Table 1 Summary of articles included in the review of HIT champions (n = 42)
Reference | Intervention | Setting | Evaluative method | Objectives | Summary findings |
|---|---|---|---|---|---|
Al-Qirim [32] | Telehealth | One Dermatology Department in New Zealand. | Case study | Explain factors influencing the adoption and diffusion of telemedicine for dermatology. | Study emphasized the importance of having a product champion for the adoption of a telemedicine initiative in New Zealand. |
Al-Qirim [33] | Telehealth | One Psychiatry Department, and one Dermatology Department in New Zealand. | Case study | Explain factors influencing the adoption and diffusion of telemedicine for psychiatry and dermatology. | Study emphasized the importance of having a product champion for the adoption of a telemedicine initiative in New Zealand. |
Andre, Ringdal, Loge, Rannestad, Kaasa [63] | Handheld symptom assessment | Oncology Department in University Hospital (Norway) | Case study | Examine responses and attitudes of users, and factors promoting implementation. | Lack of knowledge about the formal project aims, training and communication with organizational leaders were barriers to implementation. |
Ash, Stavri, Dykstra, Fournier [31] | Computerized physician order entry (CPOE) | One Teaching hospital in Virginia (USA), Veteran’s health care system in Washington (USA), one non-profit hospital in California (USA) | Multiple case study | Identify factors associated with the implementation of CPOE in inpatient and outpatient settings. | Three types of “special people” have been identified as key personnel in the implementation of CPOE. |
Ash, Gorman, Lavelle, Payne, Massaro, Frnatz, Lyman [34] | Computerized physician order entry (CPOE) | University of Virginia (USA), Veterans Affairs Puget Sound Health Care System (USA), El Camino Hospital (USA) | Observation, interviews, and focus groups | Describe perceptions of CPOE among diverse professionals in sites with successful CPOE implementation | Four themes: organizational issues (e.g., collaboration); clinical/professional issues; technical/IT implementation issues; organization of information |
Ash, Sittig, Wright [57] | Clinical decision support (CDS) | Independent physician organization in Oregon (USA). | Case study | Identify barriers and facilitators of CDS implementation in a community setting. | Joint selection and purchase, and implementation of EHRs with CDS; centrally managed EHR, and improved data are necessary. |
Ash, Sittig, Guappone, Dykstra, Richardson, Wright, Carpenter, McMullen, Shapiro, Bunce, Middleton [47] | Clinical decision support (CDS) | Two community hospitals and five ambulatory clinics in the US. | Multiple case study | Identify factors associated with implementation of CDS. | Workflow integration, well designed user interfaces, knowledge management, and intentional interaction among stakeholders are key factors in CDS implementation. |
Carlfjord, Lindberg, Andersson [35] | Computer-based lifestyle intervention. | Six primary health care (PHC) centres in Sweden. | Multiple case study | Explore organizational members’ perceptions and usefulness of a computer-based lifestyle intervention. | Extra resources, such as manpower, and committed leadership are key factors in implementation. |
Chedid, Golden, Jager [56] | University of Chicago Medicine’s Diabetic Retinopathy Screening Program | Chicago Family Health Center (Federally qualified health center). | Case study | Identify operational challenges in the implementation of a diabetic retinopathy screening program. | Strong physician leadership is a key element for the implementation of an HIT screening intervention. |
Cresswell, Sadler, Rodgers, Avery, Cantrill, Murray, Sheikh [24] | Pharmacist-led information technology intervention. | 34 primary care organizations in central England (UK). | Case Study | Understand the organizational and social environment of a pharmacist-led information technology intervention. | Face-to-face contact with practice staff, and a designated champion were keys to implementation of pharmacy HIT. |
Crosson, Etz, Wu, Straus, Eisenman, Bell [42] | Electronic prescribing | Five primary care practices in the US. | Multiple Case Study | Identify the factors associated with implementation of electronic prescribing. | Implementation of electronic prescribing requires workflow redesign, and improved health information exchange. |
Culler, Jose, Kohler, Edwards, Dee, Sainfort, Rask [45] | Inpatient pharmacy system. | Two pediatric hospitals – Egleston Children’s Health Care and Scottish Rite Children’s Medical Center (UK). | Case study | Describe the facilitators and barriers to the implementation of an inpatient pharmacy system. | Training super-users, extensive pre-implementation training, formal feedback mechanisms, and technical support following deployment are facilitators of HIT. |
Feldman, Schooley, Bhavsar [49] | Health Information Exchange (HIE) | Health system in Virginia | Case study | Investigate technical, organizational, and governance of HIE implementation | Project champions play a key decision- making role in governance |
Feldstein, Schneider, Unitan, Perin, Smith, Nichols, Lee [58] | Decision support system – Patient Panel Support Tools (PST) | Non-profit group model HMO, Kaiser Permanente Northwest, in Washington and Oregon (US). | Case study | Examine health care workers attitudes toward the adoption and use of a Patient Panel Support tool. | Implementation required roles for non-PCP staff, leadership, training, and dedicated time for using the HIT. |
