280 9 Chapter 9 various stakeholders and capture their needs through participatory design activities, such as experience journey sessions (chapter 4), structured brainstorm sessions, prototyping, simulations, and visualizations (chapters 3 and 4). While we mainly involved internal stakeholders (i.e. individuals directly involved in the development or implementation in daily practice) it is equally important to include external stakeholders such as top-management as they play a relevant role in supporting the innovation process, championing it and protecting it from short-term pressures (32, 33). When involving stakeholders, it is important to recognize that development and implementation of eHealth is an ongoing journey, wherein the value of these technologies for each stakeholder within their specific usage context needs to be understood. Stakeholder can be involved in different phases accordingly. This entails involving internal stakeholders, such as healthcare professionals and developers, earlier in the process, while engaging external stakeholders such as decision makers, regulators, financiers, and suppliers later on when addressing issues like feasibility, sustainability, and cost-benefit (27). The importance of early business development exploration Besides implementation challenges caused by lack of early stakeholder involvement, large scale implementation of eHealth faces challenges related to funding, uncertainties regarding effectiveness and scalability (Challenge four, General introduction). Unfortunately, the majority of all eHealth initiatives fail to reach the implementation and scale-up phase and stop when project or research subsidies have dried up (34). To mitigate the risk of implementation failure, it is crucial to define a suitable implementation strategy as an integral part of the eHealth development process. One critical aspect of the strategy is defining who will pay for the eHealth technology or service. Currently, many innovations fail to scale-up because of the inability to find a sustainable funding model (35). This is of particular concern in innovating within the Dutch healthcare system (in which all studies described in chapters 2 till 4 were conducted) as the end-users are rarely the payers. Instead, healthcare insurance companies, healthcare institutions or hospitals bear the costs. Therefore, for an eHealth technology or service to succeed, it must bring value to the payer. In other words, the payer should in some way benefit from the technology. This can be achieved as the technology reduces costs, improves workflow efficiency, or enhances healthcare and employee satisfaction. It is important to note that an eHealth technology that meets the needs of end-users (e.g., patients) does not necessarily guarantee willingness to pay from the intended payer (e.g., insurance companies, hospital boards). The CeHRes roadmap can be a valuable tool in addressing these considerations early in the development process. It takes a holistic approach by integrating eHealth design with implementation and business development frameworks. By addressing questions about the value created by the technology and who benefits from it, the
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