Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update)

In the paper

“Cost factors are related to start-up costs, ongoing costs, costs related to a loss of revenue and potential savings to put against these costs.”

In the paper

“Sixteen studies focussed on e-health technologies from across a range of e-health domains [15, 23, 25, 26, 30, 35, 37, 46, 47, 49, 50, 52, 53, 56–58].”

In the paper

“All studies were published between 2003 and 2014.”

In the paper

“Twelve studies were focussed on one particular type of healthcare setting including primary care/ambulatory [15, 24, 27, 28, 36, 39], hospital/inpatient/acute care [22, 29, 40, 46] and home care [19, 53].”

In the paper

“Financial incentives include the provision of initial funds to cover upfront costs [49], financial sponsorship [39], reimbursements for adoption [19, 30, 31, 36], and pay-for-performance initiatives [24, 36, 37, 49].”

What the sources say

• Not checked yetcites [49] Police RL, Foster T, Wong KS. Adoption and use of health information technology in physician practice organisations: systematic review. Inform Prim Care. 2010;18(4):245–58.
• Not checked yetcites [39] Ludwick DA, Doucette J. Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. Int J Med Inform. 2009;78(1):22–31. source
• Not checked yetcites [19] Botsis T, Hartvigsen G. Current status and future perspectives in telecare for elderly people suffering from chronic diseases. J Telemed Telecare. 2008;14(4):195–203. source

In the paper

“All papers were written in English.”

In the paper

“the remainder of the studies did not define a specific healthcare setting [16, 18, 20, 28, 34, 38, 48, 57, 58].”

In the paper

“Forty-four reviews mainly from North America and Europe were included.”

In the paper

“Twenty-one studies focussed on the implementation of e-health in to two or more types of healthcare setting [21, 23, 25, 26, 30, 31, 33, 35, 37, 41–45, 47, 49, 50, 52, 54–56]; the remainder of the studies did not define a specific healthcare setting [16, 18, 20, 28, 34, 38, 48, 57, 58].”

In the paper

“Fifteen studies originated from Canada [16, 25–29, 31–33, 36, 39, 41, 42, 44, 53], fourteen from the USA [17, 22–24, 30, 35, 38, 40, 49, 52, 54–57], three from the Netherlands [17, 20, 34], three from the UK [37, 46, 51], two from Australia [15, 43] and one each from Germany [47], Sweden [50], Norway [19], Mexico [21], Malaysia [58], Kenya [45] and Israel [48].”

In the paper

“It became clear that the relationships between studies seemed to be reciprocal (where concepts of one study encompass another), with many themes occurring across studies which were largely in agreement about the factors that influenced implementation, and from which a line of argument (overarching narrative) could be developed.”

In the paper

“A total of 2812 unique citations were identified (see Fig. 1).”

In the paper

“Complexity factors such as slow system performance [55], software and hardware that were difficult to use [27], the need for extensive software modifications [52], the work involved in transferring records between two systems [18], the inability to provide real-time access [38], data handling, reliability, slow speed, unplanned downtime [41] and connectivity issues [49] influence implementation of”

In the paper

“There were no data that could not be coded to one of the CFIR constructs, meaning the categories of the CFIR were endorsed and no additional original theoretical insights developed.”

In the paper

“Of these, 2694 could be excluded on the basis of the title or abstract, leaving 118 citations requiring the full paper before a decision could be made.”

In the paper

“Access to ongoing support to use systems was important for system use [21, 25, 28, 31, 37, 39, 43, 54] and a barrier to implementation when it was lacking [21].”

What the sources say

• Not checked yetcites [21] Castillo VH, Martinez-Garcia AI, Pulido JR. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak. 2010;10:60. source
• Not checked yetcites [25] Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, et al. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst. 2012;36(1):241–77. source
• Not checked yetcites [28] Goldstein DH, Phelan R, Wilson R, Ross-White A, VanDenKerkhof EG, Penning JP, et al. Brief review: adoption of electronic medical records to enhance acute pain management. Can J Anesth. 2014;61(2):164–79. source

In the paper

“Providing a period of transition in which end users can become familiar with and learn how to use new systems has been advocated [39, 50].”

