A methodological and operative framework for the evaluation of an e-health project Luca Buccoliero * , y , Stefano Calciolari y and Marta Marsilio y CERGAS SDA Bocconi, Milan, Italy SUMMARY Assessing public sector ICT investments represents the premise for successful implementation of an e-health strategy. The recent literature stresses the importance of going beyond the mere financial and/or technical dimensions of the analysis. Consequently, the paper proposes an example of e-health project evaluation aiming to develop measures which get close to the notion of benefits to the different stakeholders involved: top management, patients, local community. The case study refers to an Italian health care organization that implemented a project of digitalization of its clinical reports production few years ago. Based on on-field research, different approaches are used to assess costs and benefits from different stakeholders’ perspectives. The results of a multidimensional evaluation are reported to emphasize the need for different measures to assess the sustainability of an e-health project according to the financial convenience, the social role of the organization, and the contingent situation. Copyright # 2007 John Wiley & Sons, Ltd. key words: e-health; evaluation; cost-benefit analysis; digital signature; Italy INTRODUCTION The scientific evaluation of the e-health projects is particularly significant in the current debate (Ballantine et al., 1996; Athey and Stern, 2002; Van Der Meijden et al., 2003; Ammenwerth et al., 2004; Goodman, 2005; Hillestad et al., 2005). The main features of these projects are: – their great variety; 1 – the use of information and communication technology (ICT); – the impact on the relationship between healthcare providers and patients; – the significant investments required. international journal of health planning and management Int J Health Plann Mgmt 2008; 23: 3–20. Published online 4 May 2007 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/hpm.881 * Correspondence to: L. Buccoliero, Center for Research in Health and Social Care Management, CERGAS, Bocconi University, Viale Isonzo 23, 20135 Milan, Italy. E-mail: luca.buccoliero@uni-bocconi.it y (CERGAS) Center for Research on Healthcare Management (www.cergas.info). 1 The European Commission uses a broad definition (An action plan for a European e-Health Area, COM/ 2004/356): ‘‘e-Health tools or solutions include products, systems and services that go beyond simply Internet-based applications. They include tools for both health authorities and professionals as well as personalised health systems for patients and citizens. Examples include health information networks, electronic health records, telemedicine services [...].’’ Copyright # 2007 John Wiley & Sons, Ltd.