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Health information exchange (HIE) is implemented in Quebec, Canada to improve the exchange and use of clinical information for decision making in the province's health care system. The objective of this mixed-method approach study was to evaluate the usage, usability, and usefulness of an electronic health record (EHR) to access and import clinical information from a centralized HIE. First, a heuristic analysis was performed of three different commercial EHRs, using end users to analyze the integration feature through think aloud protocols. Second, interviews were conducted with advanced users to describe the usefulness. Third, usage data were analyzed to describe the level of use of each data domain, per EHR and user. The results show that usefulness is high for medication data; leading to greater use of this domain, its relation to integration, and meets the needs of general practitioners. Difficulties in the implementation processes reduced the potential of this system.

Health information exchange (HIE) is seen as an essential technology for improving health care quality and efficiency by allowing exchange of patient-centered data over time and across organizations. The objective of this study was to evaluate the usage and the perceived usefulness of a nationwide HIE in a centralized model that was implemented in 2013 in the province of Quebec, Canada. A mixed-method study was conducted with a longitudinal descriptive analysis of usage data combined with in-depth comparative case study in four selected primary care organizations and two emergency departments. Perceived benefits were reported by users across all dimensions of care performance, including accessibility, efficiency, quality and safety, and patient experience; however, the experience of users was very heterogeneous and strongly associated with the commercial electronic record system available in their work place and the implementation strategy.

Electronic prescribing, defined as the electronic generation and transmission of a medication order for community-dwelling patients, is presented as an essential technology to improve medication use. The objective of this study was to evaluate a nationwide e-prescribing system in Quebec, Canada. A mixed-method study was conducted from July 2017 until June 2018. A descriptive analysis of e-prescription usage was performed using aggregated usage data, combined with an exploratory descriptive analysis of the e-prescribing system from the perspective of users of two electronic health records (EHR) and pharmacy management systems (PMS) (n=9 prescribers; 8 pharmacy technicians and 11 pharmacists). Overall, the adoption of the system was low, with only 2% of prescriptions being electronically transmitted and retrieved during the study period. Alignment problems were identified on the prescriber's and receiver's side, generating safety issues, and hindering the potential for benefits realization.

Objective The aim of this study was to assess the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). Method A prospective mixed study was conducted. Two sources of data were mobilised: a survey with structured questionnaires and direct non-intrusive observation. The study site was the PICU of a university hospital. Users’ perceptions of six aspects of the STEP-PICU were studied: telemedicine system quality, data quality, quality of technical support, use of the new system, overall satisfaction and system benefits. Results During the 6-month experimentation period, use of the telemedicine platform was rather limited and fell short of the promoter’s expectations.The mean scores for the six user perception dimensions were low, with no differences between the two groups of users. A Mann-Whitney test showed that being an off-site pediatric intensivist or on-site fellow did not make a statistically significant difference in responses on system quality (p = .518), data quality (p = 1.00), quality of technical support (p = 1.00), system use (p = .556), overall satisfaction (p = .482), or benefits (p = .365). The low use of the STEP-PICU was attributed to three root causes: human factors, the platform’s functionalities, and technical problems. Discussion The synchronous telemedicine service for PICU was feasible but would need good pre-implementation preparation to be truly helpful. Its usefulness during the night shift and holiday on-call periods was scored as low by the off-site pediatric intensivists and the on-site fellows. It would appear that such a service could be more beneficial for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist.

Au niveau international, l’informatisation de la production des soins hospitaliers ne se développe que lentement. Un terme souvent utilisé dans la littérature pour expliquer ce phénomène est celui des "facteurs organisationnels", mais sans, la plupart du temps, que ce terme soit précisé. L’article, à partir d’une recherche observationnelle multi-sites, analyse sur le cas français les évolutions organisationnelles des unités cliniques consécutives à l’implantation d’un Dossier Patient Informatisé (DPI). Il montre que le système en place n’a subi que peu de transformations, au prix d’accommodements avec l’outil informatique. Une telle situation peut paraitre satisfaisante aux yeux des tutelles qui promeuvent l’innovation technologique, mais pose la question de la création de valeur organisationnelle, c’est-à-dire la possibilité pour les professionnels de soins de se saisir de l’outil dans une optique de transformation et d’amélioration à terme des différentes composantes de la performance., At the international level, the computerization of hospital care production develops only slowly. Past research has often used the term "organizational factors" to explain this phenomenon, but without specification so far. This article builds on results from an empirical research led in multiple French hospitals to investigate the organizational evolutions of clinical units due to the implementation of an Electronic Patient Record. It shows that the extant organizational system underwent only few transformations, thanks to local adjustments with the IT tool. Such a situation may be satisfactory for the eyes of the supervising structures which promote the technological innovation, but raises the issue of true organizational value creation.

International audience; Objective: This research looks back at a 10-year period (2004–2014) to understand the development and outlook for healthcare organization performance measurement in the Quebec healthcare system, in an attempt to objectivize relationships within the configuration of its principal institutional actors.Methods: This is a qualitative study combining the use of official publications and fieldwork based on 13 semi-directed interviews, conducted in 2014, with informers in key performance measurement positions within the Quebec healthcare system.Results: Performance measurement has generated tensions, both internally between different branches of the Department of Health and externally against a strong coalition of external institutional actors, which were defending a shared homogeneous vision of performance. Four major types of political power plays, owing to the power struggles around performance models and indicators, converged around the same implicit issue of the need to attain greater legitimacy in order to impose an authoritative frame of reference.

An EMR should support the informational needs of nursing practice. However, a multidimensional measure of the actual use of an EMR in hospitals ranked at different adoption stages revealed significant results that should be addressed to enable nurses to bring their full contribution to their patients and to the healthcare team.

International audience; The purpose was to study users' attitudes towards an electronic medical record (EMR) closely integrated into the clinicians' cancer care workflow. The EMR, implemented in an ambulatory cancer care centre, was designed as a care pathway information system providing real-time support to the coordination of shared care processes involving all the care personnel. Mixed method pre-post study design was used. The study population consisted of all care personnel. A survey measured the quality attributes of the EMR, the clinical information it produces, the perceived usefulness of the system for supporting clinical data management tasks and the perceived impacts in terms of access and quality of care. The survey shows that users' attitudes towards the EMR (response rate of 71%) measured after the go-live were positive ranging from 3.42 to 3.95 on a 5-point scale. Besides, the content analysis of 33 pre-post interviews revealed five main themes: magnitude of the changes caused by the EMR; its innovative potential; its positive benefits; an ongoing growth in users' expectancies; and the burden associated with the time required to operate the EMR. In sum, the study shows that users can largely apply innovative uses of information technologies that automate their clinical processes.

