Understanding Stakeholder Behavior in Nationwide Electronic Health Infrastructure Implementation

With governments worldwide striving to digitize the healthcare sector beyond the institutional level of individual hospitals, many countries have developed national programs to implement eHealth technologies that increase treatment efficiency and effectiveness. However, it cannot be neglected that these programs have often been longsome, costly and have been met with considerable resistance from various stakeholders. Two questions arise: why do national eHealth programs often fall behind plan long before users are reaping their benefits? And, what motivates stakeholders involved in the process to resist to the implementation of a potentially beneficial technology? We theorize that complex stakeholder structures across organizational levels offer an explanation for such failure. Using a wealth of data to form a case study on the German Electronic Health Card (`eGK'), we propose that asymmetries amongst stakeholders' objectives can posit a cause for implementation failure. The theoretical and practical implications of these findings are discussed.