Health services inquiry

Protocol

Exploring the challenges of implementing e-wellness: a protocol for an update of a systematic review of reviews

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  1. Jamie Ross,
  2. Fiona Stevenson,
  3. Rosa Lau,
  4. Elizabeth Murray
  1. east-Wellness Unit, Research Section of Primary Care and Population Health, University Higher London, London, UK
  1. Correspondence to Jamie Ross; Jamie.Ross{at}ucl.ac.united kingdom of great britain and northern ireland

Abstract

Introduction There is neat potential for e-health to deliver cost-effective, quality healthcare and spending on e-wellness systems by governments and healthcare systems is increasing worldwide. However, the literature oft describes problematic and unsuccessful attempts to implement these new technologies into routine clinical exercise. To understand and accost the challenges of implementing e-wellness, a systematic review was conducted in 2009, which identified several conceptual barriers and facilitators to implementation. As technology is speedily changing and new e-health solutions are constantly evolving to run into the needs of electric current practice, an update of this review is deemed necessary to sympathise electric current challenges to the implementation of e-health. This research aims to identify, summarise and synthesise currently available bear witness, past undertaking a systematic review of reviews to explore the barriers and facilitators to implementing e-wellness across a range of healthcare settings.

Methods and assay This is a protocol for an update of a systematic review of reviews. Nosotros will search MEDLINE, EMBASE, CINAHL, PSYCINFO and The Cochrane Library for studies published betwixt 2009 and 2014. We will check reference lists of included studies for further studies. Two authors will independently screen the titles and abstracts identified from the search; any discrepancies will exist resolved past discussion and consensus. Total-text papers will be obtained and relevant reviews volition be selected against inclusion criteria. Eligible reviews have to be based on the implementation of due east-wellness technologies. Information from eligible reviews will exist extracted using a data abstraction course. A thematic analysis of barriers and facilitators to eastward-health implementation will be conducted.

Ethics and dissemination Ethical approval is non required. The permission of the original authors to update the review was sought and granted.

Trial registration number PROSPERO CRD42015017661.

  • QUALITATIVE Inquiry
  • Change direction < HEALTH SERVICES ADMINISTRATION & Direction

This is an Open Access commodity distributed in accord with the Creative Commons Attribution Not Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, conform, build upon this piece of work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is not-commercial. See: http://creativecommons.org/licenses/past-nc/iv.0/

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  • QUALITATIVE RESEARCH
  • Alter direction < Wellness SERVICES ADMINISTRATION & MANAGEMENT

Strengths and limitations of this written report

  • This systematic review of reviews aims to produce a comprehensive overview related to the field of implementation of e-heath; and information technology will not be restricted to whatever healthcare setting or health condition.

  • Comprehensive search strategy; all citations identified from the search will exist double screened.

  • As in all systematic reviews, the search may not identify all relevant literature; this risk will be minimised past an inclusive search strategy and past citation-tracking all included papers for additional literature.

Introduction

The use of engineering in providing and delivering healthcare is pervasive worldwide.one ,2 At that place are thousands of websites offering wellness information of varying quality used by health professionals equally well as by laypersons, and online wellness information has become one of the almost of import information sources for people seeking health information in recent years.3 A survey by the Office for National Statistics reports that 43% of surveyed U.k. net users have accessed health information online and this figure increases to 59% among those anile 24–35.4 In developing countries, mobile phone technologies have improved health outcomes for chronic illness weather condition such as diabetes, heart disease and hypertension.v The apply of east-health, a term that describes the application of information, estimator or communication technology to some aspect of health or healthcare, is viewed as integral to solving problems facing healthcare systems.half dozen The European Commission states that e-health will play a key role in structural reforms that are needed to ensure the sustainability of health systems while securing access to services for all citizens.seven

Big-scale, national initiatives designed to coordinate e-health implementation are underway beyond the earth and this trend is likely to increase in the future.8 Examples of e-health technologies condign widely used include: management systems, such every bit the electronic wellness record (EHR), which allow the acquisition, manual and storage of patient data; computerised conclusion support systems including diagnostic support, alerts and reminder systems; communication systems such as telecommunication; and information resources such as the internet. In 2002, the National Health Service (NHS) pledged £11.four billion to reform the Uk's healthcare organization,9 and this has seen the on-going introduction of many new east-health systems such every bit: broadband networks; systems to electronically share Ten-rays; the cosmos of an integrated EHR organisation; and the NHS Choices website, which provides wellness information to the public via the internet.

