# 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
\begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt}} \hline \hline
**Aspect** & **Study ID** \\ \hline Social & PS5, PS17, PS13, PS15, PS19 \\ \hline Workforce availability & PS3, PS18, PS21 \\ \hline Technical support & PS7, PS16, PS13, PS12 \\ \hline Technical training & PS8, PS3, PS20, PS16, PS13 \\ \hline Physical structures & PS13, PS3 \\ \hline Network management and communication & PS14 \\ \hline Environment (ecological: natural resources) & PS15, PS12 \\ \hline Support and commitment of top management & PS4, PS6, PS8, PS10, PS13, PS16, PS21 \\ \hline Organizational structures & PS4, PS8, PS13, PS16, PS20 \\ \hline Process workflow and process integration & PS13, PS17, PS11 \\ \hline Laws and standards related to ICT and e-health & PS16, PS2, PS5, PS6 \\ \hline Financial policy of e-health & PS16, PS12 \\ \hline Agreement on clinical content & PS20 \\ \hline Privacy and security policy & PS16, PS1 \\ \hline Data management & PS14, PS2, PS13, PS16 \\ \hline Stakeholders’ involvement/engagement & PS4, PS8, PS13, PS16, PS22 \\ \hline Direct benefit to users in routine work & PS16 \\ \hline Incentives and recognition & PS3 \\ \hline Organizational culture of electronic information use & PS16, PS13 \\ \hline (Outcomes of the solution are defined by the organization itself and needed to be evaluated regularly. They vary whether they are clinical, financial, technical, or social outcomes) & PS8 \\ \hline Sufficient demand and establishment of need & PS4, PS5, PS8, PS16, PS18 \\ \hline User and organizational readiness, eGovernment policy, efficiency of legal systems in settling disputes, intellectual property protection, procedures to enforce contracts & PS16 \\ \hline Policy & PS17, PS20 \\ \hline Available and sustainable funding & PS4, PS6, PS16, PS20 \\ \hline Economic feasibility & PS10 \\ \hline Affordability of e-solution, return on investment & PS16 \\ \hline Cost-effectiveness/cost minimization & PS16, PS8 \\ \hline Revenue and reducing the cost of data archiving & PS2, PS8 \\ \hline \hline \end{tabular}
\end{table} 
Table 9: _Cont._study, they discussed the strengths and weaknesses of organizational models used for HIE in New York State, such as regional health information organization (RHIO). In addition, they provided suggestions to ensure the sustainability and effectiveness of exchange efforts. Financial issues were perceived as upfront costs, decreased profits, and funding, while political and organizational issues were summarized as the difficulty of cooperation and collaboration among healthcare organizations (e.g., other competitive hospitals). The authors suggested that existing public/government funding and codifying health laws that enforce and facilitate the HIE would help in solving these issues. Another study [30] investigated the sustainability of a pilot project for smart connected health services that used Internet of Things (IoT) technology and were provided for both patients and health professionals. The results showed that in order to sustain smart connected hospital services, it is necessary to consider the technical feasibility, economic feasibility, and organizational commitment and support. [PERSON] et al. [38] argued that the focus of healthcare technology assessment should be shifted from efficiency and effectiveness to sustainability. By proposing a reference framework, they stated that the sustainability of the technology can be achieved by assessing three aspects, along with considering the relations and interactions between them [25]. These aspects are economic, social, and political. [PERSON] et al. [9] analyzed the inhibitors and enablers that influence the sustainability of health information systems (HIS). They proposed a high-level sustainability framework based on four pillars, which are clinical, technical, socio-technical, and political/business. [PERSON] et al. [7] investigated 54 telehealth services in Australia to understand the reasons behind the continuing and ceased services, and to assess their sustainability.