Table 5.

Description and justification of implementation strategies selected

ERIC Cluster and Strategy	ERIC Description and Ancillary Material	Justification
Use evaluative and iterative strategies
Purposefully re-examine the implementation	Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care. It is beneficial to use a concrete schedule for monitoring rather than ‘as needed.’	Data considered: • 101% endorsement via CFIR-ERIC tool • High in feasibility and importance (Quadrant I) • Low reported usage among other ePSM evaluations REACH project considerations: • Feasible and important to regularly monitor implementation success, barriers to implementation, and use of other implementation strategies • Similar to strategies such as ‘conduct cyclical test of change’ and ‘develop and organize quality monitoring systems’ (i.e., to monitor the success of the implementation effort and continuously refine the implementation plan), but can be broadly applied and tailored to include cyclical tests of change if necessary CFIR constructs targeted by strategy: • Inner Setting – Compatibility • Intervention Characteristics – Complexity, Adaptability • Process – Engaging Key Stakeholders and Patients
Change Infrastructure
Change record systems	Change records systems to allow better assessment of implementation or clinical outcomes. This strategy involves changing the structure, content, function, or design of record system components such as electronic medical records to reflect the innovation	Data considered: • 29% endorsement via CFIR-ERIC tool • Low in feasibility and importance (Quadrant III) • High reported usage among other ePSM evaluations REACH project considerations: • While each centre has their own information technical teams, embedding the process to offer REACH to patients within existing electronic and automated systems used to distribute information to patients was considered important • For sites that require clinic staff to offer REACH to patients, integrating this task into their workflow was considered important. This includes documentation checklists either in the electronic medical record or another system used in the setting. It was thought that this would act as a reminder and encourage providers to complete this task Barriers targeted by strategy: • Inner Setting – Compatibility
Train and Educate Stakeholders
Conduct educational meetings	Hold meetings targeted toward educating multiple stakeholder groups (i.e., providers, administrators, other organizational stakeholders, community members, patients/consumers, families) about the clinical innovation and/or its implementation	Data considered: • 263% endorsement via CFIR-ERIC tool • High in feasibility and importance (Quadrant I) • High reported usage among other ePSM evaluations REACH project considerations: • Feasible and important to educate health care providers and administrative staff on the purpose of REACH, differences with other systems, and how REACH fits within their clinical workflow • The REACH team can tailor the number of meetings across different sites based on need Barriers targeted by strategy: • Individual Characteristics – Knowledge and Beliefs • Intervention Characteristics – Relative Advantage
Distribute educational materials	Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically	Data considered: • 110% endorsement via CFIR-ERIC tool • High in feasibility and importance (Quadrant I) • High reported usage among other ePSM evaluations REACH project considerations: • Feasible and important to effectively distribute educational materials to patients to ensure they can easily register and use the tool independently Barriers targeted by strategy: • Individual Characteristics – Knowledge and Beliefs
Engage Consumers
Intervene with patients to enhance adherence and uptake	Develop strategies with patients to encourage and problem solve around adherence. This includes patient reminders and financial incentives. Feedback regarding patients’ understanding and use of the innovation is also important to collect	Data considered: • 106% endorsement via CFIR-ERIC tool • Low in feasibility and high in importance (Quadrant IV) • High reported usage among other ePSM evaluations REACH project considerations: • Given that REACH is a remote self-management tool with a low frequency of assessments, and that the use of the tool is not linked to a clinic visit, it is important to develop a system on REACH to remind and encourage patients to log in and complete their assessments when asked Barriers targeted by strategy: • Individual Characteristics – Knowledge and Beliefs • Process – Engaging Patients
Provide interactive assistance
Centralize technical assistance	Develop and use a centralized system to deliver technical assistance focused on implementation issues. This could be the designation of a lead technical assistance organization (could also be responsible for training). The lead technical assistance entity can develop other mechanisms (e.g., call-in lines or websites) in order to share information on how to best implement the clinical innovation	Data considered: • 36% endorsement via CFIR-ERIC tool • Low in feasibility and importance (Quadrant III) • Low reported usage among other ePSM evaluations REACH project considerations: • Given that REACH is in its initial version and each centre has their own information technical teams, it was thought that centralizing technical assistance using personnel within the REACH team would provide a feasible method to monitor technical issues and coordinate with the REACH development team during the pilot phase, rather than developing a system for each site to deliver technical assistance on local implementation issues Barriers targeted by strategy: • Intervention Characteristics – Complexity • Individual Characteristics – Knowledge and Beliefs • Outer Setting – Patient Needs and Resources
Develop stakeholder interrelationships
Use advisory boards and workgroups	Create and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements	Data considered: • 182% endorsement via CFIR-ERIC tool • High in feasibility and importance (Quadrant I) • Moderate usage among other ePSM evaluations REACH project considerations: • Involving various roles such as directors, managers, and clinicians will be critical to successfully conducting the strategy ‘purposefully reexamine implementation’ (see above) • Conducting meetings with these various roles at each site will provide the REACH team with a better understanding of current clinical workflows and any changes made, direction on when and how patients are invited to register to REACH, feedback on these processes, and approvals for implementing new processes Barriers targeted by strategy: • Inner Setting – Compatibility, Relative Priority • Process – Engaging Key Stakeholders and Patients • Outer Setting – Patient Needs and Resources
Adapt and tailor to context
Tailor strategies	Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection	Data considered: • 223% endorsement via CFIR-ERIC tool • High in feasibility and importance (Quadrant I) • Low reported usage among other ePSM evaluations REACH project considerations: • REACH is being implemented within four centres. Structural differences will need to be considered when conducting several strategies such as how implementation teams are formed (organize implementation teams and team meetings), who educational meetings are targeted towards along with their frequency and duration (conduct educational meetings), and how educational materials are distributed to patients (distribute educational materials) Barriers targeted by strategy: • Inner Setting – Compatibility • Intervention Characteristics – Complexity, Adaptability

ERIC Expert Recommendations for Implementing Change, ePSM electronic prospective surveillance model, CFIR Consolidated Framework for Implementation Research