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The e-health implementation toolkit: qualitative evaluation across four European countries

Anne MacFarlane1*, Pauline Clerkin2, Elizabeth Murray3, David J Heaney4, Mary Wakeling4, Ulla-Maija Pesola5, Eva Lindh Waterworth5, Frank Larsen6, Minna Makiniemi7 and Ilkka Winblad8

Author Affiliations

1 Graduate Entry Medical School, University of Limerick, Limerick, Ireland

2 Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland

3 e-Health Unit, Department of Primary Care & Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK

4 Centre for Rural Health, University of Aberdeen, Inverness, UK

5 Department of Informatics, Umeå University, Umeå, Sweden

6 Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway

7 Oulu University Hospital, Northern Ostrobothnia Hospital District, Oulu, Finland

8 Oulu University, Oulu, Finland

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Implementation Science 2011, 6:122  doi:10.1186/1748-5908-6-122

Published: 19 November 2011



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.


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.


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.


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.