Key factors for national spread and scale-up of an eConsult innovation

Abstract

Background: Expanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada. Methods: We conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research. Results: This study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes. Conclusions: Efforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond.

Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework

“…Findings also raised a number of challenges including the following: technically challenged staff, resistance to change, cost, reimbursement, and patient characteristics [ 24 ], as well as project management, patient recruitment, leadership involvement, funding, absence of a long-term strategic plan, resistance to change, workflow changes, lack of resources, and liability [ 64 - 66 ]. These challenges are consistent with previous research concerning small-scale implementation and diffusion of video consulting services and the scale-up and spread of other eHealth interventions [ 67 , 68 ]. They also indicate that the same things that interfere with implementation at one site [eg, 48] are also seen as interfering with spread and scale-up [ 5 , 7 , 17 , 24 ], although this may be an artifact of how spread is commonly studied as the sum of multiple implementations.…”

Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia

“…This study supports international findings [ 23 , 46 ] that a commitment to continuous service evaluation is central to strengthening implementation of an ongoing eConsultant service. eConsultant is implementable in the Australian general practice context and offers a streamlined evidence-based option for patients and GPs to access timely specialist input.…”

Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery

“…In a recent article, researchers involved in studying the Champlain BASE e-consult service in Canada summarized best practices in spreading and scaling up e-consult use in Canada, based on a policy forum discussion between key stakeholders. 18 Their recommendations included bringing together stakeholders from different disciplines and organizations, building on existing policies and programs, and developing measures for evaluating impact of the spread/scale-up. Our work is complementary and synergistic with that of the Champlain BASE researchers because, despite the shared focus, our methods yielded a distinct set of concerns and recommendations.…”

“…A particularly successful example is the Champlain BASE program that began as a regional pilot and has gradually expanded across Ontario and to other Canadian provinces. 18,19 There are also private, subscription-based platforms that provide primary care practices and health systems with access to specialist e-consults, such as RubiconMD, 20 AristaMD, 21 Con-ferMed, 22 and others. Research on e-consults contains numerous insights about barriers and facilitators to successful implementation of a new e-consult program.…”

“…Research on e-consults contains numerous insights about barriers and facilitators to successful implementation of a new e-consult program. [23][24][25] However, little guidance exists on which factors health systems might want to consider prior to scaling up their existing e-consult system 18 or, indeed, implementing a huband-spoke e-consult model anew. This study is guided by the following research question: What are the barriers and facilitators to…”