title: The e-Health Implementation Toolkit: qualitative evaluation across four European countries.
abstract: BACKGROUND
  Implementation researchers have attempted to overcome the research-practice gap in e-health by developing tools that summarize and synthesize research evidence of factors that impede or facilitate implementation of innovation in healthcare settings. The e-Health Implementation Toolkit (e-HIT) is an example of such a tool that was designed within the context of the United Kingdom National Health Service to promote implementation of e-health services. Its utility in international settings is unknown.
  
  
  METHODS
  We conducted a qualitative evaluation of the e-HIT in use across four countries--Finland, Norway, Scotland, and Sweden. Data were generated using a combination of interview approaches (n = 22) to document e-HIT users' experiences of the tool to guide decision making about the selection of e-health pilot services and to monitor their progress over time.
  
  
  RESULTS
  e-HIT users evaluated the tool positively in terms of its scope to organize and enhance their critical thinking about their implementation work and, importantly, to facilitate discussion between those involved in that work. It was easy to use in either its paper- or web-based format, and its visual elements were positively received. There were some minor criticisms of the e-HIT with some suggestions for content changes and comments about its design as a generic tool (rather than specific to sites and e-health services). However, overall, e-HIT users considered it to be a highly workable tool that they found useful, which they would use again, and which they would recommend to other e-health implementers.
  
  
  CONCLUSIONS
  The use of the e-HIT is feasible and acceptable in a range of international contexts by a range of professionals for a range of different e-health systems.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland. anne.macfarlane@ul.ie
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
authors.forename: Pauline
authors.initials: P
authors.lastname: Clerkin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
authors.forename: David J
authors.initials: DJ
authors.lastname: Heaney
authors.forename: Mary
authors.initials: M
authors.lastname: Wakeling
authors.forename: Ulla-Maija
authors.initials: UM
authors.lastname: Pesola
authors.forename: Eva Lindh
authors.initials: EL
authors.lastname: Waterworth
authors.forename: Frank
authors.initials: F
authors.lastname: Larsen
authors.forename: Minna
authors.initials: M
authors.lastname: Makiniemi
authors.forename: Ilkka
authors.initials: I
authors.lastname: Winblad
mesh_terms: D003657:Decision Making; D003695:Delivery of Health Care; D005060:Europe; D005069:Evaluation Studies as Topic; D005387:Finland; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D008491:Medical Informatics Applications; D009664:Norway; D010865:Pilot Projects; D015397:Program Evaluation; D012606:Scotland; D013548:Sweden
references.citation: Implement Sci. 2009 Jul 14;4:38
references.pmid: 19594942
references.citation: J Epidemiol Community Health. 2004 Oct;58(10):811-6
references.pmid: 15365104
references.citation: Implement Sci. 2009 Nov 26;4:77
references.pmid: 19941655
references.citation: Methods Inf Med. 2003;42(4):297-301
references.pmid: 14534625
references.citation: Implement Sci. 2008 Jan 07;3:1
references.pmid: 18179688
references.citation: Evid Rep Technol Assess (Full Rep). 2006 Apr;(132):1-71
references.pmid: 17627328
references.citation: Methods Inf Med. 2003;42(4):366-70
references.pmid: 14534635
references.citation: Qual Health Res. 2015 Oct;25(10):1317-8
references.pmid: 26355022
references.citation: Implement Sci. 2010 Aug 06;5:62
references.pmid: 20687962
references.citation: Implement Sci. 2010 Nov 28;5:94
references.pmid: 21110898
references.citation: Ann Intern Med. 2006 May 16;144(10):742-52
references.pmid: 16702590
references.citation: Methods Inf Med. 2003;42(4):324-30
references.pmid: 14534629
references.citation: Implement Sci. 2007 Jun 26;2:19
references.pmid: 17594495
references.citation: Telemed J E Health. 2010 Dec;16(10):1053-9
references.pmid: 21087121
references.citation: BMJ. 1995 Jul 29;311(7000):299-302
references.pmid: 7633241
references.citation: Qual Health Res. 1999 Jan;9(1):26-44
references.pmid: 10558357
references.citation: J Am Med Inform Assoc. 2010 Nov-Dec;17(6):707-13
references.pmid: 20962135
references.citation: BMC Health Serv Res. 2011 Sep 30;11:245
references.pmid: 21961827
references.citation: Int J Med Inform. 2001 Dec;64(2-3):143-56
references.pmid: 11734382
references.citation: Lancet. 2003 Oct 11;362(9391):1225-30
references.pmid: 14568747
references.citation: BMC Med Inform Decis Mak. 2010 Oct 18;10:61
references.pmid: 20955594