What the sources say

• Not checked yetcites [39] Ludwick DA, Doucette J. Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. Int J Med Inform. 2009;78(1):22–31. source
• Not checked yetcites [50] Rahimi B, Vimarlund V, Timpka T. Health information system implementation: a qualitative meta-analysis. J Med Syst. 2009;33(5):359–68. source

In the paper

“Positive staff attitudes were described as: beliefs that the new systems would benefit patients [56], interest in the technologies, perceived usefulness and motivation in working with the systems [21].”

What the sources say

• Not checked yetcites [56] Waneka R, Spetz J. Hospital information technology systems' impact on nurses and nursing care. J Nurs Adm. 2010;40(12):509–14. source
• Not checked yetcites [21] Castillo VH, Martinez-Garcia AI, Pulido JR. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak. 2010;10:60. source

In the paper

“Generally, access to appropriate, high-quality, well-funded, and easily available training was reported as a facilitator to implementation, whereas it was reported as a barrier when it was non-existent or existent but inadequate [15, 16, 18, 20, 23, 25, 28, 31, 37, 43, 45, 50, 51, 53–58].”

What the sources say

• Not checked yetcites [15] Adaji A, Schattner P, Jones K. The use of information technology to enhance diabetes management in primary care: a literature review. Inform Prim Care. 2008;16(3):229–37.
• Not checked yetcites [16] Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. J Am Med Inform Assoc. 2011;18(4):515–22. source
• Not checked yetcites [18] Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10:231. source

In the paper

“The quality of project management during the implementation period [18], careful study of the downstream effects of implementation on workflow [55], additional training [31, 55], the adaptability of technologies to fit with roles, tasks and workflows [37] and dedicated technical support staff [31] are suggested as strategies to reduce barriers related to disruptions to workflow, roles and respons”

What the sources say

• Not checked yetcites [18] Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10:231. source
• Not checked yetcites [55] Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy. Phys Ther. 2006;86(3):434–46. source
• Not checked yetcites [31] Jarvis-Selinger S, Chan E, Payne R, Plohman K, Ho K. Clinical telehealth across the disciplines: lessons learned. Telemed e-Health. 2008;14(7):720–5. source

In the paper

“When there is a good fit, or perceived fit, between e-health systems and workflows, and when systems positively influence workplace efficiency, this facilitates use [15, 40, 41].”

What the sources say

• Not checked yetcites [15] Adaji A, Schattner P, Jones K. The use of information technology to enhance diabetes management in primary care: a literature review. Inform Prim Care. 2008;16(3):229–37.
• Not checked yetcites [40] Mack EH, Wheeler DS, Embi PJ. Clinical decision support systems in the pediatric intensive care unit. Pediatric Crit Care Med. 2009;10(1):23–8. source
• Not checked yetcites [41] McGinn CA, Grenier S, Duplantie J, Shaw N, Sicotte C, Mathieu L, et al. Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med. 2011;9:46. source

In the paper

“Incorporating workflow analysis into system design [48, 55], the integration of systems into the usual process of care [15], user-friendly systems [40] and minimising workflow interruptions during implementation [17] may minimise disruptions to workflow.”

What the sources say

• Not checked yetcites [48] Peleg M, Tu S. Decision support, knowledge representation and management in medicine. Yearbook Med Inform. 2006:72–80.
• Not checked yetcites [55] Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy. Phys Ther. 2006;86(3):434–46. source
• Not checked yetcites [15] Adaji A, Schattner P, Jones K. The use of information technology to enhance diabetes management in primary care: a literature review. Inform Prim Care. 2008;16(3):229–37.

In the paper

“Infrastructure features included electricity supply [51], available bandwidth [31, 51], access to reliable internet connectivity [45, 51], access to computers [34], electrical power [45] and access to phone lines and mobile phones [45].”

