Table 1 Study characteristics

Study characteristics of qualitative studies (n = 14)

Author/

Country

Methodology and Methods

Sample

Aim

Setting

Technology

Role

Main results

Bee et al. [35], UK

Qualitative design, semi-structured interviews.

Descriptive implementation study

N = 18

18 therapists

To explore cognitive behavioral therapists’ narratives around T- CBT, with a view to identifying current and potential influences on its uptake and implementation in statutory mental health services.

Primary health care

Telemedicine

T-CBT-Champions

The local practice-based champion had the potential to influence other health professionals with enthusiasm and experiential knowledge.

Bennett-Levy et al. [41], Australia

Qualitative design, semi- structured interviews and reports. Program Evaluation study

N = 26

26 health professionals

To provide a qualitative evaluation of the impact of e-MH training plus follow-up consultation sessions with Aboriginal health providers.

Primary health care

Telemedicine

Tech-savvy champions

Tech savvy champions suggested ideas for practicing on the Stay Strong app.

Buckingham et al. [44], England

Qualitative design, guided discussions (individual and group). Program evaluation Study

N = 53

2 carers

7 patients

21 individuals

practitioners

23 practitioners in group

To inform an online toolkit and training package (the Telerehab Toolkit) to assist the current and future health and social care workforce in conducting safe and effective remote physical assessments and consultations.

Mixed settings

Rehabilitation technologies

Digital champion

Digital champions are recommended to lead telerehabilitation and provide support to other staff members.

Chung et al. [45], Australia

Qualitative design, semi-structured interviews. Descriptive implementation study

N = 19

14 Cross-disciplinary clinicians and 5 service managers

The study sought to explore the perspectives of clinicians and service managers working in private mental healthcare regarding VR use, including potential implementation barriers and facilitators.

Hospital

Rehabilitation technologies

Opinion leader

Local opinion leaders are important for promoting, establishing credibility, and maintaining quality during the implementation period.

Fontaine et al. [36], USA

Qualitative design, semi-structured interviews. Descriptive implementation study

N = 31

31 administrative or clinical leaders

To identify the facilitators and barriers encountered by nine diverse primary care practices selected from the first 80 to achieve PCMH certification in Minnesota.

Home based care

Client Health records

Physician champions

Salary coverage for physicians and staff time that was devoted to PCMH development.

Gui et al. [29], USA

Qualitative design, email interviews. Descriptive implementation study

N = 45

45 Physician champions

To understand what strategies Physician champions must tackle challenges in their practices during the implementation and adoption processes of a EHR to be able to cultivate the best practices.

Mixed setting

Client Health records

Physician champion

Physician champions faced challenges, including inadequate training before start-up, insufficient elbow support after start-up, challenges in communication between the builders and suppliers’ company, and system design errors after start-up.

Hogan-Murphy et al. [46], Ireland

Qualitative design, semi-structured interviews. Descriptive implementation study

N = 23

23 Key stakeholders

To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings.

Hospital

Prescription and Medication management

Clinical champions

Clinical champions at ward level promoted engagement. They are involved in planning and discussions, as well as discussing what will be functional in the ward.

Kolltveit et al. [37], Norway

Interpretive description, Qualitative design, focus group interviews. Descriptive implementation study

N = 34

24 registered nurses

5 clinical leaders

1 nurse assistant

2 podiatrists

2 physicians

To identify what health care professionals in distinct staff groups perceived as essential conditions for effective implementation of telemedicine as a new health care technology in diabetes foot care.

Mixed settings

Telemedicine

Telemedicine champion

A telemedicine champion was one of four key conditions for success. Those champions were described by the health personnel in the outpatient clinics as professional, updated, and engaged, and able to use the technology.

Moss et al. [47], USA

Qualitative design, semi-structured interviews. Descriptive implementation study

N = 17

17 participants. Fourteen providers, three site champions

To understand provider perspectives on VTE prophylaxis and facilitators and barriers to using the risk calculator.

