Christina Keller

This review examines how coordination is infrastructured in digital health ecosystems where technologies, institutions, and practices intersect across organisational and professional boundaries. Drawing on a systematic analysis of the literature, we identify three interdependent infrastructural layers: technological, informational, and institutional, and four recurring processes through which coordination is enacted: building coordination capacity, standardising information, aligning work practices, and enabling boundary-spanning. Our analysis shows that these processes are shaped by persistent tensions that must be continually navigated rather than resolved. By integrating insights from coordination and infrastructuring research, we develop a conceptual framework that positions coordination as emergent and sustained through the infrastructuring work of tension navigation. The findings move beyond narrow interpretations of interoperability or organisational alignment, calling for greater attention to the sociotechnical work that sustains coordination over time.