What the sources say

• Not checked yetcites [51] Saliba V, Legido-Quigley H, Hallik R, Aaviksoo A, Car J, McKee M. Telemedicine across borders: a systematic review of factors that hinder or support implementation. Int J Med Inform. 2012;81(12):793–809. source
• Not checked yetcites [31] Jarvis-Selinger S, Chan E, Payne R, Plohman K, Ho K. Clinical telehealth across the disciplines: lessons learned. Telemed e-Health. 2008;14(7):720–5. source
• Not checked yetcites [45] Oluoch T, Santas X, Kwaro D, Were M, Biondich P, Bailey C, et al. The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: a systematic review. Int J Med Inform. 2012;81(10):e83–92. source

In the paper

“One review emphasised the need for ongoing effort after the initial ‘go-live’ phase, referring to the ‘under-recognised maintenance phase of implementation’ [29].”

What the sources say

• Not checked yetcites [29] Gruber D, Cummings GG, Leblanc L, Smith DL. Factors influencing outcomes of clinical information systems implementation: a systematic review. Comput Inform Nurs. 2009;27(3):151–63. source

In the paper

“Negative perceptions included beliefs that electronic systems would disrupt the delivery of care [49]; doubts that these systems can improve patient care, clinical outcomes or improve the quality of medical practices [43]; and distrust in the systems [37] as well as a more general staff resistance to change [28, 32, 39, 41, 49, 51–53].”

What the sources say

• Not checked yetcites [49] Police RL, Foster T, Wong KS. Adoption and use of health information technology in physician practice organisations: systematic review. Inform Prim Care. 2010;18(4):245–58.
• Not checked yetcites [43] Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson SA. Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc. 2010;17(1):25–33. source
• Not checked yetcites [37] Lluch M. Healthcare professionals' organisational barriers to health information technologies-a literature review. Int J Med Inform. 2011;80(12):849–62. source

In the paper

“The synthesis showed that findings were remarkably consistent across different e-health domains and healthcare settings and well described by the CFIR framework, with no data that did not fit the CFIR.”

In the paper

“The work of planning includes the delineation of roles and responsibilities [43], securing time to invest system selection and procurement [18], evaluating other concomitant policy and process changes [40], needs assessment and analysis, development of a business plan [44], early identification and engagement of champions [31], involving end users [16, 27, 41, 51], establishing a guiding”

What the sources say

• Not checked yetcites [43] Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson SA. Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc. 2010;17(1):25–33. source
• Not checked yetcites [18] Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10:231. source
• Not checked yetcites [40] Mack EH, Wheeler DS, Embi PJ. Clinical decision support systems in the pediatric intensive care unit. Pediatric Crit Care Med. 2009;10(1):23–8. source

In the paper

“Specifically, fears over a loss of autonomy [16, 18, 27, 34, 37, 39, 43], concerns about liability [16, 18, 22, 37, 43, 51], concerns over patient privacy and security being compromised [16, 18, 20, 23, 24, 27, 28, 30, 31, 33, 39, 41, 43, 45, 47, 49, 51–53, 56, 57], and perceived threats to patient and health professional relationships [18, 25, 27, 28, 31, 34, 37–39, 41, 43, 54, 57] through the”

What the sources say

• Not checked yetcites [16] Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. J Am Med Inform Assoc. 2011;18(4):515–22. source
• Not checked yetcites [18] Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10:231. source
• Not checked yetcites [27] Gagnon M-P, Nsangou E-R, Payne-Gagnon J, Grenier S, Sicotte C. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. J Am Med Inform Assoc. 2014;21(3):535–41. source

In the paper

“Strategies to challenge negative attitudes included fostering a culture of communication and cooperation, involving the eventual users of systems in the development and implementation [20, 49], leadership [56], friendly and context-aware user interfaces which promote perceived ease of use and usefulness [21], better education [47], and clearly and prospectively communicating intended benefits and”

