Table 2.

Characteristics of the included studies.

#	Author and country	Year	Journal	Study design and methods	Type of eHealth technology	Topics related to implementation
1	Bahls et al, Germany (36)	2020	Journal of Translational Medicine	Qualitative: -Interdisciplinary workshops with family doctors, experienced researchers, medical data managers, software architects and developers, data security experts and Technology, Methods, and Infrastructure for Networked Medical Research staff -Practices of family doctors are visited and discussions with staff were held	A generic architecture with a technical framework of tools, interfaces, and workflows for practicable and secure processing of patient data family doctors	Information about the design, implementation, and pilot testing of this generic research architecture and workflows that unlock primary care data for secondary usage
2	Botrugno et al, Italy (37)	2018	Health Policy and Technology (Elsevier)	Not specified	Telemedicine in general	Information about exploring available provisions for an EU regulatory framework for telemedicine, and to assess their suitability to regulate remote care services
3	Briganti et al, Belgium (38)	2020	Frontiers in Medicine	Not specified	Artificial Intelligence in healthcare	Information about the benefits, future opportunities, and risks of established AI applications in clinical practice on physicians, healthcare institutions, medical education, and bioethics
4	Cobianchi et al., Italy (39)	2022	Journal of the American College of Surgeons	Qualitative: –Stakeholder workshop with experts in the fields of academic surgery, radiology, surgical ethics, AI and Machine-learning, computer sciences, innovation, strategy, business models, and healthcare policies	Artificial intelligence (AI) applications aiming to support surgical decision-making processes	Information about mostly ethical (but also legal, technological, and business model related) factors that need to be considered when implementing AI applications to support surgical decision-making. These include factors related to human agency and oversight, technical robustness, privacy, and safety of data, diversity, and non-discrimination, societal and environmental well-being, and accountability.
5	Cresswell et al, United Kingdom (40)	2019	BMJ Health & Care Informatics	Qualitative: -Complementing recent work conducted by the American Medical Informatics Association (AMIA) exploring potential policy frameworks and associated strategies for Patient Generated Health Data	Integration of patient generated data into electronic health records	Information about applying emerging policy frameworks to the United Kingdom and outline five key priority areas that are intended to guide policymakers’ decision-making for patient generated data integration into electronic health records
6	Diaz-Skeete et al, Ireland (41)	2020	Health Informatics Journal	Qualitative: -Interactive workshop with clinicians, academic researchers, technologists, patient advocates, policy makers, and representatives from the health service	eHealth technologies (in particular remote monitoring systems) in community and home cardiac care	Information about the barriers and facilitators to the adoption of eHealth technology in community and home cardiac care
7	Gaebel et al, Germany (42)	2020	European Archives of Psychiatry and Clinical Neuroscience	Mixed-method: -Narrative review (status analysis of 6 countries) -Qualitative stakeholder interviews (52 interviews with experts in science, politics, small-to-medium enterprises, care providers, and patients	e-Mental Health Innovations	Information about the uptake of E-mental health, including barriers for implementation (for six different countries). Policy recommendations were provided to guide political and regulatory processes regarding the implementation of e-mental health.
8	Garani-Papadatos et al., Greece (43)	2022	Frontiers in Digital Health	Qualitative: -Ethical exploration of specific eHealth technology (MyPal4Kids)	A digital health platform in a palliative care context (pediatric cancer patients)	Information about ethical challenges, the paper provides information about what ethical considerations occurred in the development and implementation of this digital health platform, and what type of decisions they made (e.g., in terms of technological features) to tackle the barriers they explored.
9	Gilbert et al., Germany (44)	2023	Journal of Medical Internet Research	Qualitative: -Multistakeholder interactive workshops with healthcare professionals, regulators, healthcare providers, healthcare system digitization bodies, regulatory science and law academics, regulatory specialists, and consultants	Digital health technologies, particularly AI-based tools and machine learning medical tools	Information about the divergent approaches of the European Union and the United States in the implementation of new regulatory approaches in digital health. The paper poses specific challenges to the development and implementation of functional regulation (such as the MDR).