Gagnon, Desmartis, Labrecque, Legare, Lamothe, Fortin, Rancourt, Duplantie [36] | Electronic Medical Record (EMR) | Family medicine group (FMG) in Quebec, Canada. | Case study | Explore factors that influence the implementation of an EMR. | Organizational factors such as presence of a champion, innovative culture, personal characteristics, and a scientifically based implementation strategy are important. |
Garfield and Watson [50] | Telehealth | State telemedicine initiatives in Georgia, Pennsylvania, Ohio, and Wisconsin. | Multiple case study | Examine factors contributing to the success of telemedicine initiatives. | ‘Technical’ and ‘user champions’ may be necessary to implement telemedicine interventions. |
Gordon, Camhi, Hesse, Odlum, Schnall, Rodriguez, Valdez, Bakken [25] | Continuity of Care Document (CCD)/Personal Health Record (PHR). | NYPS SelectHealth HIV/AIDS care sites in New York City (USA). | Case study | Examine the processes and outcomes of a Continuity of Care Document/PHR for people living with HIV/AIDS. | Training and organizational commitment are important factors in implementation of a PHR. |
Greiver, Barnsley, Glazier, Moineddin, Harvey [37] | Electronic Medical Records | 18 community-based family physician practices in Toronto, Canada. | Case study | Examine factors influencing the implementation of electronic medical records. | EMR implementation was also influenced by lack of leadership, relative advantage, high complexity, low compatibility, and available organizational slack. |
Halbesleben, Wakefield, Ward, Brokel, Crandall [51] | Clinical Information System (CIS). Includes an electronic health record (EHR) with computerized physician order entry (CPOE). | Large, Midwestern rural referral hospital. | Case study | Explore the impact of Super Users on the implementation of a CIS. | Super-users, and leadership support for super users are important factors in implementation of (CIS). |
Hao, Padman, Telang [26] | Mobile Clinical Access Portal (MCAP) with secured wireless PDA-based solution providing access to electronic medical record system (EMR). | Community-based healthcare system in southwestern Pennsylvania. | Multivariate regression analysis | Examine empirical evidence for the contextual factors associated with physician adoption of a PDA-based electronic medical record system. | Opinion leaders have significant effects on physician adoption of PDA-based EHR systems. |
Hartswood, Procter, Rouchy, Rouncefiled, Slack, Voss [29] | Improved electronic tools for management of patient records and patient care. | Toxicology ward of a large hospital. | Case study | Explore the process of participant design of health information technology. | HIT professionals must design and develop systems with users. |
Hendy and Barlow [43] | Telehealth | Three health and social care organizations with experience in telehealth in England (UK). | Multiple case study | Examine the role of champions in telehealth initiatives. | Questions the positive and necessary role that champions play in HIT implementation. |
Hsiao, Li, Chen, Ko [23] | Mobile nursing information system | Eighty-four Nursing Directors at Hospitals in Taiwan | Multivariate regression analysis | Examine the factors associated with adoption of MNIS | Organizations should scan environment, identify mobile nursing needs, and develop vendor relationships in order to adopt. |
Leidner, Preston, Chen [28] | Hospital health information technology. | Matched pairs of CIOs and executives. | Multivariate regression analysis | Examine the hospital characteristics associated with IT innovation. | There are different types of CIO-Board dynamics that affect the role of CIO as a champion and his/her champion behaviors. |
McAlearney, Schweikhart, Medow [48] | Handheld computers in clinical practice. | 161 informants at seven clinical practice sites. | Multiple case study | Describe strategies that promote use of handheld computers. | Organizations will use different strategies that promote handheld computer use and remain responsive to physician needs. |
Miller and Sim [46] | Electronic medical record (EMR). | EMR managers in physician champions in 30 physician organizations. | Multiple case study | Identify key barriers to physician’s use of EMRs. | Practices without physician champions are likely to struggle to achieve quality or financial benefits. |
Novak, Anders, Gadd, Lorenzi [52] | Barcode medication administration (BCMA) | Multi-hospital, tertiary medical center in the US. | Case study | Examine mediators efforts to implement BCMA | Clinicians can improve the safety and effectiveness of BCMA implementation with institutional support. |
Paré, Elam, Ward [38] | Patient charting system (PCS). | Burn center of a large, not-for-profit teaching hospital. | Case study | Examine the implementation of a patient charting system. | Patient charting system implementation requires key actors anticipating and proactive with challenges; key actors are associated with quality of implementation; PCS implementation is indeterminate process, and outcomes are associated with management of the process and actions after introduction of system. |
Paré, Sicotte, Jaana, Girouard [41] | Clinical information system (CIS). | Participants with backgrounds in CIS project management. | Delphi study | Identifying the risks associated with the implementation of CIS. | Risk management is a key strategy throughout the implementation of CIS. |