Hospitals

Health care provider decision support

Physician champions and

Site champions

Physician champions promoted the use of calculators. Site champions experienced larger facilities and private physicians were a barrier to calculator use.

Olsen et al. [42], USA

Qualitative design, open-ended questions in electronic survey format. Program evaluation study

N=?

To describe barriers and best practices learned when implementing EHR-based NDPP referral programs (National Diabetes Prevention Program) in two rural health care organizations.

Mixed setting

Client health records

Provider champions

Start small with one provider champion, and make sure to not exceed resources, the providers need time to master the new technology and the providers wants to be involved in the discussions and decisions.

Owens and Charles [32], England

Qualitative design, individual interviews and focus group interviews. Descriptive implementation study

N = 23

Focus groups with 14 team members, individual interviews with 7 clinicians and 2 service managers

To test and refine the intervention in situ, before proceeding to a full trial.

Primary health care

Behavior change technology (mHealth)

Committed participants, Product champions and Clinical champions

Early clinical champions may overestimate the clinician’s readiness for the intervention.

Salbach et al. [38], Canada

Qualitative design, individual interviews and focus group interviews.

Descriptive implementation study

N = 40

33 Physical Therapists, 4 Professional Practice Leaders, 3 Professional Leaders. Program evaluation study

To examine how the contextual circumstances of acute care and of inpatient and outpatient rehabilitation practice settings influenced participants’ engagement with the toolkit and implementation strategy to effect practice change.

Hospital

Rehabilitation technology

Facilitators

Every site was asked to identify a facilitator. However, not all places had a facilitator, which resulted in no use of the strategy.

Yang et al. [43], USA

Qualitative design, Individual interviews. Descriptive implementation study

Reflections after 1000 video visits for 4 weeks. N =?

To describe Stanford Neurology Department’s transition

of all subspecialty and general neurology patient consultations to stay at home video visits.

Hospital

Telemedicine

Physician champion

Physician champion (also named as key drivers) conducted 1:1 training session to approximately 50% of providers that was a significant factor for successful deployment. Physician champion gave virtually training to schedulers, including templates and checklists. Physician champion participated in daily huddles and answering emails and were available.

Yusof [48], Malaysia

Qualitative design, semi structured interviews, observation and document analysis. Program Evaluation study

N = 193

193 system users; 134 ICU nurses, 24 anesthetists, 23 perfusionists, 10 OT technicians, and 2 surgeons.

The purposes of the study are to (1) assess CCIS (Critical Care Information System) adoption level and issues in achieving its desired outcomes which subsequently affect healthcare delivery; (2) examine current CCIS implementation status; and (3) identify lessons from influential adoption factors to inform decision making.

Hospital

Client health records

IT nurse, super user, and IT savvy clinicians

Super users received inadequate training and were trained at the same time, as they were required to perform clinical tasks. Management’s support for a champion was lacking. Super users did not find evidence that the system made a significant difference. The super user experienced their own work, and the system created more IT-savvy employees.

Study characteristics of quantitative studies (n = 4)

Author/

Country

Design

Sample

Aim

Setting

Technology

Role

Main results

Bullard [30], USA

Quantitative design, descriptive study, case study. Cost-effective study

150+ recent graduated nurses

To explore the costs of EHR implementation with the nursing super-user role in a metropolitan, not-for-profit health care system.

Hospitals

Client Health records

Super-user

Reduced labor costs were associated with super-user staffing by 31.8%.

Dugstad et al. [49], Norway

Quantitative, cross-sectional descriptive design. Program Evaluation study

N = 98

79 Care providers

19 superusers

To explore healthcare providers’ evaluation of facilitators and barriers during implementation of WNCSs in residential care settings.

Home based care

Assistive technology

WNCS super user

Digital transformation facilitator

The care providers could provide feedback regarding WNCS to their manager or a super user in a confident way (82%). There was a high degree of management engagement, and care providers reported feeling social support from the management and their colleagues (80%).