Objective (1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE. Methods A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process. Results There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list. Conclusions Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.

International audience; BACKGROUNDThe development of performance indicators that enable benchmarking between organizations is an important mechanism for accountability, organizational learning, and performance improvement. In the province of Quebec (Canada), 21 rehabilitation organizations developed a common set of performance indicators through interorganizational collaboration.PURPOSEThe aims of this study were to describe the rehabilitation organizations' use of a common set of performance indicators and to identify the factors influencing such use.APPROACHA qualitative survey was performed. Individual semistructured interviews were conducted with executives (n = 18) working at 16 rehabilitation organizations using a common set of performance indicators. A thematic analysis of the factors of use was performed according to the Consolidated Framework for Implementation Research. The use of performance indicators was categorized as purposeful, political, or passive.FINDINGSOur results showed that all organizations used the common set of performance indicators. Four factors were identified as important to all the rehabilitation organizations to explain their interest in comparative performance indicators: the need to develop their own performance indicators, the compatibility of performance information with organizational needs, complexity/simplicity of performance information, and the support offered by their common association. Sixty-three percent of rehabilitation organizations made purposeful or political use of performance indicators. Three main factors contributed to typify those organizations from the others: the perceived quality of the performance indicators, the leadership of decision makers, and the resources available.PRACTICE IMPLICATIONSOur results showed that use of performance indicators can support the initiation of projects for improving the quality of care. Key recommendations are proposed to decision makers that may enhance performance indicators' use.

International audience; Organizations that provide health services are increasingly in need of systems and approaches that will enable them to be more responsive to the needs and wishes of their clients. Two recent trends, namely, patient-centered care (PCC) and personalized medicine, are first steps in the customization of care. PCC shifts the focus away from the disease to the patient. Personalized medicine, which relies heavily on genetics, promises significant improvements in the quality of healthcare through the development of tailored and targeted drugs. We need to understand how these two trends can be related to customization in healthcare delivery and, because customization often entails extra costs, to define new business models. This article analyze how customization of the care process can be developed and managed in healthcare. Drawing on relevant literature from various services sectors, we have developed a framework for the implementation of customization by the hospital managers and caregivers involved in care pathways.

Background Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice. Method Seven ethnographic case studies in French HCOs combining in situ observations and 37 semi-structured interviews. Results A significant proportion of potential QAF users, such as anesthetists or other health professionals were often unaware of quality data. They were, however, involved in improvement actions to meet the QAF criteria. In fact, three intertwined factors influenced QAF appropriation by anesthesia teams and impacted practice. The first factor was the action of clinical managers (chief anesthetists and head of department) who helped translate public policy into local practice largely by providing legitimacy by highlighting the scientific evidence underlying QAF, achieving consensus among team members, and pointing out the value of QAF as a means of work recognition. The two other factors related to the socio-material context, namely the coherence of information systems and the quality of interpersonal ties within the department. Conclusions Public policy tends to focus on the metrological validity of QIs and on ranking methods and overlooks QI implementation. However, effective QI implementation depends on local managerial activity that is often invisible, in interaction with socio-material factors. When developing national quality improvement programs, health authorities might do well to specifically target these clinical managers who act as invaluable mediators. Their key role should be acknowledged and they ought to be provided with adequate resources.

SCOPUS: ed.j, info:eu-repo/semantics/published

International audience; OBJECTIVE:To describe second-generation electronic prescription (eRx) technologies and identify their impacts on the medication management process in primary care. Second-generation eRx technologies have focused on networking various stakeholders so that they can communicate electronically.METHOD:Using key words, a search was conducted of the relevant databases up to January 2011. A manual search was conducted of the bibliographies of the studies as well as the prior systematic reviews found. The tables of contents of the major periodicals in the field were also searched. This included studies of the impacts of eRx technologies that allow electronic circulation of information between prescription sites and dispensing sites, independent of the methodology used. A structured form was used to extract the data. The studies' impacts were classified by stage in the medication management process (prescription, transmission of the prescription, execution of the prescription and use of the medication).RESULTS:Nineteen observational studies were included in this review. Most of them (10/19) have evaluated users' perceptions using interviews, focus groups or questionnaires. Two technology models stand out: the push model, under which the prescriber directs the prescription toward a specific pharmacy, and the pull model, under which any authorized pharmacy can download a given prescription into its system. The push model is the most widely used, particularly in the United States. Communication between prescribers and dispensers is usually unidirectional, and communications standards have to be refined. The only demonstrated impacts of second-generation eRx technologies were found at two levels: positive impacts on the quality of the pharmacological profile available to professionals, and negative impacts on the execution of prescriptions in pharmacies. Stakeholders' perceptions were mixed and reflected considerable differences according to context, the type of technology used, the intensity of its use and its maturity. Electronic transmission of prescriptions provides a new way to monitor patient compliance.CONCLUSION:There is little empirical data demonstrating benefits to second-generation eRx technologies, even if it is a highly promoted model for improving primary care quality. More research is required, with studies that measure the impacts of second-generation technologies using empirical data and conducted in the context of actual use. Future studies should also employ the same terminology and provide full descriptions of context, type of technology and intensity of use

