9 PERFORMANCE IMPROVEMENT QUARTERLY,25(2) PP. 9–25 © 2012 International Society for Performance Improvement Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/piq.21119 Responsive Evaluation as a Guide to Design and Implementation: Case Study of an E-Health Learning System Scott P. Schaffer and Hannah Kim E -health applications to increase and optimize patient–provider interactions as a follow-up to office visits have been shown to lead to better health outcomes (Wagner et al., 2001). In the case study examined in this article, a health care provider team, a health care information technology team, and a univer- sity research team partnered to develop and implement an e-health learning system (Schaffer & Kim, 2011). Learning system design and implementation was greatly influenced by the use of the responsive evaluation model (Stake, 2002). e model suggests that if implemen- tation is to meet the practical needs of stakeholders, projects should evolve over time through stakeholder interactions that take into account issues such as time, budget, and resources. In addition, Ely’s conditions-of- change model (1990), which has roots in innovation dif- fusion theory (Rogers, 1995), helped the study partners identify the degree to which issues, limitations, and con- straints in the project environment should be consid- ered in the design, development, and implementation of the innovation. Challenges regarding the adoption of the e-health support system and implementation of this type of learning environment are discussed. Theoretical Framework Ely (1990) suggests that eight fundamental conditions should be in place to facilitate adoption of a technology innovation: dissatisfaction with the status quo; sufficient knowledge and skills; availability of resources; Evaluation of the design and imple- mentation of a web-based e-health application offers an opportunity to apply extensive research findings and evidence-based practices from the learning and performance literature. In this study, we examined how interac- tions between stakeholders influenced the design, implementation, and out- comes of an e-health education sys- tem. The online system was designed for adults with diabetes. A midsized suburban medical practice in the Mid- west partnered with a private sector information technology provider and a university research team to develop the system for patients. Design of the support system was based on a model developed by Schaffer and colleagues, and the implementation strategy was informed by Ely’s conditions-of- change model. Analyses of design and pilot study implementation processes were accomplished through the lens of responsive evaluation. Discussion of the successes, tensions, and challenges related to the design of learning and performance environments in the e-health context will guide future sys- tem design and evaluation efforts.