Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review

• Published in: Bulletin of the World Health Organization Vol. 90; no. 5; pp. 357 - 364
• Main Authors: Mair, Frances S, May, Carl, O’Donnell, Catherine, Finch, Tracy, Sullivan, Frank, Murray, Elizabeth
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.05.2012; The World Health Organization
• Subjects: Attitude to Computers; Barriers; Citations; Coding; Criteria; Efficiency, Organizational; Electronic Health Records - instrumentation; Gaps; Health; Health Policy & Services; Health services; Health Services Research; Hospitals; Humans; Inclusions; Libraries; Medical research; Methods; Organizational Culture; Program Development; Program Evaluation; Quality of Health Care - statistics & numerical data; Risk management; Studies; Systematic review; Systematic Reviews; Telemedicine - instrumentation; Theme Issue; Theory; United Kingdom
• ISSN: 0042-9686; 1564-0604; 1564-0604
• DOI: 10.2471/BLT.11.099424

To systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject. MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework. Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (i) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii) effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation processes might be reconfigured by user-produced knowledge. The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.