International audience; BackgroundWe investigated the effects associated with a telehomecare program for patients with chronic obstructive pulmonary disease as part of a retrospective and prospective comparative randomized trial. This project was carried out in a regional homecare service for patients with severe chronic lung disease, located in Montreal, Canada.MethodsFor a period of 21.5 months, we followed a group of 60 patients receiving remote care and a comparable group of 60 patients receiving regular homecare services. We measured the intervention's effects on consumption of health services (emergency room visits, hospital admissions, and home visits by nurses and respiratory therapists) and the economic viability of the telehomecare program.ResultsThe results indicate that the intervention significantly reduced the number of hospitalization days and, to a smaller extent, the number of emergency room visits. Our economic analysis yielded positive results; the telehomecare program saved $1613 per patient per year compared to traditional homecare, representing a net gain of 14%.ConclusionDespite the positive results found in this study, future research is needed to confirm the cost effectiveness of home telemonitoring for COPD patients. These assessments ought to consider key economic parameters as well as the effects of home telemonitoring on the perceived quality of life and other relevant clinical indicators.; ContexteCette étude présente une analyse des effets associés à un programme de télésoins à domicile desservant une clientèle souffrant de maladie pulmonaire obstructive chronique. Celle-ci fut menée au service régional de soins à domicile (SRSAD) de l’hôpital Maisonneuve-Rosemont qui prodigue des soins à une clientèle atteinte de la maladie pulmonaire obstructive chronique (MPOC).MéthodologieUn essai comparatif randomisé de type rétrospectif et prospectif fut réalisé sur une période de 21,5 mois avec un groupe de 60 patients recevant des soins à distance et un groupe similaire de 60 patients recevant les soins à domicile réguliers.RésultatsLes analyses statistiques indiquent que le programme de télésoins mis en place au SRSAD a permis une diminution importante du nombre de séjours à l’hôpital et, dans une moindre mesure, du nombre de visites à l’urgence. Sur le plan économique, le programme de télésoins a généré une économie annuelle de $ 1613 par patient en comparaison des soins à domicile traditionnels, ce qui représente un gain net de 14 %.ConclusionMalgré ces résultats encourageants, des études futures devront être réalisées afin de confirmer la viabilité économique des télésoins à domicile en contexte de MPOC. Celles-ci devront prendre en compte non seulement les paramètres économiques considérés dans la présente étude mais également divers indicateurs cliniques dont la qualité de vie perçue et le nombre de décompensations évitées.

Les indicateurs de qualite se multiplient a l’hopital. Ils ont pour objectif affiche par les pouvoirs publics d’ameliorer les pratiques medicales et maitriser les risques. Or, la recherche en gestion montre que l’usage reel des indicateurs differe souvent de la doctrine et que leur deploiement n’implique pas necessairement appropriation.Dans cette perspective, l’article analyse l’usage d’un indicateur de tenue du dossier anesthesique (DAN). Il s’appuye sur une etude qualitative menee dans quatre hopitaux ainsi qu’a la Haute Autorite de Sante (HAS) et la Societe Francaise d’Anesthesie-Reanimation (SFAR).Les resultats revelent que le perimetre d’appropriation de l’indicateur dans les etablissements est limite mais qu’il a a des repercussions sur l’ensemble des equipes, notamment par la modification de la structure du dossier anesthesique. On note aussi des pratiques emergentes comme l’utilisation de l’indicateur dans la negociation de moyens par les service, et au niveau de la SFAR dans le reinvestissement pour la recherche.. Cette etude contribue a une meilleure comprehension de la facon dont les professionnels de sante s’emparent des outils de pilotage de la qualite, en creant parfois des usages non prescrits par les concepteurs. Elle apporte egalement un eclairage sur le role des societes savantes dans le deploiement des politiques publiques.

Objectives: There have been very few assessments of the economics of home telemonitoring, and the quality of evidence has often been weakened by methodological flaws. This has made it difficult to compare telehomecare with traditional home care for the chronic diseases studied. This economic analysis is an attempt to address this gap in the literature.Methods: We have analyzed the consumption of healthcare services by 95 patients with various chronic diseases over a 21-month period, that is, 12 months before, 4 months during home telemonitoring use, and over 5 months after withdraw of the technology.Results: Our findings indicate significant benefits to the home telemonitoring program as evidenced by large reductions in number of hospitalizations, length of average hospital stay, and, to a lesser extent, number of emergency room visits. Contrary to expectations, however, the number of home visits by nurses increased both during and after the telemonitoring intervention. In terms of the financial analysis, the telehomecare program resulted in significant savings: the equivalent of over CAD1,557 per patient as calculated on an annualized basis. This represents a net gain of 41 percent as compared to traditional home care.Conclusions: While the present economic analysis led to positive results, additional assessments should be conducted to confirm the cost-effectiveness of this mode of care delivery.

International audience; Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders’ perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders’ perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers’ rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score > 8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance.

The aim of the Eastern Quebec telepathology network is to provide uniform diagnostic telepathology services across a huge geographic region with a low population density. This project is intended to provide surgeons and pathologists with frozen section and second opinion services anywhere and at any time across the entire region, in order to avoid unnecessary patient transfer. The project has been implemented in 21 sites, each equipped with a whole slide scanner, a macroscopy station, a videoconferencing device and a viewer/case management and collaboration solution. Of the 21 sites, 6 are devoid of a pathology laboratory, two have no pathologist and 5 have only one pathologist on site. Signs of improvement of medical care in this region are already apparent since the Eastern Quebec telepathology network has been implemented. However, it is important not to underestimate the challenges related to change management in the course of implementation of such a new technology.

International audience; Developing quality indicators (QI) for national purposes (eg, public disclosure, paying-for-performance) highlights the need to find accessible and reliable data sources for collecting standardised data. The most accurate and reliable data source for collecting clinical and organisational information still remains the medical record. Data collection from electronic medical records (EMR) would be far less burdensome than from paper medical records (PMR). However, the development of EMRs is costly and has suffered from low rates of adoption and barriers of usability even in developed countries. Currently, methods for producing national QIs based on the medical record rely on manual extraction from PMRs. We propose and illustrate such a method. These QIs display feasibility, reliability and discriminative power, and can be used to compare hospitals. They have been implemented nationwide in France since 2006. The method used to develop these QIs could be adapted for use in large-scale programmes of hospital regulation in other, including developing, countries.

We investigated the effects of the introduction of mobile computing on the quality of home care nursing practice in Québec. The software, which structured and organized the nursing activities in patients' homes, was installed sequentially in nine community health centres. The completeness of the nursing notes was compared in 77 paper records (pre-implementation) and 73 electronic records (post-implementation). Overall, the introduction of the software was associated with an improvement in the completeness of the nursing notes. All 137 nurse users were asked to complete a structured questionnaire. A total of 101 completed questionnaires were returned (74% response rate). Overall, the nurses reported a very high level of satisfaction with the quality of clinical information collected. A total of 57 semi-structured interviews were conducted and most nurses believed that the new software represented a user-friendly tool with a clear and understandable structure. A postal questionnaire was sent to approximately 1240 patients. A total of 223 patients returned the questionnaire (approximately 18% response rate). Overall, patients felt that the use of mobile computing during home visits allowed nurses to manage their health condition better and, hence, provide superior care services. The use of mobile computing had positive and significant effects on the quality of care provided by home nurses.

