title: Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review.
abstract: OBJECTIVE
  To systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.
  
  
  RESULTS
  Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (i) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii) effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation processes might be reconfigured by user-produced knowledge.
  
  
  CONCLUSIONS
  The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.
authors.affiliation: Institute of Health and WellBeing, University of Glasgow, Scotland. frances.mair@glasgow.ac.uk
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
authors.forename: Carl
authors.initials: C
authors.lastname: May
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Tracy
authors.initials: T
authors.lastname: Finch
authors.forename: Frank
authors.initials: F
authors.lastname: Sullivan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
mesh_terms: D001292:Attitude to Computers; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000295:instrumentation*; D006302:Health Services Research; D006801:Humans; D015279:Organizational Culture; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care / Q000706:statistics & numerical data; D017216:Telemedicine / Q000295:instrumentation*; D006113:United Kingdom