title: An integrated strategy of knowledge application for optimal e-health implementation: a multi-method study protocol.
abstract: BACKGROUND
  E-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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  This 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.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada. marie-pierre.gagnon@fsi.ulaval.ca
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Fortin
authors.forename: Lise
authors.initials: L
authors.lastname: Lamothe
authors.forename: Michel
authors.initials: M
authors.lastname: Labrecque
authors.forename: Julie
authors.initials: J
authors.lastname: Duplantie
mesh_terms: D003661:Decision Support Techniques; D006801:Humans; D020407:Internet; D019359:Knowledge; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016134:Organizational Policy; D010934:Planning Techniques; D011792:Quebec; D017216:Telemedicine / Q000706:statistics & numerical data*