Mylaine Breton
1* 
, Catherine Lamoureux-Lamarche
1, Mélanie Ann Smithman
1, Erin Keely
2, Maxine Dumas Pilon
3, Alexander Singer
4, Gerard Farrell
5, Paula Louise Bush
6, Catherine Hudon
7, Lynn Cooper
8, Véronique Nabelsi
9, Élizabeth Côté-Boileau
1 , Justin Gagnon
6, Isabelle Gaboury
1, Carolyn Steele Gray
10 , Marie-Pierre Gagnon
11 , Regina Visca
6, Clare Liddy
12,131 Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
2 Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
3 Collège québécois des médecins de famille, Family Medicine Center, St-Mary’s Hospital, McGill University, Montréal, QC, Canada
4 Department of Family Medicine, University of Manitoba, Winnipeg, MN, Canada
5 Department of Family Medicine, Memorial University, St. John, NL, Canada
6 Department of Family Medicine, McGill University, Montréal, QC, Canada
7 Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
8 Canadian Injured Workers Alliance, Thunder Bay, ON, Canada
9 Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
10 Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
11 Faculté des sciences infirmières, Université Laval, Québec City, QC, Canada
12 Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
13 C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, ON, Canada
Abstract
Background: Effective healthcare innovations are often not scaled up beyond their initial local context. Lack of practical knowledge on how to move from local innovations to large-system improvement hinders innovation and learning capacity in health systems. Studying scale-up processes can lead to a better understanding of how to facilitate the scale-up of interventions. eConsult is a digital health innovation that aims to connect primary care professionals with specialists through an asynchronous electronic consultation. The recent implementation of eConsult in the public health systems of four Canadian jurisdictions provides a unique opportunity to identify different enabling strategies and related factors that promote the scaling up of eConsult across jurisdictions.
Methods: We conducted a narrative case study in four Canadian provinces, Quebec, Ontario, Manitoba, and Newfoundland & Labrador, over a 3-year period (2018–2021). We observed provincial eConsult committee meetings (n=65) and national eConsult forums (n=3), and we reviewed internal documents (n=93). We conducted semi-structured interviews with key actors in each jurisdiction (eg, researchers, primary care professionals, specialists, policy-makers, and patient partners) (n=40). We conducted thematic analysis guided by the literature on factors and strategies used to scale up innovations.
Results: We identified a total of 31 strategies related to six key enabling factors to scaling up eConsult, including: (1) multi-actor engagement; (2) relative advantage; (3) knowledge transfer; (4) strong evidence base; (5) physician leadership; and (6) resource acquisition (eg, human, material, and financial resources). More commonly used strategies, such as leveraging research infrastructure and bringing together various actors, were used to address multiple enabling factors.
Conclusion: Actors used various strategies to scale up eConsult within their respective contexts, and these helped address six key factors that seemed to be essential to the scale-up of eConsult.