The practice of community pharmacists is being challenged by the appearance of electronic prescription (e-Rx) technology. This article examines the disruptions caused by e-Rx technology to the jurisdiction of community pharmacists based on a model developed from work by Abbott (1988). The main disruptions to professional activities were investigated by qualitative methods in a series of interviews with pharmacists and physicians separated in two groups: practitioners who tested a typical e-Rx technology and stakeholders involved in the implementation of this large-scale e-Rx project in Quebec, Canada. The findings suggest that the technology may disrupt the jurisdiction of community pharmacists, mainly by changing the distribution of information among physicians and community pharmacists. More specifically, the technology represents both a threat to community pharmacists - by supporting the dominant position held by physicians if it gives them access to information held exclusively by pharmacists - and an opportunity - by redistributing information to the pharmacists' benefit, allowing them to improve the quality of their inferences about medication. However, it would appear that the opportunities offered by the technology generate concerns and tensions, both between physicians and pharmacists and between the pharmacists themselves. This phenomenon may well work against the implementation and use of available tools.

Objective: To assess the impact of a home telemonitoring technology on patients with chronic obstructive pulmonary disease in terms of care satisfaction, patient empowerment, improved quality of life, and utilization of hospital and home care. Design: Aq uasiexperimental retrospective and prospective design was developed with a matched control group to compare the effects of telemonitoring (the experimental group, n ¼ 23) with the traditional homecare offering (the control group, n ¼ 23). Measurements: Satisfaction, patient empowerment, and quality of life were measured using validated Likert scales, whereas the data on care utilization were collected from the participating patients’ medical record. Results: Mixed results were observed. The clinical effects of home telemonitoring were very positive in terms of patients’ satisfaction and empowerment. The perceptions of care providers as well as those of patients were congruent in this respect. Also, the study suggests that telemonitoring may have a positive effect on quality of life for patients with chronic obstructive pulmonary diseases. In contrast, the results were disappointing in terms of resource savings for the use of both homecare and hospital care. Conclusion: Capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology.

From the Research Centre and theService of Hematology and Oncology,University of Montreal Hospital Centre;Departments of Family Medicine,Health Administration, and Medicine,Faculty of Medicine, University ofMontreal; Maisonneuve-RosemontHospital; School of Social Work andDepartment of Psychology, Universityof Quebec at Montreal, Montreal; andFaculty of Education, University ofSherbrooke, Sherbrooke, Quebec,Canada.Submitted October 29, 2009; acceptedJanuary 11, 2010; published onlineahead of print at www.jco.org onMarch 1, 2010.Supported by Grant No. IHP-97582from the Canadian Institutes of HealthResearch.Authors’ disclosures of potential con-flicts of interest and author contribu-tions are found at the end of thisarticle.Corresponding author: Serge Daneault,MD, Unite´ des Soins Palliatifs, HoˆpitalNotre Dame, 1560 rue Sherbrooke est,Montreal, Quebec, Canada H2L 4M1;e-mail: serge.daneault.chum@ssss.gouv.qc.ca.© 2010 by American Society of ClinicalOncology0732-183X/10/2813-2310/$20.00DOI: 10.1200/JCO.2009.26.8425

Interest in health information exchange (HIE), defined as the use of information technology to support the electronic transfer of clinical information across health care organizations, continues to grow among those pursuing greater patient safety and health care accessibility and efficiency. In this paper, we present the results of a longitudinal multiple-case study of two large-scale HIE implementation projects carried out in real time over 3-year and 2-year periods in Quebec, Canada. Data were primarily collected through semi-structured interviews ( n = 52) with key informants, namely implementation team members and targeted users. These were supplemented with non-participants observation of team meetings and by the analysis of organizational documents. The cross-case comparison was particularly relevant given that project circumstances led to contrasting outcomes: while one project failed, the other was a success. A risk management analysis was performed taking a process view in order to capture the complexity of project implementations as evolving phenomena that are affected by interdependent pre-existing and emergent risks that tend to change over time. The longitudinal case analysis clearly demonstrates that the risk factors were closely intertwined. Systematic ripple effects from one risk factor to another were observed. This risk interdependence evolved dynamically over time, with a snowball effect that rendered a change of path progressively more difficult as time passed. The results of the cross-case analysis demonstrate a direct relationship between the quality of an implementation strategy and project outcomes.

Summary Objectives: The primary aim of this study was to assess the antecedents of health information technology (HIT) innovativeness in public hospitals. To do so, we built upon our own previous work to relate the level of HIT innovativeness to organizational capacity characteristics. Methods: We conducted a survey of chief information officers (CIOs) in public hospitals in the two largest Canadian provinces to identify the level of HIT innovativeness in these settings and test nine research hypotheses derived from the proposed research model. Results: A total of 106 completed questionnaires were received, which represents a response rate of 52%. Our findings indicate strong support for the research model. Seven out of nine hypotheses were supported indicating a significant relationship between HIT innovativeness and structural, financial, leadership, and knowledge sharing capacity characteristics. Results also reveal a moderate level of HIT innovativeness in the surveyed hospitals, with more emphasis on administrative systems and their integration than on clinical systems and emerging technologies. Conclusions: This study demonstrates that organizational characteristics are related to HIT innovativeness; this relationship holds irrespective of the public or private nature of hospitals.

The primary aim of this study is twofold. First, the authors seek to identify the factors that influence members of the general public to conduct Internet searches for health information. Their second intent is to explore the influence such Internet use has on three types of personal empowerment. In the summer of 2007 the authors conducted a household sample survey of a population of Canadian adults. A total of 261 self-administered questionnaires were returned to the researchers. Our findings indicate that use of the Internet as a source of health information is directly related to three main factors: sex, age and the individual’s perceived ability to understand, interpret and use the medical information available online. Further, their results lend support to the notion that using the Internet to search for information about health issues represents a more consumer based and participative approach to health care. This study is one of the first to relate Internet use to various forms of personal empowerment. This area appears to have great potential as a means by which consumers can become more empowered in managing personal health issues.

