Abstract
BackgroundThere is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health.MethodsMEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR).ResultsForty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation.ConclusionThis systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those planning implementation. New interpretations of a large amount of data across e-health systems and healthcare settings have been generated and synthesised into a set of useable recommendations for practice. This review provides a further empirical test of the CFIR and identifies areas where additional research is necessary.Trial registrationPROSPERO, CRD42015017661 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0510-7) contains supplementary material, which is available to authorized users.
Highlights
There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide
This review identified and synthesised a large body of literature on the implementation of e-health which covered a wide range of healthcare systems and e-health
The synthesis showed that findings were remarkably consistent across different e-health domains and healthcare settings and well described by the Consolidated Framework for Implementation Research (CFIR) framework, with no data that did not fit the CFIR
Summary
There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. 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]. This highlights the strong need for those undertaking the implementation of e-health to understand factors that influence implementation and be well equipped to devise strategies and interventions to improve the widespread effective use of e-health and address blockages to implementation. 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
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