Despite the potential benefits of eastward-wellness, implementation of these systems is ofttimes reported every bit problematic.nine Implementation of EHR and electronic prescribing systems has lagged in about European nations also as in the USA,10 costs associated with implementing eastward-health often screw and time delays are reported.9 Barriers to implementation of innovations within the healthcare setting may arise at the private, organisational and wider levels of the healthcare systems, and interact in circuitous and variable ways.11 ,12 These factors may as well be innovation-specific and context-specific. Studies have described fiscal, legal, social and upstanding barriers to implementation, arising at the organisational and individual level, including users' lack of awareness of the benefits, low east-health literacy, a shortage of evidence of cost-effectiveness and interoperability (the ability of different information engineering science systems and software applications to communicate, exchange data and employ the information that has been exchanged) as well as security concerns.ane ,13 Recognising and understanding barriers and facilitators is crucial for devising strategies and interventions to amend the widespread effective utilize of due east-health, and addressing blockages to implementation.

A systematic review of reviews by Mair et al14 synthesised the literature on the implementation of e-wellness interventions in healthcare settings published up until 2009. This review institute a growing accent on issues related to e-health systems' workability and how innovations impact organisational structures and goals. The review highlighted the need for acceptable resources, peculiarly financial, as well as administrative support, policy support, standards and interoperability. Relatively lilliputian attention was establish to be given to: e-health's effects on roles and responsibilities; take chances management; ways to appoint with professionals; and ensuring that the potential benefits of new technologies are fabricated transparent through ongoing evaluation and feedback.

As the use of e-wellness is rapidly growing and changing, and the nature of healthcare systems are continually shifting, an update of this review was deemed timely. The Cochrane Collaboration emphasises the importance of updating systematic reviews, every bit testify on a given subject is generally dynamic and continually evolving.fifteen This may exist particularly true for the field of e-wellness, every bit the past 6 years take seen an increase in spending on data and communications technology (ICT) by healthcare systems globally and the delivery of healthcare via e-health. Every bit well as an increment in spending, the period since the original systematic review has seen the invention and widespread adoption of technologies such every bit smartphones, tablets and applications, which can be used to access and deliver healthcare. The factors that promote or inhibit the implementation of due east-health may also have evolved over this time, given the dynamic and expanding nature of e-health utilisation in healthcare systems, and new challenges and strategies for overcoming them may exist reflected in the literature.

The aim of this review is to update a systematic review of reviews in guild to summarise and synthesise published review literature on barriers and facilitators to implementing eastward-health in health services. The Mair et alfourteen systematic review was selected to update as it is the chief review in the area of east-health implementation. A review of reviews is accounted more than appropriate than a further primary systematic review, equally the body of literature on east-health implementation is so vast, and a secondary review of this will allow a broad overview of the literature to exist synthesised, and will avert duplicating work already undertaken by other primary reviews.

Methods and analysis

In updating the Mair et alfourteen systematic review, the methods described by those authors will be replicated, including the criteria for including and excluding studies, and the search strategy. This review will analyse information thematically.

Criteria for considering studies for review

This volition be a systematic review of reviews including data from qualitative and quantitative reviews that will replicate the methodology described in the Mair et al14 systematic review. The eligibility criteria for study inclusion has been adult using the framework PICO, which stands for participants, interventions, comparators and outcomes (table one).

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Table 1

PICO criteria for including studies

Inclusion and exclusion criteria

Papers will be included if they run into the PICO criteria. Below is a detailed description of the inclusion and exclusion criteria for the types of studies to be considered, which is taken from the Mair et alxiv systematic review and volition be used to assess the papers in this review.