Rea et al. [50], USA

Quantitative descriptive design, electronic survey. Descriptive Implementation Study

N = 14

14 nurse champions

To investigate if use of a QI cloud-based software technology accessible on mobile devices causes differences in rates, causes differences in compliance with evidence-based CAUTI prevention practices, level of nurse champion satisfaction and identification of benefits and barriers and perceptions of adopting the technology.

Hospital

Health care provider decision support

Nurse champion

The nurse champion was responsible for quality improvement.

Schwarz et al. [39], Australia

Quantitative descriptive design, cross-sectional survey. Descriptive Implementation Study

N = 104

104 AHPs

To provide an overview of AHPs’ perceptions of EMR implementation across three sites (both regional and metropolitan), with a focus on identifying perceptions before, during, and after implementation in relation to subjective perceptions, barriers and facilitators and overall satisfaction.

Hospital

Client health records

Clinician change champion

The presence of a profession-specific clinician “change champion” was the most important factor in facilitating the implementation of electronic medical records among allied health personnel. The champion could provide practical and cultural support if needed. Additionally, 62% of respondents agreed that they received enough support during the implementation, while 8% disagreed.

Study characteristics of mixed methods studies (n = 5)

Author/

Country

Design

Sample

Aim

Setting

Technology

Role

Main results

Bail et al. [51], Australia

Mixed-methods case study, observations, individual interviews, surveys, focus group interviews and hospital admission data analysis. Descriptive Implementation Study

N = 152

20 patient interviews

33 patient surveys

48 clinician interviews

51 clinician surveys

Admission data analysis

To investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting.

Hospital

Client Health records, electronic bedside nursing chart

Super-user

Six of eight trained nurse super-users were moved from the ward during the implementation period of four weeks, which was inconsistent with a trial implementation.

Helmer-Smith et al. [33], Canada

Multi-method approach, cross-sectional study, use data, close-out survey and focus group interviews. Program Evaluation study

N = 16

10 PCPs,

4 administrations,

2 nurse champions.

To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing (ePrescribing), robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings.

Home based care

Telemedicine

Clinician champion

Clinical champions at the ward level promoted engagement. They are involved in planning and discussions, as well as discussing what will be functional in the ward.

Orchard et al. [34], Australia

Mixed Methods study. Cross sectional pilot study. Semi-structured interviews. Program Evaluation study

N = 989

972 patients screening,

17 health personnel interviews

To determine the feasibility of practice nurse screening in Australia during the flu-vaccination period.

Primary health care

Health care provider decision support

Practice manager

A practice champion was important for the success of the implementation since he/she led and enhanced it. The practice champion suggested that it is necessary to finance the setup and filing, as well as the expenses for the time spent by nurses during the screening process.

Stewart et al. [40], UK

Mixed-methods evaluation, online questionnaire, semi structured interviews and focus group interviews. Program Evaluation study

N = 63

63 General practice staff

To evaluate the rapid and reactive implementation of RAC in general practice in response to the COVID-19 pandemic, through the lens of eNPT, to identify factors that promoted or inhibited implementation, and identify the ‘work’ that is required for ‘normalization’ into routine clinical care.

Primary health care

Telemedicine

Practice champion

Identify a practice champion to lead the implementation, since no one usually takes the responsibility. A practice champion is often a GP who plays a strategic role in providing adaptive care. A practice champion was important for engaging other personnel.

Yuan et al. [31], USA

Mixed method design, comparative case study, observation, in-depth interviews and pre-/follow up surveys. Descriptive implementation study

N = 67

24 In-depth interviews superuser/non-superuser

43 pre-/follow up surveys

To provide insight that may help health care organizations better select, prepare, and support super users so that they can realize their potential for positive influence on the implementation of EHRs, and health information technology broadly.

Hospital

Client health records

Superuser

Volunteered superusers were proactive, explained through practical use and the logic behind it, used positive frameworks when discussing implementation procedure, and shared information about EHR. Department heads identified superusers who were tech-savvy; Designated superusers supported their employees on demand; they practically showed how the technology worked but did not explain the logic behind it. Designated superusers spoke neutrally about EHR and provided limited information.