# 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 results revealed that insufficient demand, issues with technology, funding, loss of senior management support, and loss of the interest of clinicians are the failure reasons among the ceased telehealth services. On the other hand, the success factors of sustainable healthcare services are sufficient demand, available funding, and developing organizational structures that help to integrate telehealth into their regular operations. Furthermore, they demonstrated the importance of routinization and integration of the telehealth service, especially when it is executed within an existing clinical unit. Moreover, they stated that in the public sector, the funding is not a major issue; as long as the need and the support could be demonstrated, then the funds would follow. Additionally, the sustainability of a telehealth application called TeleRehab was discussed by [PERSON] et al. [28] and concluded that six factors impact the sustainability of TeleRehab. These factors are organizational strategy, establishment of need, organizational stakeholders, organizational commitment, human factors, revenue/cost savings, and outcomes. Organizational strategy addresses the customer, clinical operations, financial, and clinical development for health care providers and the organization. The human factors involve acceptance, long-term commitment of healthcare providers, specialized training, and user satisfaction. In addition, the outcomes of the e-solution vary whether they are clinical, financial, technical, or social outcomes. Therefore, they should be defined by the organization itself and need to be evaluated regularly. It was stated that a partnership of collaborators within an organization, including clinical, technical, and administrative professionals, will help in ensuring the success and sustainability of a telemedicine program. Similar dimensions were mentioned in other studies that presented frameworks and methods to assess e-health sustainability. [PERSON] et al. [35] evaluated the contribution of four frameworks for the implementation of e-health systems in a resource-constrained environment. The evaluation was carried out in terms of four sustainability dimensions. These are social, environmental, economic, and technological. They underlined that it is essential to consider the alignment of social, economic, and environmental factors with the technology factor to ensure the sustainability of e-health. In a following study [33], [PERSON] et al. presented the topic of sustaining the e-health implementation and emphasized the importance of the technological, social, organizational, and economic dimensions in this regard. The study proposed a conceptual framework for the sustainability of e-healthimplementation that focused on both organizational and technological dimensions. The organizational dimension comprises some aspects such as resources (i.e., human, physical, and financial resources), workflow process, and management support, while the technological dimension encompasses system quality, information quality, and service quality. Furthermore, they underlined the techno-organizational processes that are essential for the success of e-health implementation. These processes are user training, data management, stakeholder engagement, project management, and organizational communications. [PERSON] [32] proposed a framework that includes five dimensions, which are management, organization, technology, environment, and social. The framework helps in the long-term assessment of the sustainability of IT applications and projects in healthcare and their implications on the healthcare organization, with respect to the five mentioned dimensions. With regard to engineering requirements, [PERSON] et al. [8] have demonstrated the need for defining sustainability software requirements that are not focused only on the energy consumption of the software. Instead, they developed a design catalog called SCH-CAT for sustainable connected health applications.