title: What Are Complex eHealth Innovations and How Do You Measure Them? Position Paper.
abstract: OBJECTIVE
  eHealth and innovation are often regarded as synonyms - not least because eHealth technologies and applications are new to their users. This position paper challenges this view and aims at exploring the nature of eHealth innovation against the background of common definitions of innovation and facts from the biomedical and health informatics literature. A good understanding of what constitutes innovative eHealth developments allows the degree of innovation to be measured and interpreted.
  
  
  METHODS
  To this end, relevant biomedical and health informatics literature was searched mainly in Medline and ACM digital library. This paper presents seven facts about implementing and applying new eHealth developments hereby drawing on the experience published in the literature.
  
  
  RESULTS
  The facts are: 1. eHealth innovation is relative. 2. Advanced clinical practice is the yardstick. 3. Only used and usable eHealth technology can give birth to eHealth innovatio. 4. One new single eHealth function does not make a complex eHealth innovation. 5. eHealth innovation is more evolution than revolution. 6. eHealth innovation is often triggered behind the scenes; and 7. There is no eHealth innovation without sociocultural change.
  
  
  CONCLUSIONS
  The main conclusion of the seven facts is that eHealth innovations have many ingredients: newness, availability, advanced clinical practice with proven outcomes, use and usability, the supporting environment, other context factors and the stakeholder perspectives. Measuring eHealth innovation is thus a complex matter. To this end we propose the development of a composite score that expresses comprehensively the nature of eHealth innovation and that breaks down its complexity into the three dimensions: i) eHealth adoption, ii) partnership with advanced clinical practice, and iii) use and usability of eHealth. In order to better understand the momentum and mechanisms behind eHealth innovation the fourth dimension, iv) eHealth supporting services and means, needs to be studied. Conceptualising appropriate measurement instruments also requires eHealth innovation to be distinguished from eHealth sophistication, performance and quality, although innovation is intertwined with these concepts. The demanding effort for defining eHealth innovation and measuring it properly seem worthwhile and promise advances in creating better systems. This paper thus intends to stimulate the necessary discussion.
authors.affiliation: U. Hübner, Health Informatics Research Group, Hochschule Osnabrück, Caprivistr. 30A, 49076 Osnabrück, Germany, E-mail: u.huebner@hs-osnabrueck.de.
authors.forename: U
authors.initials: U
authors.lastname: Hübner
mesh_terms: D004059:Diffusion of Innovation; D057286:Electronic Health Records; D007857:Leadership; D008490:Medical Informatics / Q000639:trends*; D018802:Patient-Centered Care
keywords: IT-adoption; eHealth; electronic health record system; innovation; measurement