10	Jacquemard et al, Ireland (45)	2021	BMC Medical Ethics	Qualitative: -Re-examination of literature to determine ethical challenges and opportunities -Workshops with multidisciplinary stakeholders (ethicist, senior hospital-based physician, eHealth expert) to discuss and reach consensus on interpretation of the literature	Electronic health records	Information about ethical concerns that occur in the design, development, implementation, and use of an electronic health records
11	Jusob et al., United Kingdom (46)	2022	Journal of Public Health	Qualitative: -Modified version of the engineering design process	A novel privacy framework to address privacy threats/concerns in the context of mHealth and the management of chronic diseases	Information about possible privacy threats and concerns in the development and implementation of mHealth. The paper proposes a new privacy framework for mHealth, in which they describe requirements for the framework and the choices they made based on these requirements.
12	Karacic Zanetti and Nunes, Croatia (47)	2023	Computers	Qualitative: -Investigation of health wallets’ specific features and capabilities	Health wallet (an integrated digital platform that allows individuals to manage and control their own health information)	Information about the implementation of health wallets. In particular a risk-based approach to identify and prioritize data security risks, system interoperability, cross-border healthcare challenges, data accuracy, and ethical challenges. The paper provides a practical framework for healthcare organizations to allocate resources while ensuring that patient data remain secure and private.
13	Kühler et al, France (48)	2022	Clinical Therapeutics	Qualitative: -Working group with experts from pharmaceutical, medical device, and tech companies	Not a specific eHealth technology, but the paper focusses on European Union regulatory frameworks for connected combined products, such as medical devices	Information about identified challenges in developing and releasing connected combined products and the paper highlights and discusses gaps in the European Union Regulations.
14	Leimanis et al, Latvia (49)	2021	European Journal of Sustainable Development	Qualitative: -Considering of international legal regulations	Artificial Intelligence in healthcare	Information about ethical, regulatory, and social issues raised by applying artificial intelligence in healthcare, from sustainable development perspective
15	Li et al., United Kingdom (50)	2023	BMC Medical Informatics and Decision Making	Qualitative: -Interview study	Electronic Health Records (EHR)	Information about (the lack of) EHR interoperability, including facilitators and barriers to improve EHR interoperability.
16	Martani et al, Switzerland (51)	2019	Swiss Medical Weekly	Qualitative: -Field research into all insurers’ data-sharing apps on the Swiss Market	Insurers’ apps that permit customers to share their data in exchange for monetary rewards	Information about the features and functioning of the apps, and ethically relevant aspects related to the usage of these apps.
17	Parimbelli et al, Italy (52)	2018	International Journal of Medical Informatics (Elsevier)	Qualitative: -Workshops with system developers, researchers, physicians, nurses, legal experts, healthcare economists, and administrators	Telemedicine systems, with the focus on real-world, non-mediate interaction with the final user	Information about the risks and legal implications connected to the development and use of modern telemedicine systems.
18	Prodan et al, Germany (53)	2022	Frontiers in Digital Health	Qualitative: -Interviews with public bodies and industry -Multi-stakeholder workshop	Digital therapeutics (“apps on prescription”)	Information about how the approval and adoption of digital therapeutics within health systems have been approached in five selected European countries and regions, including success factors that scale up the adoption.
19	Rakers et al., The Netherlands (54)	2023	Elsevier Health Policy and Technology	Qualitative: -Interview study	Remote Patient Monitoring (RPM)	Information about the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands. In addition, the paper proposes actionable recommendations.
20	Rauwerdink et al, the Netherlands (55)	2021	Journal of Medical Internet Research	Mixed method: -Questionnaire -Semi-structured interviews	eHealth technologies with various subjects and themes, from the Citrien Fund program eHealth (2016–2019)	Information about the barriers and facilitators of the development of the 29 included eHealth projects
21	Redrup Hill et al., United Kingdom (56)	2023	Frontiers of Digital Health	Qualitative: -Multistakeholder interactive workshops	A semi-automated deep-learning system (AI) with as example the clinical pathway for the early detection of Barett's Oesophagus and oesophageal adenocarcinoma.	Information about ethical and legal considerations that influence human involvement in the implementation of AI in a clinical pathway. Opinions of stakeholders are shared about the risks and potential harms of AI, the impact of AI on human experts, equity and bias, transparency and oversight, patient information and choice, and accountability, moral responsibility, and liability for errors.
