JMIR Publications

ABSTRACT

Background:

Non-communicable disease (NCD) management is critical to reducing the attributable health burdens. Although Health Information Technology (HIT) is a crucial strategy to improve chronic disease management, many healthcare systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management.

Objective:

We aim to identify the barriers and facilitators, analyze how these factors influence the HIT implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence.

Methods:

: We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, EMBASE, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies published in peer-reviewed journals involving HIT-related interventions for NCD management were included. Studies that do not discuss the relevant outcome measures or do not have direct contact or observation of stakeholders were excluded. The analysis of selected studies is conducted in two parts. In part 1, we analyze how the intrinsic attributes of HIT intervention affect the successfulness of implementation by utilizing the first domain of Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on CFIR and Ferlie and Shortell’s Level of Change framework.

Results:

We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease population and HIT interventions. In part 1, having a relative advantage to existing health care systems was the most prominent intrinsic facilitator (e.g., convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework. The key barriers of the extrinsic factors of HIT included health literacy and lack of digital skills. Key facilitators of the extrinsic factors of HIT included physicians' suggestions, cooperation, integration into workflow, and adequate management of data. The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness to implementation was highlighted.

Conclusions:

Internal factors of HIT and external human factors of implementation both interplay in the implementation of HIT for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care, tackling usability issues, and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, various disease populations, long-term implementations, and various countries with appropriate research methods.