Towards a Framework for National eHealth Evaluation and Monitoring: A Combined Top-Down and Bottom-Up Approach Using Sweden as Example.

Conducting evaluation and monitoring of national eHealth implementation aligned with national eHealth strategies should be prioritized concerning the insufficient scientific evidence and the current challenges in measuring eHealth effects and impacts where most approaches aim to measure at the micro level. This study aimed to build an evaluation and monitoring framework for national eHealth, using the Swedish national eHealth strategy as example, and to develop the process in doing so. Combining both top-down and bottom-up approaches, the WHO-ITU national eHealth strategy toolkit, as a systematic guidance, and two Swedish reports were used for development of the framework. Experts' opinions on the framework were collected and converged by the Delphi technique. The final draft suggested a framework containing 19 eHealth outcomes, 13 eHealth outputs, and 107 eHealth outcome and output indicators for 4 prioritized stakeholders, which can support comprehensive measurements to follow up the current advancement of eHealth in Sweden.