What the sources say

• Not checked yetcites [20] Broens TH, Huis in't Veld RM, Vollenbroek-Hutten MM, Hermens HJ, van Halteren AT, Nieuwenhuis LJ. Determinants of successful telemedicine implementations: a literature study. J Telemed Telecare. 2007;13(6):303–9. source
• Not checked yetcites [49] Police RL, Foster T, Wong KS. Adoption and use of health information technology in physician practice organisations: systematic review. Inform Prim Care. 2010;18(4):245–58.
• Not checked yetcites [56] Waneka R, Spetz J. Hospital information technology systems' impact on nurses and nursing care. J Nurs Adm. 2010;40(12):509–14. source

In the paper

“All the included reviews reported multiple factors that were important for implementation, and no single factor was identified as a key barrier or facilitator.”

In the paper

“The attitudes of colleagues [25, 41] and patients [25, 27, 41] were also reported to influence staff attitudes with regard to e-health acceptance as were staff demographic factors [23, 46, 56].”

What the sources say

• Not checked yetcites [25] Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, et al. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst. 2012;36(1):241–77. source
• Not checked yetcites [41] McGinn CA, Grenier S, Duplantie J, Shaw N, Sicotte C, Mathieu L, et al. Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med. 2011;9:46. source
• Not checked yetcites [27] Gagnon M-P, Nsangou E-R, Payne-Gagnon J, Grenier S, Sicotte C. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. J Am Med Inform Assoc. 2014;21(3):535–41. source

In the paper

“Training [25, 37, 43] and financial incentives [37] were cited as strategies to overcome skill-related barriers.”

What the sources say

• Not checked yetcites [25] Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, et al. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst. 2012;36(1):241–77. source
• Not checked yetcites [37] Lluch M. Healthcare professionals' organisational barriers to health information technologies-a literature review. Int J Med Inform. 2011;80(12):849–62. source
• Not checked yetcites [43] Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson SA. Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc. 2010;17(1):25–33. source

In the paper

“Evaluation was seen as important to ensure system benefits [29, 48], to increase health professional acceptance through demonstration of benefits [31, 34, 41, 43] and to secure ongoing funding [53],”

What the sources say

• Not checked yetcites [29] Gruber D, Cummings GG, Leblanc L, Smith DL. Factors influencing outcomes of clinical information systems implementation: a systematic review. Comput Inform Nurs. 2009;27(3):151–63. source
• Not checked yetcites [48] Peleg M, Tu S. Decision support, knowledge representation and management in medicine. Yearbook Med Inform. 2006:72–80.
• Not checked yetcites [31] Jarvis-Selinger S, Chan E, Payne R, Plohman K, Ho K. Clinical telehealth across the disciplines: lessons learned. Telemed e-Health. 2008;14(7):720–5. source

In the paper

“Key factors for effective implementation included outer context, in particular, the need for supportive legislation, and recognised standards.”

In the paper

“Four reviews included data on the effects of the e-health systems implemented [24, 36, 49, 52]; these reported mixed effects.”

What the sources say

• Not checked yetcites [24] Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. J Am Board Fam Med. 2010;23(5):655–70. source
• Not checked yetcites [36] Lau F, Price M, Boyd J, Partridge C, Bell H, Raworth R. Impact of electronic medical record on physician practice in office settings: a systematic review. BMC Med Inform Decis Mak. 2012;12:10. source
• Not checked yetcites [49] Police RL, Foster T, Wong KS. Adoption and use of health information technology in physician practice organisations: systematic review. Inform Prim Care. 2010;18(4):245–58.

In the paper

“The use of the CFIR highlighted that the individual e-health technology, the outer setting, the inner setting, the individual health professionals, and the process of implementation are all important for implementation and should be considered carefully when attempts are made to implement e-health into health systems.”

In the paper

“Both reviews highlighted the importance of policies and incentives; adequate infrastructure and resources; engagement of key personnel; organisational readiness; individuals’ knowledge and beliefs; and the fit of innovations with workflows, processes and systems.”

