# Toward a Comprehensive Understanding and Evaluation of the Sustainability of E-Health Solutions
## 4 Results
### The Sustainability of E-Health Solutions
#### 4.2.3 Evaluation/Assessment Methods  
Eight of the primary studies [8; 25; 29; 32; 33; 34; 35; 36] discussed a method, a framework, a model, or a theory to evaluate the sustainability of e-health solutions. These are the JD-AHP approach [25], the technology continuance theory (TCT) model [29], the HCC-MOTES framework [32], a conceptual framework to sustain e-health implementation [33], a model to evaluate m-health systems [34], the SCH-CAT catalog [8], a conceptual framework for e-health systems in a resource-constrained environment [35], and a model for sustaining telemedicine projects [36]. The e-health solutions mentioned in the studies are smart e-health applications, EMRs, information technology in healthcare, the Electronic Health Management Information System (eHMIS), m-health systems, and telehealth. Table 10 presents a summary of the proposed evaluation/assessment methods. \begin{table}
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**Study ID** & **Method of Assessment** & **Type of Assessment Methods** & **Source** & **E-Health Solution** & **Evaluated/Validated in Real Context?** \\ \hline PS5 & AHP method & Mathematical equations & Proposed & Smart e-health applications & No \\ \hline PS9 & Model & Theory & Technology Continuance Theory (TCT) & Electronic medical records (EMRs) & Yes, evaluated \\ \hline PS12 & Framework & Qualitative metrics and KPIs & Existing literature and validated sets & Information Technology (IT) in Healthcare & No \\ \hline PS13 & Conceptual framework & NA & Proposed & Electronic Health Management Information System (eHMIS) & Yes, evaluated \\ \hline \hline \end{tabular}
\end{table} 
Table 10: Tools and assessment methods proposed by the primary studies. [PERSON] and [PERSON] [25] identified several factors that are critical to the sustainability of technology applications in healthcare. By using the JD-AHP method proposed in their study, the priority of critical sustainability factors in two or more technologies are compared by a decision-maker to determine which technology is more likely to be sustained. Using 10 smart technologies in e-health, the proposed method was compared against existing methods, which are AHP, OWA, and MACBETH. However, as stated in the study, this method works for one decision-maker, if more were involved, then the sustainability problem becomes considerably complicated. [PERSON] et al. [29] used the TCT model to evaluate the continuance usage intention of an EMR system among users (i.e., healthcare professionals) in the post-adoption phase. In their study, the hypotheses discussed the positive effect of satisfaction, attitude, perceived usefulness, and perceived ease of use for healthcare professionals on their continuance intention to use the EMR system. In order to test the hypotheses, a survey was carried out on 195 respondents consisting of various healthcare professionals from five hospitals. Results showed that all hypotheses in the TCT model were supported, which indicates the significant power of TCT to explain EMR system continuance usage intention of both short- and long-term users. As indicated in their study, TCT will help policymakers and managers in the healthcare sector to understand the factors that result in the ongoing use of an EMR system after the adoption phase. [PERSON] [32] developed a framework, named HHC-MOTES, that contains a novel set of key performance indicators (KPIs) to evaluate the sustainability of healthcare IT projects in terms of five dimensions (management, organization, technology, environment, and social). The framework aimed to provide a qualitative measurement of various aspects related to the sustainability of IT applications in healthcare. It is stated in the study that the HHC-MOTES framework can be used by healthcare decision-makers for strategic decisions regarding introducing or updating IT systems or examining current systems and identify limitations and shortcomings.