title: Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update).
abstract: There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health.
  
  
  
  MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR).
  
  
  
  Forty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation.
  
  
  
  This systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those planning implementation. New interpretations of a large amount of data across e-health systems and healthcare settings have been generated and synthesised into a set of useable recommendations for practice. This review provides a further empirical test of the CFIR and identifies areas where additional research is necessary.
  
  
  
  PROSPERO, CRD42015017661.
authors: e-Health Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. Jamie.Ross@ucl.ac.uk.
authors: Jamie
authors: 0000-0001-8720-5911
authors: J
authors: Ross
authors: e-Health Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
authors: Fiona
authors: F
authors: Stevenson
authors: e-Health Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
authors: Rosa
authors: R
authors: Lau
authors: e-Health Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
authors: Elizabeth
authors: E
authors: Murray
mesh_terms: D001076:Aptitude; D020811:Biomedical Technology / Q000592:standards; D000066491:Clinical Decision-Making; D003365:Costs and Cost Analysis; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000592:standards; D006285:Health Planning; D006291:Health Policy; D006801:Humans; D012196:Review Literature as Topic; D013597:Systems Analysis; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data*; D057170:Translational Research, Biomedical
keywords: Implementation; Synthesis; Systematic review; Update; e-Health