A virtual medical imaging department is an innovative and demanding organizational model, to the extent that the underlying goal is to achieve a continuous and advanced organizational integration of human and physical resources, clinical data, and clienteles. To better understand the kind of benefits offered, we conducted a survey of three groups of users--radiologists, radiological technologists, and medical specialists--working in a five-site virtual organization. We received 127 valid questionnaires, for an overall response rate of 66%. The assessments vary according to the use made of the system. The scores for system quality and the quality of the data produced were markedly higher for intra-hospital use (respectively 7.9 and 8.7 out of 10) than for inter-hospital use (5.4 and 7.0). Despite the negative assessments they made of inter-hospital use, users maintained a positive attitude toward some type of virtual organization of medical imaging. Indeed, the score for Overall satisfaction with the system was very high, 8.9 out of 10. Moreover, the scores for Intended future use of the system were very high for both intra-hospital use (8.9) and inter-hospital use (8.7). We also found significant differences in perceptions among user groups.

Objectives:This research integrates existing literature on information technology (IT) in hospitals, and proposes and validates a comprehensive IT capacities assessment tool in these settings.Methods:A comprehensive literature review was conducted on Medline until September 2006 to identify studies that used specific IT measures in hospitals. The results were mapped and used as a basis for the development of the proposed instrument, which was tested through a survey of Canadian healthcare organizations (N= 221).Results:A total of seventeen studies provided indicators of clinical and administrative IT capacities in hospitals. Based on the mapping of these indicators, a comprehensive IT capacities assessment instrument was developed including thirty-four items exploring computerized processes, thirteen items assessing contemporary technologies, and eleven items investigating internal and external information sharing. A time frame was inserted in the tool to reflect “plans for” versus “current” implementation of IT; in the latter, the extent of current use of computerized processes and technologies was measured on a (1–7) scale. Overall, the survey yielded a total of 106 responses (52.2 percent response rate), and the results demonstrated a good level of reliability and validity of the instrument.Conclusions:This study unifies existing work in this area, and presents the psychometric properties of an IT capacities assessment tool in hospitals. By developing scores for capturing IT capacities in hospitals, it is possible to further address important research questions related to the determinants and impacts of IT sophistication in these settings.

Summary Objective: Since it is important to develop strategies for the successful implementation of electronic clinical information systems, the aim of this study is to explore where, and to what extent, users’ attitudes toward the former system that is being replaced may vary. Methods: A cross-sectional survey of 346 nurses and physicians practicing in two Canadian teaching hospitals resulted in a total response rate of 63%. User attitudes were measured in three dimensions: a) user satisfaction with the system’s quality attributes, b) perceived system usefulness, and c) perceived impact on quality of care and patient safety. The current system (the one being replaced) was analyzed as a dual system composed of both paper-based and electronic records. Results: The results on user satisfaction demonstrate a wide variation in opinions, with satisfaction ranging from 4.2 to 7.7 on a 10-point disagree-agree, Likert scale. The quality attributes varied by record type, with differences that were systematically in favor of the electronic record component, which received higher scores. The results also highlighted large differences by user group. Physicians and nurses systematically rated the two record formats differently. The nurses were more satisfied with the attributes of the paper-based record. Multivariate regression analyses results also revealed strong interdependencies among the three dimensions of user attitudes, to the extent that perceived system usefulness was strongly correlated with system quality attributes and the system outcomes were also correlated, although less strongly, with the two former system dimensions. Conclusion: Understanding users’ attitudes toward a clinical information system in use, both in its paper and electronic aspects, is crucial for developing more successful implementation strategies for electronic record systems.

Summary Objective: The aim of this study is to gain a better understanding of the risk factors influencing the success of clinical information system projects. Methods: This study addresses this issue by first reviewing the extant literature on information technology project risks, and second conducting a Delphi survey among 21 experts highly involved in clinical information system projects in Québec, Canada, a region where government have invested heavily in health information technologies in recent years. Results: Twenty-three risk factors were identified. The absence of a project champion was the factor that experts felt most deserves their attention. Lack of commitment from upper management was ranked second. Our panel of experts also confirmed the importance of a variable that has been extensively studied in information systems, namely, perceived usefulness that ranked third. Respondents ranked project ambiguity fourth. The fifth-ranked risk was associated with poor alignment between the clinical information systems’ characteristics and the organization of clinical work. The large majority of risk factors associated with the technology itself were considered less important. This finding supports the idea that technology-associated factors rarely figure among the main reasons for a project failure. Conclusions: In addition to providing a comprehensive list of risk factors and their relative importance, the study presents a major contribution by unifying the literature on information systems and medical infor - matics. Our checklist provides a basis for further research that may help practitioners identify the effective countermeasures for mitigating risks associated with the implementation of clinical information systems.

Disembedded presence. The recomposition of patients and medical practices in telenephrology Telemedicine appears to be an attractive means for patients and specialists to be present to one another. However, while technologies are mobilized by actors in specific clinical projects, they also impose on them their potentialities and their limitations. By acting on the actors themselves, technologies recompose the medical practices in a problematic way. This recomposition of patients and medical practices is the prism through which a telenephrology case is analysed. The case sheds light on the manner in which the clinical relation is recomposed by the introduction of technologies whose potential implications may conflict with actors’ projects. This may explain the under-use of those technologies., La télémédecine apparaît comme un moyen séduisant de rendre présents les uns aux autres, patients et spécialistes. Toutefois, si les acteurs peuvent mobiliser les technologies dans des projets cliniques spécifiques, les technologies leur imposent leurs propres possibilités et limites et, ce faisant, agissent sur eux, recomposant les pratiques médicales d’une manière potentiellement problématique. La reconstitution des patients et des pratiques médicales par les technologies de l’information et de communication est au centre de l’analyse d’un cas de télénéphrologie. Elle montre comment l’introduction de technologies peut être lourde de possibles, parfois incompatibles avec les projets de ses acteurs, ce qui pourrait expliquer la sous-utilisation de ces technologies., La recomposición de los pacientes y de las prácticas médicas en telenefrología. Presencias desfazadas La telemedicina constituye un medio que seduce fácilmente debido a que ofrece la posibilidad de relacionar a los especialistas con sus pacientes. Sin embargo, pese a que los participantes pueden utilizar las tecnologías de la información para proyectos clínicos específicos, éstas les imponen a su vez sus propias posibilidades y limitaciones. Así, las tecnologías actúan sobre ellos y recomponen las prácticas médicas de una forma que puede ser potencialmente problemática. La reconstitución de los pacientes y de las prácticas médicas por parte de las tecnologías de la información y de las comunicaciones, constituye la esencia del análisis de un caso de telenefrología. Dicho análisis muestra las dificultades que surgen por el uso de estas tecnologías, debido a las innumerables posibilidades que presentan, lo que conlleva que algunas veces resulten incompatibles con los proyectos de los participantes. Lo anterior permite explicar las razones por las cuales el uso de las tecnologías de la información sigue siendo limitado., Daudelin Geneviève, Lehoux Pascale, Sicotte Claude. La recomposition des patients et des pratiques médicales en télénéphrologie. Les présences décalées. In: Sciences sociales et santé. Volume 26, n°3, 2008. pp. 81-106.