Papers will be included if they are:

  1. Systematic reviews: where relevant literature has been identified by ways of structured search of bibliographic and other databases; where transparent methodological criteria are used to exclude papers that do non meet an explicit methodological benchmark, and which presents rigorous conclusions almost outcomes.

  2. Narrative reviews: where relevant literature has been purposively sampled from a field of research; where theoretical or topical criteria are used to include papers on the grounds of type, relevance and perceived significance; with the aim of summarising, discussing and critiquing conclusions.

  3. Qualitative metasyntheses or meta-ethnographies: where relevant literature has been identified by means of a structured search of bibliographic and other databases, where transparent methods had been used to draw together theoretical products, with the aim of elaborating and extending theory.

Papers will exist excluded if they are:

  1. Secondary analyses (including qualitative metasyntheses or metaethnographies) of existing data sets for the purposes of presenting cumulative outcomes from personal research programmes.

  2. Secondary analyses (including qualitative metasyntheses or metaethnographies) of existing information sets for the purposes of presenting integrative outcomes from different inquiry programmes.

  3. Discussions of literature included in contributions to theory edifice or critique.

  4. Summaries of literature for the purposes of information or commentary.

  5. Editorial discussions that argue the case for a field of research or a course of action.

Where an abstract states information technology is a review, but there is no supporting evidence in the main newspaper, such as details of databases searched or criteria for selection of papers (either on methodological or theoretical grounds), the newspaper will be excluded.

Search strategy for identification of studies

The search strategy volition be based on the following two concepts: e-health and implementation. The search strategy will include a combination of medical discipline headings and free-text words. Medical field of study headings referring to east-health include:

  • Medical-Informatics-Applications,

  • Management-Data-Systems,

  • Decision-Making-Computer-Assisted,

  • Diagnosis-Computer-Assisted,

  • Therapy-Figurer-Assisted,

  • Medical-Records-Systems-Computerized,

  • Medical-Order-Entry-Systems,

  • Electronic-Mail,

  • Videoconferencing,

  • Telemedicine,

  • Figurer-Communication-Networks and

  • Internet.

There are no thesaurus terms for implementation, and then this concept will exist searched for past looking for these text words in the titles, keywords or abstracts:

  • Routin*,

  • Normali?*,

  • Integrat*,

  • Facilitate*,

  • Bulwark*,

  • Implement* and

  • Adopt*.

Comprehensive electronic searches of MEDLINE, EMBASE, CINAHL, PSYCINFO and The Cochrane Library (which include Cochrane Database of Systematic reviews, Cochrane Central Register of Controlled Trials, DARE, NHSEED (NHS Economic Evaluation Database), Wellness Engineering science Assessment Database) will be conducted. The search strategy can be found in online supplementary file 1.

The Mair et alxiv systematic review was based on 37 reviews published between one January 1995 and 31 July 2009. This electric current review volition replicate the systematic search strategy for literature published from 1 Baronial 2009 and the 37 previously identified studies will likewise be included in the synthesis.

In that location will be no limitation of language. Citation searches volition exist carried out in ISI Spider web of Science and reference lists of all included articles volition be screened for boosted literature.

Selection of studies

Titles and abstracts of all identified records will be independently double screened to ensure consistency and agreement of inclusion past JR and RL. Full text articles that are potentially eligible will be obtained, and assessed for eligibility against the prespecified inclusion and exclusion criteria. Any discrepancies between reviewers will exist resolved through discussion and the involvement of a third reviewer (EM), if necessary.

Data extraction and management

A data extraction form will be developed and data will be extracted to categorise identified reviews in terms of: publication date, land of origin, aim, setting, e-health domain, databases searched, inclusion and exclusion criteria, data extraction method, quality assessment method, method of assay/synthesis, the number of papers included in the review and factors that influence the implementation of eastward-health.

