Stakeholder behavior in national eHealth implementation programs

As the capabilities of eHealth technologies have considerably improved over recent years, many countries have developed national programs to implement such technologies with the aim of increasing treatment efficiency and effectiveness beyond the scope of just a few individual healthcare providers. However, these programs are often longsome, costly and have previously been met with fierce resistance from key stakeholders. Two questions arise: firstly, why do national eHealth programs stall long before end-users are reaping the benefits? Secondly, what motivates stakeholders, particularly healthcare providers, involved in the rollout process to resist to the implementation of a potentially beneficial technology? Our study builds on a wealth of observatory qualitative data as well as semi-structured interviews to theorize that complex stakeholder structures across organizational levels offer an answer to these questions. Based on the case of the German Electronic Health Card ('eGK'), we propose that asymmetries amongst stakeholders׳ objectives can posit a cause for implementation issues, risks and failure. The theoretical and practical implications of these findings are discussed.