Identifying and Overcoming Policy‐Level Barriers to the Implementation of Digital Health Innovation in Ontario: Qualitative Study
Authors: Soobiah C. , Desveaux L. , Bhatia S. , Shaw J. 
Published: August 2020

Research ObjectiveDigital health innovation is the cornerstone of health care modernization internationally, yet innovations often fail to become part of routine practice. Translating evidence into practice remains a challenge despite the accumulating body of evidence regarding factors underlying success and failure. Innovations that establish proof of concept often lack a strategic plan for diffusion, which complicates adoption; however, high‐level policy barriers impede widespread adoption more broadly for even the most well‐positioned innovations. The aim of this study was to explore the challenges and opportunities in the implementation of digital health innovation to identify policy‐level actions to support uptake at scale.Study DesignA qualitative study was conducted using a constructivist paradigm. Semi‐structured interviews were conducted with senior leadership members from organizations engaged in digital health planning and/or implementation activities in Ontario, Canada. Interviews were transcribed and analyzed inductively to the point of thematic saturation (point at which no new themes emerged). Findings are presented in terms of the key aspects of policy that require attention to best promote the adoption of digital health innovations at a system level.Population StudiedThe research team generated a list of key organizations involved in digital health activities in Ontario, Canada, which was circulated to a broader advisory group for further recommendations. Participants were required to hold a senior position within their respective organizations to ensure they could speak to system‐level barriers.Principal FindingsTen participants participated across nine interviews. Participants were from the Ontario Ministry of Health, Ontario Telemedicine Network, Canada Health Infoway, Ontario MD, and the MaRS Excellence in Clinical Innovation program and represented key organizations engaged in the governance, implementation, and adoption of digital health activities. The importance of strong leadership at an organizational and system level was viewed as critical to the successful implementation of digital health innovation, with an emphasis on establishing a culture of innovation. Participants described six key priorities requiring action at the policy level to catalyze digital health innovation, including: 1) a system‐level definition of innovation; 2) a clear overarching mission for digital health innovation; and 3) clearly defined organizational roles. Operationally, there is a need to 4) provide guidance on standardized processes; 5) shift the emphasis to change management; and 6) align funding structures.ConclusionsGovernments and decision makers play a central role in charting the digital course by developing a vision and creating the foundation upon which (currently fragmented) innovation activities will be modeled. Health care systems around the world and their stakeholders can reflect on these findings and recommendations to consider their utility in advancing local health innovation agendas.Implications for Policy or PracticeThese findings emphasize the critical role of the government in developing a shared vision and creating a foundation upon which digital health innovation activities can be implemented and adopted in health care systems. Achieving change may rely more on the thoughtful and efficient reconfiguration of existing practices as opposed to the addition of new resources.Primary Funding SourceOntario Ministry of Health Canada.