What the sources say

• Not checked yetcites [60] Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, et al. Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci. 2016;11(1):1–39.

In the paper

“This systematic review is reported following the ENTREQ statement guidelines to enhance transparency in reporting qualitative evidence synthesis [11].”

What the sources say

• Not checked yetcites [11] Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181. source

In the paper

“The protocol for this systematic review has been published [9] and registered with the Prospective Register of Systematic Reviews (registration number CRD42015017661).”

What the sources say

• Not checked yetcites [9] Ross J, Stevenson F, Lau R, Murray E. Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews. BMJ Open. 2015;5(4):e006773. source

In the paper

“The CFIR provides a systematic way of identifying the factors that are important for implementation, and its use also allows identification of areas where there is insufficient evidence and further research is required.”

What the sources say

• Not checked yetcites [8] Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. source

In the paper

“High-profile implementation failures continue to be reported, such as the failure of implementation of an e-health system in a major UK teaching hospital, leading to reduced performance, demoralised staff, costs of £200 million and the trust being put into special measures [6].”

What the sources say

• Not checked yetcites [6] Computing. Addenbrooke's Hospital £200m IT system proves an epic fail. 2015. http://www.computing.co.uk/ctg/news/2427100/addenbrookes-hospital-gbp200m-it-system-proves-an-epic-fail . Accessed 17 Jun 2016.

In the paper

“However, although there is widespread agreement about the importance and potential benefits of e-health, realisation of these benefits has often been slower than anticipated, often because of difficulties with implementation [4].”

What the sources say

• Not checked yetcites [4] Wachter RM. Making IT Work: Harnessing the power of health information technology to improve care in England. Report of the National Advisory Group on Health Information Technology in England. 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/550866/Wachter_Review_Accessible.pdf . Accessed 27 Sept 2016.

In the paper

“With a plethora of reviews on the implementation of different e-health technologies available, it may be difficult for clinicians, managers or policymakers to locate and apply an appropriate body of evidence for their specific circumstances.”

In the paper

“A systematic review of reviews provides a summary of evidence from a variety of different levels, including the combination of different interventions, different populations and different settings [10] in a coherent and economical way [7].”

What the sources say

• Not checked yetcites [10] Smith V, Devane D, Begley C, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11(1):15. source
• Not checked yetcites [7] Mair FS, May C, O'Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bull World Health Organ. 2012;90(5):357–64. source

In the paper

“There was no limitation of language.”

In the paper

“The original review [7] was based on 37 papers published between 1995 and 31 July 2009.”

What the sources say

• Not checked yetcites [7] Mair FS, May C, O'Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bull World Health Organ. 2012;90(5):357–64. source

In the paper

“Because the aim was to describe and synthesise a body of qualitative literature and not determine an effect size, studies were not excluded based on this assessment.”

In the paper

“The CFIR [8], consolidates implementation factors from a broad array of implementation theories and is composed of five major constructs made up of components that influence the implementation of innovations into practice (see Table 2).”

What the sources say

• Not checked yetcites [8] Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. source

In the paper

“Any discrepancies between reviewers were resolved through discussion.”

In the paper

“Full-text papers of references that were deemed potentially eligible were obtained and assessed for eligibility against the pre-specified selection criteria.”

In the paper

“Data were re-categorised from one construct to another and discussions between JR, EM and FS were held until the reviewers were confident that all data were coded into appropriate constructs or categories.”

In the paper

“Meta-ethnography, as described in depth by Noblit and Hare [13], focusses on interpretation to ‘synthesise understanding’, unlike other approaches to qualitative synthesis, such as thematic analysis, which seek to summarise data [14].”

What the sources say

• Not checked yetcites [13] Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. Newbury Park: Sage;1988. source
• Not checked yetcites [14] Bearman M, Dawson P. Qualitative synthesis and systematic review in health professions education. Med Educ. 2013;47(3):252–60. source

In the paper

“Reference lists of all included studies were also screened for additional literature.”