22	Reindl et al, Germany (57)	2021	IEEE Xplore	Not specified	Robot-assisted haptic telepresence tools	Information about the legal framework of telemedicine in EU, and practical physical safety, data security, and system usability implications learned from implementing a telemedicine station prototype.
23	Schlieter et al, Germany (58)	2019	Journal of Medical Internet Research	Qualitative: -2-Round group workshop	Digital health innovations (in general)	Information about enablers and barriers for scaling up digital health innovations, in the context of achieving large-scale implementations that will benefit the population as a whole
24	Scobie et al, United Kingdom (59)	2020	Learning Health Systems	Qualitative: -Seminar, bringing together National Health Service leaders, academics, practitioners, and policymakers	Learning health systems	Information about requirements for the development of learning health systems, including national policy implications and actions.
25	Sheikh et al, United Kingdom (60)	2021	The Lancet Digital Health	Not specified	Learning health systems	Information about achieving the optimal balance between top-down and bottom-up implementation, improving usability and interoperability, developing capacity for handling, processing, and analyzing data, and addressing legal and ethical challenges.
26	Shull et al, Spain (61)	2019	JMIR Medical Informatics	Not specified	Digital health systems (and their interoperability with electronic health records)	Information about the evolution and obstacles of electronic health records, potential barriers for interoperability with digital health systems, and best practices from examples they provide.
27	Silven et al, the Netherlands (62)	2022	BMC Health Services Research	Qualitative: -Series of multidisciplinary focus groups with stakeholders who have relevant digital health expertise	Digital health in clinical practice	Information about challenges of responsibility and liability when prescribing digital health in clinical practice
28	Tozzi et al, Italy (63)	2021	BioLaw Journal	Not specified	Artificial Intelligence in healthcare	Information about potential ethical challenges and risks of implementing artificial intelligence tools in clinical practice, GDPR, and informed consent.
29	Van den Wijngaart et al, the Netherlands (64)	2018	Journal of Medical Internet Research	Qualitative: -Qualitative survey study	A web-based portal to monitor asthmatic children as a substitution for routine outpatient care	Information about barriers and facilitators for the implementation and use of this web-based portal
30	Van Rooden et al, the Netherlands (65)	2021	Clinical Microbiology and Infection	Qualitative: -2 workshops of stakeholder discussions -A taskforce was installed that further elaborated governance aspects by reviewing documents and websites, consulting experts, and organizing teleconferences	Automated surveillance for healthcare-associated infections	Information about the governance aspects (both legal and ethical) of large-scale implementation of automated surveillance of infections
31	Van Velthoven et al, United Kingdom (66)	2019	Journal of Medical Internet Research	Qualitative: -Stakeholder workshop with patients, carers, local hospitals, pharmacy retailers, health insurers, health services researchers, engineers, and technology and pharmaceutical companies in Switzerland	Digital health innovations (in general)	Information about facilitators and barriers of sustainable adoption of digital health innovations, needs and expectations of stakeholders, and the safety, quality, and usability of the innovations.
32	Verweij et al., The Netherlands (67)	2022	BMC Health Services Research	Qualitative: -Case study of a digital care platform with in-depth interviews	A digital health platform for patients with chronic myeloid leukemia	Information about barriers and facilitators for the implementation of the digital health platform. In addition, a comprehensive implementation guide was developed for launching future digital care platforms in daily clinical platforms.
33	Wong et al, Switzerland (68)	2022	The Lancet Regional Health—Europe	Not specified	Digital health technologies (in context of effective surveillance systems in public health)	Information about the opportunities, challenges, and implications of the increasing digitalization of public health in Europe.
34	Zarif et al, United Kingdom (69)	2022	Springer/ Health and Technology	Not specified	Digital health innovations (in general)	Information about the ethical challenges that adoption of digital healthcare technology presents, contextualized at multiple levels, with suggested potential solutions.
35	Zemplényi et al, Hungary (70)	2023	Frontiers in Public Health	Mixed method: -Survey to rank predetermined barriers from literature -Stakeholder workshops to develop and review recommendations based on the barriers	Artificial Intelligence tools	Information about human factor related barriers, data related barriers, methodological barriers, regulatory and policy related barriers, and technological barriers of AI. In addition, this paper proposes recommendations on how to overcome the most important ones (based on a stakeholder ranking of the barriers).