on existing frameworks, insights from practice and empirical research (van Gemert-Pijnen et al., 2013; van Gemert-Pijnen et al., 2011). These pillars are described in the following section.