Jean-Paul Fortin

The dynamics of IT adoption in a major change process in healthcare delivery

The main objective of the study is to comprehend the dynamics of interactions between partners (caregivers, promoters, consultants, patients and managers) involved in the implementation process of an integrated delivery system designed to support the treatment of women with breast cancer. Preliminary findings permit to identify adoption/resistance factors at individual, professional and organizational levels in addition to technological factors. They give insights on the challenges to be faced when redesigning work processes in an interorganizational setting. Significant adoption factors include individual participation to the project and positive assessment of benefits of the system by individuals as well as by professional groups. On the other hand, the absence of a multidisciplinary committee and the complexity of the environment, the tasks and the technology are among the factors identified as troublesome. In terms of the dynamics of the process, our observation reveals that promoters have adopted a contingent and political approach. While this strategy is usually considered appropriate in healthcare organizations, information generated by this study has allowed for a better understanding of important factors and mechanisms to consider and address in the subsequent phases of implementation.

The Challenges of Implementing a “Patient-Oriented” Telepathology Network; the Eastern Québec Telepathology Project Experience

Background: The aim of the Eastern Québec telepathology project is to provide uniform diagnostic telepathology services across a huge geographic region with a low population density. This project is intended to provide surgeons and pathologists with frozen section and second opinion services anywhere and at any time across the entire region in order to avoid unnecessary patient transfer. Methods: The project has been implemented in 21 sites, each equipped with a whole slide scanner, a macroscopy station, two videoconferencing devices and a viewer/case management and collaboration solution. Of the 21 sites, 6 are devoid of a pathology laboratory. Of the remaining 15 sites, two have no pathologists, 6 have one and 7 have two or more. Results: The project has been successful and most appreciated by pathologists and surgeons. We report a number of challenges related to change management that we had to take into account in the course of implementation of this network. The challenges underscore the need for regular visits and active support to participating centers by the project team. Conclusion: The Eastern Québec telepathology network is successful and improves medical care in this region. In the course of implementation, we encountered a number of challenges which required innovative solutions.

An integrated strategy of knowledge application for optimal e-health implementation: A multi-method study protocol

BackgroundE-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system.MethodsA three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels.ResultsThis study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects.ConclusionThese results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must.

The impact of organizational characteristics on telehealth adoption by hospitals

Human and organizational factors are central to the adoption of various telehealth technologies and influence their diffusion into integrated networks. The aim of this paper is twofold. Firstly, a conceptual framework for assessing organizational factors that condition telehealth adoption by hospitals is proposed. Secondly, the results of an exploratory study conducted among the 32 hospitals involved in the Provincial Extended Telehealth Network of Quebec (Canada) are presented and discussed. Relevant concepts from different theoretical frameworks were combined to propose a comprehensive framework of potential factors affecting telehealth adoption by hospitals. A questionnaire was administered via telephone interviews to the DSP (Director of Medicine) of each of the 32 hospitals. Level of telehealth adoption was assessed by computing the number of transmissions performed since the hospitals adhesion to the network. Then, contingency analyses were performed to determine which organizational factors were significantly associated with telehealth adoption. Finally, the paper discusses some of the implications pertaining to the organizational dimensions affecting telehealth adoption by hospitals and proposes avenues to facilitate the diffusion of this technology.

Factors associated with intended and effective settlement of nursing students and newly graduated nurses in a rural setting after graduation: A mixed-methods review

OBJECTIVES To identify factors that influence the initial plan and final decision to choose a rural area as first employment location in final-year nursing students or newly graduated nurses. DESIGN We conducted a mixed-methods review of the literature, including both published and gray literature, using established criteria. Two reviewers performed data extraction of relevant information independently. DATA SOURCES We retrieved empirical studies from the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. We also searched for empirical studies in the technical and gray literature and reviewed journals related to rural health. Additionally, we conducted searches in websites such as the Center for Health Workforce Planning and Analysis, as well as Google and Google Scholar search engines. RESULTS Of the 523 studies thus screened, 15 were included for data extraction. We identified more than 40 factors associated with initial plans and final decision to settle in a rural area among nursing graduates. CONCLUSIONS Only limited literature is currently available on the factors associated with the intention of nursing students or newly graduated nurses of practicing in rural areas and on the relationship between intention and effective behavior. This review highlights the needs for further research in this field.