Objective: Home telemonitoring represents a patient management approach combining various information technologies for monitoring patients at distance. This study presents a systematic review of the nature and magnitude of outcomes associated with telemonitoring of four types of chronic illnesses: pulmonary conditions, diabetes, hypertension, and cardiovascular diseases. Methods: A comprehensive literature search was conducted on Medline and the Cochrane Library to identify relevant articles published between 1990 and 2006. A total of 65 empirical studies were obtained (18 pulmonary conditions, 17 diabetes, 16 cardiac diseases, 14 hypertension) mostly conducted in the United States and Europe. Results: The magnitude and significance of the telemonitoring effects on patients' conditions (e.g., early detection of symptoms, decrease in blood pressure, adequate medication, reduced mortality) still remain inconclusive for all four chronic illnesses. However, the results of this study suggest that regardless of their nationality, socioeconomic status, or age, patients comply with telemonitoring programs and the use of technologies. Importantly, the telemonitoring effects on clinical effectiveness outcomes (e.g., decrease in the emergency visits, hospital admissions, average hospital length of stay) are more consistent in pulmonary and cardiac studies than diabetes and hypertension. Lastly, economic viability of telemonitoring was observed in very few studies and, in most cases, no in-depth cost-minimization analyses were performed. Conclusion: Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions. Future studies need to build evidence related to its clinical effects, cost effectiveness, impacts on services utilization, and acceptance by health care providers.

feedback. With the large number of people experiencing hypertension worldwide and the burden of this medical condition, home blood pressure (BP) telemonitoring has become popular given its potential for reducing cost and improving patient care. This study provides an overview on the current evidence and trends of hypertension telemonitoring, and presents recommendations for future studies in this area. A comprehensive literature search was conducted from 1966 to 2006 on Cochrane Library, ScienceDirect, PubMed, MEDLINE, EMBASE, CINAHL, and PsycINFO using the key words ‘hypertension’, ‘blood pressure’, ‘telemonitoring’, ‘telecare’, ‘telemedicine’, ‘biotelemetry’, ‘telehealth’, and ‘telehomecare’. Fourteen studies involving telemonitoring experiments were found and included in this review, ten of which were conducted in Europe and the US. The studies present evidence on the positive impacts of telemonitoring on patients and their conditions (e.g. significant BP control, better medication adherence, changes in patients’ lifestyle). However, the results of the studies should be considered with caution due to the limitations of study designs. Furthermore, little is known about the effects of telemonitoring on services utilization and only one study demonstrated a detailed cost-effectiveness analysis of this approach. This review presents preliminary evidence on the benefits of telemonitoring as a successful patientmanagement approach. However, at present, limited information exists that would substantiate its effects on the utilization of health services (e.g. office and emergency room visits, hospitalizations) and demonstrate its economic viability. Future studies should examine the effects of mediating variables and the mechanisms through which BP control is achieved. Further research should also incorporate designs that allow more control and investigate its effects over longer time periods with larger diversified samples of patients.

International audience; In a context of growing concern for patient safety and service quality, this article aims at identifying the key factors for indicators implementation in the French healthcare system. It is based on an historical approach of the case of quality regulation in hospitals. This study underlines the necessary steps of implementation car­ried by different institutional actors (politics, academ­ics, professional). It focuses on the conditions for the emergence of this new kind of regulation.; Cet article porte un regard rétrospectif sur les quinze dernières années considérées comme une période charnière dans la régulation de la qualité hospitalière. Il se concentre principalement sur l’innovation instru­mentale qu’a pu constituer l’adoption des indicateurs de qualité. Fondé sur une démarche historique appuyée par un travail d’enquête, il restitue les facteurs clés qui ont contribué à l’émergence de ce nouvel instrument. Ce faisant, l’article présente à la fois les enjeux dont il a fait l’objet, les soutiens dont il a bénéficié et les résistances rencontrées lors de sa mise en œuvre.

International audience; Background: The uses of internet-based technologies (e.g. patient portals, websites and applications) by cancer patients could be strong drive for change in cancer care coordination practices. The goal of this study was to assess the current utilisation of internet-based technologies (IBT) among cancer patients, and their willingness to use them for their health, as well as analyse the influence of socio-demographics on both aspects.Methods: A questionnaire-based survey was conducted in June 2013, over seven non-consecutive days within seven outpatient departments of Gustave Roussy, a comprehensive cancer centre (160,000 consultations yearly), located just outside Paris. We computed descriptive statistics and performed correlation analysis to investigate patients’ usage and attitudes in correspondence with age, gender, socioeconomic status, social isolation, and place of living. We then conducted multinomial logistic regressions using R.Results: The participation level was 85% (n = 1371). The median age was 53.4. 71% used a mobile phone everyday and 93% had access to Internet from home. Age and socioeconomic status were negatively associated with the use of IBT (p < 0.001). Regarding patients’ expected benefits, a wide majority valued its use in health care, and especially, the possibility to enhance communication with providers. 84% of patients reported feeling comfortable with the use of such technologies but age and socioeconomic status had a significant influence.Conclusion: Most patients used IBTs every day. Overall, patients advocated for an extended use of IBT in oncology. Differences in perceived ease of use corresponding to age and socioeconomic status have to be addressed.

