Table 2 Summaries of the three cases

Case 1: An eHealth application to support digital entry to primary care

In 2016, physcians developed an eHealth application to support digital entry to primary care, with the aim of providing healthcare professionals with the ability to triaging patients digitally, thereby increasing accessibility and improving care effiency. Tha application enables registered patients to contact their primary care centre digitally, answering questions about their health and reasons for contacting a care provider, which are then compiled into a medical report that are visible to healthcare centre employees. Patients request are first assessed by a nurse, who can ask follow up questions via chat or video and decide if the patient’s request can be handled by a nurse or if a physician or other healthcare professionals need to be involved. Physcians or other healthcare professionals can be invitaded to participate in online communication regarding the errend (the communication between healthcare professionals is not visible to patients), or the patient errend can be delegated to another healthcare professional via the eHealth application. The application can also be used to iniate contact with patients regarding medical results and appointments

This case study focus on the deployment of the eHealth application at three primary healthcare centres, in total, 31 interviews were conducted (17 nurses, 6 physicians, 3 managers, 2 administrators, 2 psychologists and 1 physiotherapist)

Case 2: An eHealth application for continuous monitoring

In 2014, a professor in computer science and his colleagues developed an eHealth application for remote monitoring of patients experiencing kidney failure and who require home dialysis. The development of the application was based on the study of healthcare professionals work, mainly the work of nurses, and involved digitalising manual patient data reporting in close collaboration with healthcare representatives, including physcians and nurses. Patients are remotely monitored through a encrypted tablet, which enables secure login without identification. Each patient has their own unique care profile in the eHealth application and the healthcare professionals monitor the dialysis treatment at home, in real time, by automatically transmitting health parameters such as weight and blood pressure through Bluetooth technology. The application presents the results to healthcare professionals and patients through visualisations and trend curves. Patients either perform their own dialysis four times a day or have assisted treatments, in which municipal nurses perform the home dialysis and use the same tablet to report data as patients who perform their own treatment. Patients can communicate with healthcare professionals through video calls, chat messages, and photos if necessary. Nurses attend daily to the patient-reported data while the physicians mostly attend to the trend curves and patient data overview before physical visits (these normally take place every six weeks for each patient), when a prescription is changed for a patient, and/or when a patient’s values are unstable and require attention. Sometimes, the nurses also initiate a conversation with the responsible physician regarding medical data in the eHealth application that need to be addressed

This case study focus on the deployment of the eHealth application at clinics in five different hospitals, in total of 30 interviews were conducted (21 nurses, 8 physicians, and 1 administrator)

Case 3: A digital eHealth application for intermediate monitoring

In early 2000s, a development company created a digital eHealth application aimed at making healthcare more efficient. The first version of the application was tested and further developed in collaboration with a clinic specialised in aftercare for patients following myocardial infarction. The eHealth application enables patients to exchange information and communicate with healthcare professionals via a web application. Patients log in using their individual ID and enter their predetrimened vital parameters in the downloadable webapplication for smartphones, tablets or computers. The application. Includes a chat function that allows communication between healthcare professionals and patients. Patients have a unique care profile in the eHealth application where they report health parameters like blood pressure and weight. Patients use their own technical equipment, and if a particular patient does not have a blood pressure cuff, for example, they do not report their blood pressure. The application creates a visualisation of the patients condition, and an assessment is shown to healthcare professionals using different colours: red indicating urgency, yellow indicating a need for attention, and green indicating that everything is well with the patient. At the three hospital clinics studied, patients did not have scheduled times for reporting data into the application. Some patients reported regularly, regardless of their state of health, while others only reported when their health was deteriorating. Nurses assessed the patient-generated on a daily basis and are responsible for keeping track of patients, while physcians use the application before patient contact

This case study, focus on the deployment of the eHealth application at three hospital clinics, in total 14 interviews were conducted (9 nurses, 3 physicians, and 2 managers)