eHealth implementation in Europe: a scoping review on legal, ethical, financial, and technological aspects

Background: The evolution of eHealth development has shifted from standalone tools to comprehensive digital health environments, fostering data exchange among diverse stakeholders and systems. Nevertheless, existing research and implementation frameworks have primarily emphasized technological and organizational aspects of eHealth implementation, overlooking the intricate legal, ethical, and financial considerations. It is essential to discover what legal, ethical, financial, and technological challenges should be considered to ensure successful and sustainable implementation of eHealth.Objective: This review aims to provide insights into barriers and facilitators of legal, ethical, financial, and technological aspects for successful implementation of complex eHealth technologies, which impacts multiple levels and multiple stakeholders.Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, and ACM Digital Library (2018–2023) for studies describing the implementation process of eHealth technologies that facilitate data exchange. Studies solely reporting clinical outcomes or conducted outside Europe were excluded. Two independent reviewers selected the studies. A conceptual framework was constructed through axial and inductive coding, extracting data from literature on legal, ethical, financial, and technological aspects of eHealth implementation. This framework guided systematic extraction and interpretation.Results: The search resulted in 7.308 studies that were screened for eligibility, of which 35 (0.48%) were included. Legal barriers revolve around data confidentiality and security, necessitating clear regulatory guidelines. Ethical barriers span consent, responsibility, liability, and validation complexities, necessitating robust frameworks. Financial barriers stem from inadequate funding, requiring (commercial) partnerships and business models. Technological issues include interoperability, integration, and malfunctioning, necessitating strategies for enhancing data reliability, improving accessibility, and aligning eHealth technology with existing systems for smoother integration.Conclusions: This research highlights the multifaceted nature of eHealth implementation, encompassing legal, ethical, financial, and technological considerations. Collaborative stakeholder engagement is paramount for effective decision-making and aligns with the transition from standalone eHealth tools to integrated digital health environments. Identifying suitable stakeholders and recognizing their stakes and values enriches implementation strategies with expertise and guidance across all aspects. Future research should explore the timing of these considerations and practical solutions for regulatory compliance, funding, navigation of responsibility and liability, and business models for reimbursement strategies

Resilient performance in maintenance operations:managing unexpected failures

Unexpected failures of physical assets are often stated as the primary operational risk to asset-intensive organizations. Managing these failures is of critical importance to maintenance operations. This study demonstrates the operationalization and application of organizational resilience in a railway pit stop system, in order to identify changes for improvement in managing unexpected failures, using the soft systems methodology. A new ability (ability to inform) has been identified from the field as an important driver for resilient performance. Further research is needed to defend this position

Asset life cycle plans: twelve steps to assist strategic decision-making in asset life cycle management

Effective management of physical assets should deliver maximum business value. Therefore, Asset Management standards such as PAS 55 and ISO 55000 ask for a life cycle approach. However, most existing methods focus only on the short term of the asset's life or the estimation of its remaining life. These methods do not consider alignment to changing corporate objectives in a variable context, nor do they adopt a multidisciplinary perspective. This chapter argues that, to create maximum value, Asset Management should be a multidisciplinary and strategic practice that considers the complete life cycle of the asset: Asset Life Cycle Management. A practical twelve-step approach is presented to develop an Asset Life Cycle Plan (ALCP) in which expert sessions are used to identify the main lifetime impacts that influence the creation of business value from the use of the asset. The steps are illustrated with an example from practice. The chapter concludes that the ALCP supports asset managers in making long-term strategic decisions in a timely and effective manner. </jats:p