# Toward a Comprehensive Understanding and Evaluation of the Sustainability of E-Health Solutions
## 5 E-Health Sustainability Model
### Phases of Designing and Validating the E-Health Sustainability Model  
Figure 3 presents the phases of building the model. Based on the SLR results, the extracted sustainability aspects were grouped into five dimensions according to the categorizing criteria (refer to Table 11) to form the e-health sustainability model. These dimensions are technology, organization, resources, social, and economic. The categorization of the dimensions was deduced from the literature, as they were mentioned to be the main dimensions of e-health sustainability [10]. In addition, to make sure that the grouping of dimensions is consistent and comprehensive, we used qualitative coding analysis where each aspect/dimension mentioned in the SLR results was given a code describing its content. Hence, if a dimension was mentioned in a number of papers with almost similar definitions and if the given codes were similar, such as in technology, we added a dimension named technology. On the other hand, if two dimensions were given two similar definitions but one definition is more general, we checked the codes and grouped them into one group or separate groups accordingly. For example, regarding the political/legal dimension, it was mentioned as a dimension in some papers. However, because its definition overlaps partially with the organization's definition, we included political/legal as an aspect under the organization dimension (as in PS15 and PS16). The significance of representing the sustainability of e-health solutions through multiple dimensions arises from the fact that focusing on only one dimension is insufficient for evaluating software's sustainability [46]. Following that, the extracted aspects (refer to Table 9) were categorized into the five sustainability dimensions based on the criteria of each dimension that are presented in Table 11. As shown in Table 12, the definitions of the dimensions were obtained from SLR studies and were used as guidance to the development of the categorization criteria that is used to map the aspects with dimensions in this study. Each dimension is explained in detail in the following sections. Figure 3: Building phases of the sustainability model. Figure 4 illustrates the three levels (i.e., dimensions, aspects, and elements) of the sustainability model. Dimensions are in the first level of the sustainability model that cannot be eliminated as each one of them influences the sustainability of e-health. Each dimension contains aspects, which represent the second level in the model. The fulfillment of these aspects is reflected in their dimension and indirectly impacts the sustainability  
\begin{table}
\begin{tabular}{p{113.8 pt} p{227.6 pt}} \hline \hline
**Dimension** & **Criteria of Aspect Categorization** \\ \hline Technology & Any aspect that fits under the technology category is an external entity/attribute that is associated with the new technology itself and does not depend on or belong to the organization. The aspect in this category should \\ Technology & \(\bullet\) contribute directly to the overall soundness of an e-health solution that is under evaluation OR \\  & \(\bullet\) be a part of hardware or software of an e-health solution that is under evaluation (i.e., it could be input/output, components, properties, or attributes, etc.). \\ \hline Organization & \(\bullet\) The aspects in this category are associated with the readiness of the organization to adopt an e-solution. \\ • Organization & \(\bullet\) The aspect regulates, defines, and impacts the way an e-solution is adopted in the organization. \\ \hline Resources & Any aspect belongs to this category represents or belongs to an organization’s resources that affect the deployment of an e-solution. \\  & The aspect should \\  & \(\bullet\) contribute to the operating environment of the e-health solution AND \\  & \(\bullet\) help in maintaining acceptable level of using e-health solution. \\ \hline Social & The aspects belong to this category is concerned with the user interaction and use of an e-solution.