Sommaire: La volonte de transformation du systeme de sante est propice a une recrudescence du discours public sur la responsabilisation du patient. Les technologies d'information et de communication (tic) sont regulierement envisagees comme moyens pouvant permettre au patient d'exercer un role accru dans la prise en charge des questions de sante. Ce texte vise a cerner le sens de la responsabilisation dans un contexte de telesoins a domicile. L‘etude d'un service de suivi a domicile met en lumiere l'un des quatre paradigmes d'interpretation de la responsabilisation du patient: le paradigme professionnel qui est oriente vers l'habilitation en matiere de sante. Par une double lecture representant les approches sociologique et psychologique, cette etude montre les possibilites et les limites d'une technologie de telesoins a domicile par rapport a six principales variables: acces aux connaissances; developpement d'une reflexion argumentee; influence sur l'action ou la decision; competence percue; controle percu; et interiorisation des buts. Les resultats permettent d'observer le haut niveau d'exigence que representerait une initiative visant l’emergence de patients informes et competents. Surtout des patients “experts” dans une vision de la responsabilisation fondee sur la reconnaissance du caractere holistique des connaissances, du principe d'autonomie de pensee et du potentiel d'influence du patient sur une variete de decisions. En conclusion, sont precisees les implications qu'ont ces resultats sur la gestion du systeme public de sante. Abstract: The willingness to transform the health care system is conducive to a new wave of public discourse on patient empowerment. Information and communications technologies (ict) are regularly considered as means that allow the patient to exercise increased control in addressing health issues. This text aims at examining this phenomenon within the tele-homecare context. The study of a follow-up home-care service highlights one of the four paradigms of the interpretation of patient empowerment: the professional paradigm that is health empowerment-oriented. By using both a sociological and a psychological approach, the study identifies the possibilities and limitations of tele-homecare technology, based on six major variables: access to knowledge, development of critical thinking, personal impact on action or decision, perceived competency, perceived control, and internalization of goals. The results show the high level of requirements needed for an initiative that would produce informed, competent and, most importantly, “expert” patients according to a vision of empowerment based on the recognition of the holistic nature of knowledge, the principle of autonomous thinking, and the patient's potential impact on a variety of decisions. In conclusion, the article defines the implications of these results in terms of the management of the public health system.

A risk analysis framework was used to examine the implementation barriers that may hamper the successful implementation of interorganizational clinical information systems (ICIS). In terms of study design, an extensive literature review was first performed in order to elaborate a comprehensive model of project risk factors. To test the applicability of the model, we next conducted a longitudinal multiple-case study of two large-scale ICIS demonstration projects carried out in Quebec, Canada. Variations in the levels of several risk dimensions measured throughout the duration of the projects were analyzed to determine their impact on successful implementation. The analysis shows that the proposed framework, composed of five risk dimensions, was very robust, and suitable for conducting a thorough risk analysis. The results also show that there are links between the quality of the risk management and the level of project outcomes. To be successful, it is important that the implementation efforts be distributed proportionally according to the importance of each of the risk factors. Furthermore, because the risks evolve dynamically, there is a need for high responsiveness to emerging implementation problems. Thus, implementation success lies in the ability of the project management team to be aware of and to manage several risk threats simultaneously and coherently since they evolve dynamically through time and interact with one another.

Objective. The objective of our study was to perform a cost-minimization analysis of a wide-area teleradiology network. Design. A prospective analysis of all transmissions over 1 year (data transmitted at the time of the remote consultation, and health outcomes of patients from medical record). Intervention. The inter-hospital teleradiology network of the Aquitaine area (RIHRA) is a telemedicine system enabling the management of remote emergencies and elective radiology consultations. Main outcome measure. A cost-minimization study enabled a comparison of care procedures following the use of the network with those which would have been implemented without the network. The outcome measures of effectiveness were the transfers, hospitalizations, and consultations avoided or added. Fixed and variable costs were estimated. Results. Among the 664 transmissions included in the study, 562 (85%) were performed in emergency and 102 (15%) for elective (non-emergency) cases. In emergency, 48% of transfers were avoided. For elective teleconsultations, a transfer was avoided for 37% of the patients and hospitalization for 12%. An extra consultation occurred after remote consultation for 2% of the patients. Annual saving can be estimated at 102 779 EUR for the Aquitaine area. Conclusions. This study underlines the efficiency of an inter-hospital teleradiology network. A qualitative evaluation of the impact of the use of the system should be carried out to improve technical and organizational operations.

We analysed the cost-effectiveness of a teleconsultation service after five years of operation. The service provides diagnostic consultation at a distance for children suffering from cardiac pathologies. A retrospective study was performed with all 78 infants who had received a paediatric cardiology teleconsultation over a four-year period from January 1998. The cost-effectiveness of telecardiology was compared with that of the conventional means of providing services. Teleconsultation proved to be an effective and reliable method of enhancing access to tertiary care. The number of patient journeys (both emergency transfers and semi-urgent or elective visits to the tertiary care centre) was reduced by 42%. However, the cost analysis demonstrated that teleconsultation did not result in overall cost savings: the total cost of telecardiology was C dollars 272,327 and the total cost of conventional care would have been C dollars 157,212. There were direct savings for patients but not for the health-care system, because of the high cost of the equipment and telecommunication fees. Telemedicine therefore represented a supplementary cost of C dollars 1500 per patient. In summary, telemedicine added to cost but increased effectiveness. The incremental cost-effectiveness ratio of teleconsultation was estimated to C dollars 3488 per patient journey avoided.

The performance construct may be one of the most elusive in organization theory. Health care organizations are particularly complex owing to their dual lines of accountability, i.e. professional and administrative. This article examines the factors affecting performance indicator development and use at the technical/managerial and institutional levels, including the accreditation process and the relationship between levels. Using institutional and rational/goal theory, the motivations behind performance measurement behavior at different organizational levels was explored. Results show that the institutional level is motivated by legitimacy while the technical/managerial level is motivated by rationality. Tensions exist between the two levels and between indicator development and use.

Contexte : Un centre hospitalier universitaire pediatrique montrealais dispense des cours par visioconference. La visioconference permet de transmettre en temps reel des informations visuelles et auditives a distance. Objectifs : L'objectif de cette enquete est de mieux comprendre, a l'aide des theories des medias riches et de la distance transactionnelle, la dynamique d'apprentissage en visioconference. Methodes : L'enquete a porte sur deux groupes d'externes en stage de pediatrie (n = 23). Un questionnaire a reponses fermees a ete utilise. Resultats : L'etude revele que la faiblesse de l'interaction (cours de type magistral, style d'enseignement) et le contenu tres formalise entrainent une forte distance transactionnelle qui implique une grande autonomie de l'apprenant. Les resultats revelent egalement une ambiguite assez marquee chez les etudiants a distance inherente a la faible interaction et au peu de discussions. Les notes de cours comblent cependant les besoins d'information reduisant ainsi l'incertitude liee au contenu. Conclusion : Notre analyse montre que si l'environnement pedagogique de la visioconference repond aux objectifs d'apprentissage des etudiants, il se revele moins efficace que le cours traditionnel face a face et appelle une pedagogie davantage adaptee a cette forme d'enseignement.