Paré, Sicotte, Poba-Nzaou, Balouzakis [61] | Mobile computing technology; Clinical information system (CIS). | Future users of mobile computing technology in home care organizations; and a large teaching hospital implementation of CIS. | Multivariate regression analysis | Examine clinicians’ early perceptions of organizational readiness for change with clinical information system projects. | Organizational readiness for change is a key factor in clinician’s initial support for implementation of CIS. |
Piscotty, Tzeng [59] | Clinical information system (CIS) | Regional multi-hospital system. | Multiple case study | Explore CIS readiness activities adopted by chief nurse executives. | Chief nurse executives suggested that champions are necessary at multiple organizational levels to obtain buy in and gather support for implementation. |
Poe, Abbott, Pronovost [55] | Electronic health records (EHR) | Clinical units at an academic medical center (n = 9). | Structured program evaluation | Evaluate the effectiveness of peer coaches impact on increasing learner satisfaction and confidence in EHR use. | Peer coaches had a positive effect on satisfaction and confidence. |
Postema, Peeters, Friele [44] | Telehealth | Care organizations in the Netherlands (n = 3). | Multiple case study | Examine the key factors that improve implementation of video communication. | Technical stability and the alignment of the external environment with organizational goals and implementation strategy are key factors. |
Shachak, Montgomery Dow, Barnsley, Tu, Jadad, Lemieux-Charles [74] | Electronic medical records (EMR) | Four family health teams, one family health organization (Canada). | Multiple case study | Investigate user expectations and needs for end-user support for EMR. | Highlights importance of on-site support and super-users in liaison roles, local development of support practices, and gaps in understanding of other organizational members’ work processes. |
Sharkey, Hudak, Horn, Barrett, Spector, Limcangco [60] | Clinical decision support tools for pressure ulcer prevention. | Nursing homes in Washington, D.C. (USA) (n = 14). | Multivariate regression analysis | Examine nursing home factors associated with implementation of clinical decision support tools for pressure ulcer prevention. | High involvement of nurse managers, in-house dietitian, high participation from staff educator and QI personnel, internal champions, and openness to redesign were associated with implementation. |
Shaw, Howard, West, Crabtree, Nease, Tutt, Nutting [39] | EPIC quality improvement intervention. | Primary care practices in Colorado (USA) (n = 14) | Multiple case study | What are the roles of champions in the implementation of organizational innovations. | Two types of champions are key – specific project champions, and organizational change champions. |
Sloane, Wroth, Halladay, Bray, Spragens, Stearns, Zimmerman [40] | Quality monitoring and reporting initiative. | Primary care practices in North Carolina (USA) | Multiple case study | Examine the factors that impact initiation and maintenance of a quality monitoring and reporting process. | Complex sets of factors are required to implement and sustain quality-reporting interventions. |
Verhoeven, Steehouder, Hendrix, van Gemert-Pijnen [27] | Website with infection control guidelines. | Health care workers at 5 occupational groups in 4 hospitals in the Netherlands and Germany (n = 20). | Multiple case study | Identify factors impacting health care workers use of a website for communicating infection control guidelines. | Organizational factors play the key role in implementation, and inclusion of the health care workers is essential in the design process. |
Wright, Ash, Erickson, Wasserman, Bunce, Stanescu, St Hilaire, Panzenhagen, Gebhardt, McMullen, Sittig [53] | Clinical decision support (CDS) | Two community hospitals; an academic medical center and outpatient clinic; Veterans Administration hospital outpatient clinics; community outpatient independent physician association; and academic outpatient clinic. | Multiple case study | Examine activities in the implementation of CDS. | Implementation of CDS requires a variety of skills and activities. |
Yuan, Bradley, Nembhard [30] | Electronic health records (EHR) | Two medical units of a large academic hospital | Mixed methods case study | Investigate behaviors of EHR super-users. | Super-users may support or hinder implementation. |
Yusof [64] | Critical care information system | Intensive care unit of tertiary referral center (Malayasia) | Case study | Examine factors associated with adoption of a critical care information system | Champions may be important, but other organizational factors may promote or hinder implementation. |
Zandieh, Yoon-Flannery, Kuperman, Langsam, Hyman, Kaushal [62] | Electronic health records (EHR) | Practice managers (n = 11) and medical directors (n = 12) from ambulatory care network of large teaching hospital in New York City (USA). | Case study | Examine the different approaches to EHR implementation between organizations from paper-based vs. legacy EHRs. | Physician information technology champions was a priority for organizations with paper-based records implementing EHRs, but not a priority for those moving from a legacy EHR to a more sophisticated EHR. |