# Toward a Comprehensive Understanding and Evaluation of the Sustainability of E-Health Solutions
## 4 Results
### The Sustainability of E-Health Solutions
#### 4.2.2 Sustainability Dimensions
The catalog contains five dimensions: economic, individual, social, environment, and technical; all of these have their own sustainability requirements except for the economic dimension, whose requirements were not covered because they are not considered inherent requirements. The catalog was used in the study to evaluate the sustainability of a connected health app for blood donation. [PERSON] et al. [36] discussed two models that aim to assist in the successful implementation and sustainability of e-health solutions. The technology, users, work processes, finances, and policy categories were included in both models, as they contribute to the sustainability of e-health solutions. Along with that, [PERSON] et al. [10] proposed an optimization integrated fuzzy QFD methodology to determine the optimal strategies that can be used to mitigate a service's barriers and achieve an organization's sustainability goals. They emphasized three dimensions that must be considered and balanced for sustainable service design. These dimensions are social, environmental, and economic. The proposed methodology was applied to an m-health services setting in Bangladesh, by which lists of barriers and strategies to mitigate them were identified regarding m-health service sustainability. The results of the study emphasized the importance of training the service providers and collecting customers' feedback to improve the service quality. Furthermore, they stated that mitigating a service's barriers has a substantial impact on the sustainable health service. Moreover, some studies argued that user acceptance is significant to sustain e-health solutions. [PERSON] et al. [37] developed an explanatory model for the telehealth services' sustainability. In their work, they argued that the acceptance of clinicians is the key factor that influences the sustainability of telehealth services. The model shows how other components, such as workforce availability, clinician demand, adequate technology, and resourcing are related to clinician acceptance. The two factors, clinician demand for the service and adequate technology, impact the clinician acceptance of the service, which in turn influences the clinician workforce availability and leads to the telehealth service being sustained. To achieve clinician acceptance, the study suggested two strategies, legitimation and relationship building. Legitimation consists of promoting positive beliefs about telehealth among clinicians, while relationship building is concerning with maintaining good relationships with those who provide the care, both of which are shown in the model as parts of champions promoting telehealth. The continuous usage intention of electronic medical records (EMRs) among healthcare professionals was evaluated using technology continuance theory (TCT) in [29]. With continuance of usage being one factor of sustainability, the study focused on the six acceptance constructs that influence continuance usage. The six constructs are confirmation, satisfaction, perceived usefulness (PU), perceived ease of use (PEU), attitude, and continuance intention. [PERSON] [34] identified the concerns of m-health implementation when sustainable use is the intended goal for the system. The concerns were discussed in terms of the patient's and health practitioner's perspectives (e.g., acceptance, usefulness, wearability, and quality of service), as well as the considerations of hardware and software design (e.g., compatibility, data management, functionality, and interoperability). Technical, political, and management dimensions were the focus of other studies. [PERSON] [27] addressed the role of technical support for hardware, software, and people-ware in sustaining the hospital information system (IS) and information technology (IT) infrastructure. [PERSON] [31] stated that two goals must be considered equally for the sustainability of healthcare information systems, which are process integration and systems integration.