In the paper

“Data from discussions were included as they often contained further interpretations from the authors, which offered important insights and enhanced the richness of the findings.”

In the paper

“Titles and abstracts of all identified records were independently assessed by JR and RL.”

In the paper

“Data were extracted from the included studies by JR, and data extraction and coding was checked by EM.”

In the paper

“Data on the methodological quality of the included reviews was extracted based on ENTREQ statement guidelines [11] and was used to describe the quality of the included reviews.”

What the sources say

• Not checked yetcites [11] Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12:181. source

In the paper

“Comprehensive electronic searches of MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were conducted.”

In the paper

“The use of a framework like the CFIR aids the transferability and comparability of findings from this review to other implementation studies and allows those undertaking implementation to access the parts of this review that are of most interest to them.”

What the sources say

• Not checked yetcites [8] Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. source

In the paper

“Implementation climate includes the compatibility or general fit between the e-health intervention and the organisation [16, 23, 31, 33, 37, 46, 49, 59].”

What the sources say

• Not checked yetcites [16] Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. J Am Med Inform Assoc. 2011;18(4):515–22. source
• Not checked yetcites [23] Fitzpatrick L, Melnikas A, Weathers M, Kachnowski S. Understanding communication capacity. Communication patterns and ICT usage in clinical settings. J Healthc Inf Manag. 2007;22(3):34–41.
• Not checked yetcites [31] Jarvis-Selinger S, Chan E, Payne R, Plohman K, Ho K. Clinical telehealth across the disciplines: lessons learned. Telemed e-Health. 2008;14(7):720–5. source

In the paper

“Separate reviews are brought together, compared and contrasted, which allows for new insights to be generated across the literature and synthesised into a simple overview of a large body of work.”

In the paper

“Findings suggest that issues around implementation are multi-level and complex.”

In the paper

“Lau et al.’s review found that the perceived benefits or harm of implementation such as expectations of more efficient workflow or lower productivity were only an important factor for the implementation of e-health interventions and was not present in the data for other types of interventions (guidelines or evidence-based practice, management of care, public health or preventative medicine, integ”

What the sources say

• Not checked yetcites [60] Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, et al. Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci. 2016;11(1):1–39.

In the paper

“Although this review was rigorous, carefully executed and employed a robust methodological approach, it has several limitations.”

In the paper

“Finally, the data available for the synthesis was limited by what previous reviewers included in their reviews, and therefore, it is not possible to tell whether the areas of the CFIR which are not addressed are not important or just not addressed.”

In the paper

“The original review reported a concentration on organisational issues within the literature.”

What the sources say

• Not checked yetcites [7] Mair FS, May C, O'Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bull World Health Organ. 2012;90(5):357–64. source

In the paper

“Although also strongly present in this review, the use of the CFIR sensitised the focus of analysis to other factors as well including factors related to the innovation, outer context, individuals and the process of implementation.”

In the paper

“It was often not clear whether the data came from the primary studies or were subsequent interpretations by the authors of included reviews.”

In the paper

“The use of a meta-ethnographic approach provided a rigorous and transparent approach to the data analysis and the translation of the studies into one another, which allowed the development of an overarching narrative which endorsed the value of the CFIR framework.”

In the paper

“In this review, there was a focus given to the role of reflecting and evaluating which may represent an increased awareness of their importance in implementation.”

In the paper

“Reviews of reviews inevitably result in a time-lag, as new primary data must first be published, then included in a review and then into a review of reviews.”

In the paper

“Many reviews did not specify whether the data came from clinicians, nurses, other primary care staff or multidisciplinary teams; therefore, it was not possible to differentiate the perspectives of specific roles (e.g. nurses).”

In the paper

“The original authors reported that very little attention had been paid in ensuring that the potential benefits of new technologies are made transparent through ongoing evaluation and feedback.”

What the sources say

• Not checked yetcites [7] Mair FS, May C, O'Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bull World Health Organ. 2012;90(5):357–64. source