Value-based Governance of E-health In National and Regional Contexts

Summary

Norwegian Centre for E-health Research is commissioned to assess e-health within an HTA framework.

This project aims to explore: 1. The use of HTA (for assessing) 2. Value-based governance of e- and m-health strategies.

By conceptualizing, comparing and contrasting governance practices, the purposes are:

1. Contribute to transparency and adjustment of values in e-governance.

2. Capacity building for HTA of e-governance.

Introduction

Globally, countries are investing substantially in e-health. Failures of programs to achieve valuable economic, clinical and societal outcome are increasingly reported. Unsuitable governance models may be one explanation. Research on governance models’ usefulness for realization of valuable outcomes is incomplete and scattered. Our goal is to fill this gap by producing knowledge on e-governance in Norway.

Hypotheses:

1. Co-governance and Relational Coordination will positively impact the realization of valuable outcome.

2. Multilateral stakeholder dialogue and collaboration, including health service delivery perspective, have been proposed to innovate HTA. This will improve the relevance of HTA e-governance research.

Methods

1. Systematic Review of e-governance in healthcare

2. Participatory observations, in depth interviews/focus groups

3. Document retrieval and analyses

4. Creation and support of arenas for dialogue between stakeholders on values and governance

5. Analyses of co-produced value adjustments

6. Analyses of the usefulness of the Scientific Dialogue Approach for changing HTA paradigms

Study populations

1. Governmental bodies responsible for innovation of EHR in Norway

2. Regional and municipal authorities and management responsible for implementation of EHR

3. The leaders of different levels at a municipal "Health House" established as a hybrid between primary and specialist health services

Preliminary Results

The project runs between January 2018 - 2022.

Expected findings:

1. Diverging and common values

2. Diverging governance models

3. Diverging attitudes towards "best governance practices"

4. Diverging levels of trust

6. Different world views, belief-systems and individual values

7. Attitudes towards consensus building or conflict

8. Experiences to feed into the discussion of stakeholder dialogue as an HTA approach

Concusions

We expect:

1. to present results from the systematic review and preliminary findings from the first phases of participatory observations.

2. That results from the overall project will have high impact on the Norwegian governance models of e-health.

3. Publications in high impact scientific journals.

References

1. Greenhalgh, Trisha, Jill Russell: Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles, (2010) https://doi.org/10.1371/journal.pmed.1000360

2. Fenger, Menno, Victor Bekkers: The Governance Concept in Public Administration, in Bekkers et al: Governance and The Democratic Deficit, (2007), Aldershot: Ashgate

3. Gittell, Jody Hoffer: Transforming relationships for high performance. The power of Relational Coordination, (2016), University Press. California

4. Husereau, Don et al: CHANGING HEALTH TECHNOLOGY ASSESSMENT PARADIGMS? International Journal of Technology Assessment in Health Care,3 2:4(2016), Cambridge University Press