Central to the success of many recent health system reforms is the implementation of new primary health care delivery models. The central characteristic common to these new models usually emphasises interdisciplinary collaboration. Using empirical research, this paper studies interdisciplinary collaboration among various groups of professionals within an original Canadian primary health care delivery model, the Quebec Community Health Care Centres (CCHCs). The entire population of more than 150 CHCCs have been surveyed. The goals of this study are (1) to measure the achieved intensity of inter-professional collaboration among Quebec CHCCs, and (2) to identify the organisational and professional factors fostering or limiting interdisciplinary collaboration. The results show that Quebec CHCCs have reached modest results in achieving interdisciplinary collaboration especially since interdisciplinary collaboration is a central objective that has been pursued for more than 25 years. This study demonstrates that the main factors associated with interdisciplinary collaboration are closely linked to work group internal dynamics. Interdisciplinary collaboration is linked to the simultaneous and antagonistic effect of some central intragroup process factors. Conflicting values and beliefs are present that both enhance and limit interdisciplinary collaboration. The presence of conflicting stimuli seriously undermines the strength of the CHCC work group's shared beliefs and strongly limits interdisciplinary collaboration. The results also stress the importance of administrative formalisation initiatives to enhance collaboration among different professions. The efficacy of formalisation in this context is based on its capacity to offer an articulated and operative interdisciplinary framework that can generate a counteractive effect to the traditional professional framework. It offers concrete rules that help align the work group beliefs with interdisciplinary values. The formalisation of functions and processes appears thus to be an interesting means to further interdisciplinary collaboration.

Since the early 1990s, telemedicine, or the use of information technology to support the delivery of health care from a distance, has increasingly gained the support of clinicians, administrators and policymakers across industrialised countries. However, the "theory of use" behind telemedicine-its rationale and the manner in which clinicians are expected to use it in their daily activities--has been only marginally investigated. In this paper we present the results of a qualitative study which examines the theory of use behind teleconsultation from the viewpoint of physicians (n = 37) in six specialities, practising in Quebec (Canada) hospitals. We employ Giddens' Structuration Theory (1984) to analyse the views, communications needs and referral strategies of physicians. Two questions are explored: (1) To what extent can teleconsultation be integrated into the routines of diverse medical specialities'? and (2) Why and how might clinicians use this technology? Our research indicates that specialities relying on either thorough physical examinations or specialised investigative techniques are unlikely to restructure their work routines to accommodate teleconsultation, which they view as limited. Specialities that primarily exploit images or numerical data tend to perceive teleconsultation as more useful. The perceived enabling properties of teleconsultation increase as a function of the distance the patient would have to travel to be seen directly by a consultant. The constraining properties are linked to the type of information transmitted, since physicians believe that only objective data can be safely consulted from a distance, whereas relying on the remote physician's interpretation of subjective information is deemed inappropriate. We thus conclude that the development of teleconsultation should be consolidated around applications whose theory of use is compatible with existing clinical routines, or offers opportunities to restructure clinical work according to the needs of providers and remote communities.

Aim: The goal of this study was to identify which patient characteristics had a significant impact on the patient-perceived usefulness of information technologies (IT) in health care and the current utilization by patients. Methods: A questionnaire-based survey was conducted in 2013, over seven non-consecutive days within seven outpatient departments of a comprehensive cancer center. We computed descriptive statistics based on survey responses and performed correlation analysis (Spearman test) to investigate characteristics of patients' IT usage and attitudes in relation to age, gender, socioeconomic status, social isolation, and place of living (urban/rural). We then performed multinomial logistic regression models for which likelihood ratio tests were used. Results: The participation level was 85% (n = 1371). 70% of respondents were females, and the median age was 53.4 years. 84% of patients reported feeling comfortable with the use of computers, tablets and smartphones. 71% of them used a mobile phone every day and 68% were daily Internet users. Age and socioeconomic status were negatively associated with the use of IT (p Study findings indicate that age and socioeconomic status were negatively associated with the perceived ease of use of IT (p IT applications useful/very useful neutral not useful/rather not useful n/a Schedule an appointment 71% 6% 22% 1% Communicate via emails with your physician 75% 5% 18% 2% Get help with medication monitoring (reminders, side effects) 61% 12% 26% 1% Get information about disease/support 69% 12% 18% 1% Get access to external contacts (psychologist, nurses,..) 66% 13% 20% 1% Conclusions: Most patients were connected to the Internet and used information technologies on a daily basis. Overall, they expressed an interest in using these tools in health care. Differences in perceived ease of use of IT according to age and socioeconomic status have to be addressed. Disclosure: All authors have declared no conflicts of interest.

Background and objective The objective of this study was to identify physicians’ and pharmacists’ perceptions of the challenges and benefits to implementing a nationwide electronic prescribing network linking medical clinics and community pharmacies in Quebec, Canada. Methods Forty-nine people (12 general practitioners, 2 managers, 33 community pharmacists, and 2 pharmacy staff members) from 40 points of care (10 primary care clinics (42% of all the connected sites) and 30 community pharmacies (44%)) were interviewed in 2013. Verbatim transcripts were analyzed using thematic analysis. Results A low level of network use was observed. Most pharmacists processed e-prescriptions by manual entry instead of importing electronically. They reported concerns about potential errors generated by importing e-prescriptions, mainly due to the instruction field. Paper prescriptions were still perceived as the best means for safe and effective processing of prescriptions in pharmacies. Speed issues when validating e-prescription messages were seen as an irritant by physicians, and resulted in several of them abandoning transmission. Displaying the medications based on the dispensing data was identified as the main obstacle to meaningful use of medication histories. Conclusions Numerous challenges impeded realization of the benefits of this network. Standards for e-prescription messages, as well as rules for message validation, need to be improved to increase the potential benefits of e-prescriptions. Standard drug terminology including the concept of clinical medication should be developed, and the implementation of rules in local applications to allow for the classification and reconciliation of medication lists from dispensing data should be made a priority.