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Purpose  This paper aims to investigate the eHealth ecosystem’s evolution during the coronavirus disease 2019 (COVID-19) pandemic and its effects on the progression of care for patients with chronic cardiovascular disease.    Design/methodology/approach  To attain the aim of the study, this study chose to adopt a qualitative method that matches the complexity of the issue. The study was conducted in a real context through 44 face-to-face semi-structured interviews of key informants at different levels of the Italian eHealth service ecosystem, via Microsoft Teams. The interviews were carried out from June 2020 to January 2021. In this research, we adopted an abductive approach that enabled a process where the theoretical framework and the data analysis evolved at the same time.    Findings  The study results were used to develop a conceptual framework that considers the key factors enabling and constraining the evolutionary process of the eHealth service ecosystem. In particular, the drivers that emerged from the study were actor role empowerment, actor–network engagement and resource reconfiguration while the inhibitors were inter- and intra-actor misalignment, resource myopia and the platformisation gap. The findings also revealed the pivotal role of the meso level in the development of the eHealth service ecosystem, boosted by the COVID-19 pandemic.    Originality/value  By adopting a service ecosystem perspective, this paper contributes, at both a theoretical and a managerial level, to a better understanding of the dynamics related to the diffusion of eHealth. The study identifies the main issues that researchers, managers and policymakers should address to support the evolution of the eHealth service ecosystem, with particular regard to chronic cardiovascular disease.

The long and winding road of eHealth. The service ecosystem perspective