Towards consistent modes of e-health implementation: structurational analysis of a telecare programme’s limited success Albert Boonstra & Marjolein van Offenbeek University of Groningen, Faculty of Economics & Business, PO Box 800, 9700 AV Groningen, The Netherlands, email: albert.boonstra@rug.nl; email: m.a.g.van.offenbeek@rug.nl Abstract. Telecare is the use of information and communication systems to facilitate care delivery to individuals in their homes. Although the expectations of telecare are high, its implementation has proved complex. This case study dem- onstrates this complexity through a structurational analysis of a telecare imple- mentation process. The paper shows how structuration concepts enable a combined analysis of actors’ interactions with a technology and of the interaction among these actors from different institutional contexts. In this example, frag- mented multi-actor agency induced an inconsistent implementation mode, leading to unsuccessful telecare appropriation. This paper concludes with a preliminary proposal for more consistent telecare implementation modes. These modes may better support the actors’ reflexive monitoring and dialogue and inform further research. Keywords: telecare, e-health, structurational model, stakeholders, institutional context, implementation INTRODUCTION Most Western countries are facing a future with an aging population, and as a consequence, rising health care costs (Poisal et al., 2007; OECD, 2009). A situation of increasing demands for health care coupled with limited budgets encourages health care providers and insurers to develop efficient ways to expand their current services. In achieving equal or even better services at lower costs, information and communication technologies are portrayed as part of the solution (Sauer & Willcocks, 2007). As a result, an e-health field has emerged that includes health-related applications such as telemedicine, shared medical records, e-cure and domot- ics. This paper offers a structurational analysis of the complexity inherent in implementing one e-health application, telecare. Telecare is the use of information and communication technology to facilitate health and social care delivery to individuals in their homes (Barlow et al., 2006). The telecare technology doi:10.1111/j.1365-2575.2010.00358.x Info Systems J (2010) 20, 537–561 537 © 2010 Blackwell Publishing Ltd