SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability. We consider how evidence-based implementation strategies can be built to support eHealth implementation. What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context. Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.

基层医疗中电子健康（eHealth）应用的落地实施仍面临诸多挑战。加深对实施决定因素的认知与理解，对于制定循证实施策略、优化电子健康应用的采纳率与可持续性至关重要。本研究探讨如何构建循证实施策略以支撑基层医疗中的电子健康落地。需考量的实施策略，取决于特定场景下电子健康实施面临的（潜在）障碍与促进因素。因此，本文首先结合综合实施研究框架（Consolidated Framework for Implementation Research, CFIR）的五大领域，梳理关键的实施障碍与促进因素：成本被认定为电子健康实施的核心障碍；隐私与安全问题、电子健康应用缺乏公认标准，同样会阻碍实施进程。关键利益相关者参与实施过程、规划干预措施的落地、提供培训与支持，则是重要的促进因素。为赋能医护人员与研究人员，本文提出一套面向基层医疗电子健康应用的循证实施策略开发与应用分步方法，具体包含以下步骤：（1）明确电子健康应用；（2）界定待解决问题；（3）明确期望达成的实施行为；（4）选择实施策略；（5）对实施策略进行评估。为提升实施策略与应用场景的适配性，该分步方法同时考量实施进程所处阶段与特定情境。采用本文提出的此类方法，或可助力改善基层医疗中电子健康应用的落地效果。