Each article will be carefully read by JR, and data relating to barriers and facilitators will exist abstracted from the results and discussion sections of included papers. Information from the discussions will be included as they frequently comprise interpretations from the reviewer, which may offer farther insights and raise the richness of the findings in this review of reviews. All data extraction will be checked by another reviewer (EM) who volition critically examine the extraction performed by JR by checking the accurateness of data extraction, including review characteristics (eg, author, reference, aims and objectives, setting, number and type of principal studies included in the review), and the data extracted on barriers and facilitators.

Data synthesis

Once all data has been coded, it will be critically examined. If required, the coding framework volition exist refined and data recategorised from one theme to another, or into new themes and newly created themes volition be re-configured if required. Any incertitude about coding will be discussed between JR, FS and EM. A thematic assay will exist presented focusing on barriers and facilitators to implementation. A clarification will be given of whatever pregnant differences that emerge between this review and the previous systematic review.14

Assessment of methodological quality

Because we are aiming to describe and synthesise a body of qualitative literature, and not to determine an outcome size, we volition not conduct quality appraisal of the included studies, as it will not affect this interpretive synthesis.

Discussion

This review will nowadays up-to-appointment findings on factors that influence the implementation of eastward-health into routine exercise within health settings by reviewing, summarising and synthesising the available literature. It volition examine the barriers and facilitators identified from previous attempts to integrate due east-health into practice and in doing and then volition generate possible strategies for future implementation. Equally an update to a previous systematic review, the findings of this review will provide an opportunity to assess whether barriers and facilitators to implementing east-health evolve or vary over time. It would seem likely, given the rapid growth and evolution of e-health technologies, that there will be differences in the factors that inhibit their implementation over time, and this volition be important to recognise when devising strategies for the implementation of due east-wellness into practice. Information technology is besides likely, however, that several of the barriers and facilitators identified in the original systematic review will remain consistent over time, which may reflect factors that are intrinsic to implementing eastward-health, or indeed whatsoever new innovation into healthcare settings.

A forcefulness of this review is that it will not exist limited by healthcare setting or any specific health concern and, therefore, findings will be applicable to a wide range of health services. A systematic review of reviews was selected as it allows a wide field such as this, containing many primary papers, to exist synthesised. However, a potential limitation of this method is that there may exist a long gap betwixt the principal studies being conducted and the fourth dimension the reviews are conducted. To mitigate the potential of missing very current insights, a scoping search of primary literature volition exist conducted prior to publication of this review, and if deemed advisable, will be incorporated into the discussion of the findings.

When planning implementation, information technology is important to identify potential barriers and facilitators as early every bit possible in the procedure,16 to permit appropriate strategies to be formulated. In conducting this review, common challenges to east-wellness implementation described in the literature will be synthesised to provide learning opportunities for the implementation of due east-health. Given the increased spending on ICT past healthcare systems effectually the world, and the often reported failures in integrating e-wellness systems into practise, this review will provide researchers, clinicians, commissioners and health service managers with an up-to-date agreement of the potential barriers and facilitators to successful implementation that can be applied when developing interventions and planning implementation.

Amendments

In the event of protocol amendments, the date of each amendment will exist accompanied by a clarification of the change and the rationale.

Acknowledgments

The authors are grateful to the authors of the original systematic review (Professor Frances Mair, Professor Carl May, Professor Elizabeth Murray, Dr Tracy Finch, Dr George Anderson, Professor Catherine O'Donnell, Professor Paul Wallace and Professor Frank Sullivan) for allowing us to update their piece of work. The authors are grateful to the reviewers for their insightful comments.

References

  1. ↵
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  4. ↵

    Function for National Statistics. Net Access—Households and Individuals, 2013. 2013.

  5. ↵
  6. ↵
  7. ↵
  8. ↵
  9. ↵

    Public Accounts Committee. The national programme for IT in the NHS: an update on the commitment of detailed care records systems. Great britain: .

  10. ↵
  11. ↵
  12. ↵
  13. ↵
  14. ↵
  15. ↵
  16. ↵

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