Crossing Boundaries: Transferring eHealth services across the Northern Periphery

Health care organisations in Finland, Norway, Scotland and Sweden face similar challenges when it comes to providing health services in the sparsely populated rural areas. Vast distances, centralized health services, harsh climate and limited access to public transport can make accessing health services difficult. In order to provide health services for the population of the Northern Periphery it is necessary to develop health care service models which can address the problems of isolation, remoteness and centralized health services. One way of overcoming these issues is to develop eHealth services that focus on increasing access to health services in the rural areas. As health care organisations’ resources are often limited, the possibilities to develop, test and implement eHealth services can be restricted. Thus, transferring existing eHealth services across organisational and national boundaries can be beneficial, as the services have already been tested in practice. Taking advantage of the knowledge health care organisations in different countries have can support organisations in their drive to develop service provision models that reach out to the population of the Northern Periphery. The main objective of this thesis is to understand how local conditions influence the outcomes of eHealth transfer. In order to do so the transnational implementation of five eHealth services was investigated in five case studies. This research gives insight into how differences in organisational structure, ICT infrastructure and the size of the patient base impact health care organisations’ possibility to transfer and utilize existing eHealth services. In addition, this research offers rich insights into how these factors impact the sustainability of eHealth services. The case studies also illustrate how stakeholder collaboration and knowledge exchange impact the process of transferring eHealth services, and how patients’ and professionals’ level of trust in eHealth services can materialize in practice. In addition, this thesis demonstrates why the benefits obtained with a specific eHealth service may, or may not be duplicable in another organisational context. The research discussed in this thesis also contributes to the understanding of how assessing organisational readiness prior to transferring and eHealth services can facilitate the implementation process.