Integrating scientific evidence to support telehomecare development in a remote region.

This study aimed to understand how different types of knowledge have influenced the decision making process regarding the implementation of telehomecare in the organization of regional healthcare services in the Province of Quebec (Canada). A case study was conducted in order to explore how scientific evidence was integrated in the decision-making processes regarding the implementation of a telehomecare system in the Gaspésie-Magdalene Islands Health Region. A total of 14 semistructured interviews were completed with key organizational decision makers (regional managers, organization managers, healthcare professionals, and technological managers). Two researchers independently carried out data analysis, encouraging iterations and validation with study participants. The Gaspésie-Magdalene Islands Telehomecare Project is based on a technological solution named Intelligent Distance Patient Monitoring and constitutes a relevant example of the evolution of an e-health solution. Indeed, the first reports of the experiment influenced decision makers to continue the deployment of the solution. Decision makers from all groups agreed on the importance of using past experience to avoid pitfalls and ensure an optimal decision-making process. They highlighted the importance of knowledge translation between sites as well as within sites. Knowledge translation played an important part in the success of the project. Efficient strategies to transfer evidence to organizational decision making have been identified such as an endusers forum, where researchers provide support by sharing evidence with end-users and actively participate in knowledge translation.

Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders

BACKGROUND Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. METHODS Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. RESULTS We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). CONCLUSION ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.

The Eastern Quebec Telepathology Network: a support to the improvement to the public health care system

Summary The Eastern Quebec Telepathology Network is aimed at providing uniform diagnostic telepathology services in a huge territory with a low population density. It has been designed to provide intraoperative consultations (frozen sections) in smaller community hospitals and to allow pathologists working alone to rapidly obtain a second opinion. This study provides an interim evaluation of the benefits of the network. The network involves 24 sites, of which seven are devoid of a pathology laboratory, three have no pathologist and six have one pathologist on site. Since the beginning of the implementation, the coverage in pathology in this territory was improved: 1) telepathology allowed pathologists to work outside of their office and to provide surgeons with faster diagnoses of urgent biopsies; 2) expected interruptions of the intraoperative consultation coverage were avoided ; 3) intraoperative consultations were provided to surgeons in hospitals devoid of pathology laboratory; 4) expert opinions were obtained with reduced isolation for pathologists working alone and improved turn-around time; 5) merging of smaller laboratories resulted in a more stable pathology coverage and an attractive effect on the recruitment of young pathologists; 6) videoconferencing and macroscopy station allowed real-time communication between a pathologist and the remote technician for macroscopic description; and 7) several technical procedures were standardized (staining, sectioning, reporting). In conclusion, the Eastern Quebec Telepathology Network was designed to improve medical care to patients. In a short period of time, an improvement of the organization of health cares and of the delivery of services is already apparent. Background Canada is a huge country with a low population density. The province of Quebec is the largest but the second most populated province with its 7,957,600 inhabitants. The territory covered by the Eastern Quebec Telepathology Network spans over 452,600 km 2 in which 1,7 million

The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network

Background: The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Methods: Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. Results: The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). Conclusion: The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological considerations.

La réorientation des services de santé et la promotion de la santé : une lecture de la situation

La Charte d’Ottawa constitue un tournant majeur dans la vision qu’a le monde de la sante, des moyens et des strategies a mettre en place pour apporter des reponses aux attentes des populations. Des attentes qui ne se limitent plus a la conception biomedicale classique de la sante, tres orientee vers les soins et centree sur la maladie, mais la depassent desormais pour integrer la prevention de la maladie et la promotion de la sante. Pour y arriver, cinq axes strategiques d’actions ont ete identifies : 1) elaborer une politique publique saine ; 2) creer des milieux favorables ; 3) renforcer l’action communautaire ; 4) acquerir des aptitudes individuelles ; et 5) reorienter les services de sante. Pres de trois decennies apres la Charte d’Ottawa, qu’en est-il vraiment de la reorientation des services de sante au regard de la promotion de la sante ? Pour repondre a cette question, nous allons discuter le bilan propre a cet axe, tout en analysant les differents elements et facteurs qui ont contribue a un tel bilan, juge mitige par une large partie de la litterature.