Table 1.

Summary of articles included in the review of HIT champions (n = 42)

Reference	Intervention	Setting	Evaluative method	Objectives	Summary findings
Al-Qirim [32]	Telehealth	One Dermatology Department in New Zealand.	Case study	Explain factors influencing the adoption and diffusion of telemedicine for dermatology.	Study emphasized the importance of having a product champion for the adoption of a telemedicine initiative in New Zealand.
Al-Qirim [33]	Telehealth	One Psychiatry Department, and one Dermatology Department in New Zealand.	Case study	Explain factors influencing the adoption and diffusion of telemedicine for psychiatry and dermatology.	Study emphasized the importance of having a product champion for the adoption of a telemedicine initiative in New Zealand.
Andre, Ringdal, Loge, Rannestad, Kaasa [63]	Handheld symptom assessment	Oncology Department in University Hospital (Norway)	Case study	Examine responses and attitudes of users, and factors promoting implementation.	Lack of knowledge about the formal project aims, training and communication with organizational leaders were barriers to implementation.
Ash, Stavri, Dykstra, Fournier [31]	Computerized physician order entry (CPOE)	One Teaching hospital in Virginia (USA), Veteran’s health care system in Washington (USA), one non-profit hospital in California (USA)	Multiple case study	Identify factors associated with the implementation of CPOE in inpatient and outpatient settings.	Three types of “special people” have been identified as key personnel in the implementation of CPOE.
Ash, Gorman, Lavelle, Payne, Massaro, Frnatz, Lyman [34]	Computerized physician order entry (CPOE)	University of Virginia (USA), Veterans Affairs Puget Sound Health Care System (USA), El Camino Hospital (USA)	Observation, interviews, and focus groups	Describe perceptions of CPOE among diverse professionals in sites with successful CPOE implementation	Four themes: organizational issues (e.g., collaboration); clinical/professional issues; technical/IT implementation issues; organization of information
Ash, Sittig, Wright [57]	Clinical decision support (CDS)	Independent physician organization in Oregon (USA).	Case study	Identify barriers and facilitators of CDS implementation in a community setting.	Joint selection and purchase, and implementation of EHRs with CDS; centrally managed EHR, and improved data are necessary.
Ash, Sittig, Guappone, Dykstra, Richardson, Wright, Carpenter, McMullen, Shapiro, Bunce, Middleton [47]	Clinical decision support (CDS)	Two community hospitals and five ambulatory clinics in the US.	Multiple case study	Identify factors associated with implementation of CDS.	Workflow integration, well designed user interfaces, knowledge management, and intentional interaction among stakeholders are key factors in CDS implementation.
Carlfjord, Lindberg, Andersson [35]	Computer-based lifestyle intervention.	Six primary health care (PHC) centres in Sweden.	Multiple case study	Explore organizational members’ perceptions and usefulness of a computer-based lifestyle intervention.	Extra resources, such as manpower, and committed leadership are key factors in implementation.
Chedid, Golden, Jager [56]	University of Chicago Medicine’s Diabetic Retinopathy Screening Program	Chicago Family Health Center (Federally qualified health center).	Case study	Identify operational challenges in the implementation of a diabetic retinopathy screening program.	Strong physician leadership is a key element for the implementation of an HIT screening intervention.
Cresswell, Sadler, Rodgers, Avery, Cantrill, Murray, Sheikh [24]	Pharmacist-led information technology intervention.	34 primary care organizations in central England (UK).	Case Study	Understand the organizational and social environment of a pharmacist-led information technology intervention.	Face-to-face contact with practice staff, and a designated champion were keys to implementation of pharmacy HIT.
Crosson, Etz, Wu, Straus, Eisenman, Bell [42]	Electronic prescribing	Five primary care practices in the US.	Multiple Case Study	Identify the factors associated with implementation of electronic prescribing.	Implementation of electronic prescribing requires workflow redesign, and improved health information exchange.
Culler, Jose, Kohler, Edwards, Dee, Sainfort, Rask [45]	Inpatient pharmacy system.	Two pediatric hospitals – Egleston Children’s Health Care and Scottish Rite Children’s Medical Center (UK).	Case study	Describe the facilitators and barriers to the implementation of an inpatient pharmacy system.	Training super-users, extensive pre-implementation training, formal feedback mechanisms, and technical support following deployment are facilitators of HIT.
Feldman, Schooley, Bhavsar [49]	Health Information Exchange (HIE)	Health system in Virginia	Case study	Investigate technical, organizational, and governance of HIE implementation	Project champions play a key decision- making role in governance
Feldstein, Schneider, Unitan, Perin, Smith, Nichols, Lee [58]	Decision support system – Patient Panel Support Tools (PST)	Non-profit group model HMO, Kaiser Permanente Northwest, in Washington and Oregon (US).	Case study	Examine health care workers attitudes toward the adoption and use of a Patient Panel Support tool.	Implementation required roles for non-PCP staff, leadership, training, and dedicated time for using the HIT.
Gagnon, Desmartis, Labrecque, Legare, Lamothe, Fortin, Rancourt, Duplantie [36]	Electronic Medical Record (EMR)	Family medicine group (FMG) in Quebec, Canada.	Case study	Explore factors that influence the implementation of an EMR.	Organizational factors such as presence of a champion, innovative culture, personal characteristics, and a scientifically based implementation strategy are important.
Garfield and Watson [50]	Telehealth	State telemedicine initiatives in Georgia, Pennsylvania, Ohio, and Wisconsin.	Multiple case study	Examine factors contributing to the success of telemedicine initiatives.	‘Technical’ and ‘user champions’ may be necessary to implement telemedicine interventions.
Gordon, Camhi, Hesse, Odlum, Schnall, Rodriguez, Valdez, Bakken [25]	Continuity of Care Document (CCD)/Personal Health Record (PHR).	NYPS SelectHealth HIV/AIDS care sites in New York City (USA).	Case study	Examine the processes and outcomes of a Continuity of Care Document/PHR for people living with HIV/AIDS.	Training and organizational commitment are important factors in implementation of a PHR.
Greiver, Barnsley, Glazier, Moineddin, Harvey [37]	Electronic Medical Records	18 community-based family physician practices in Toronto, Canada.	Case study	Examine factors influencing the implementation of electronic medical records.	EMR implementation was also influenced by lack of leadership, relative advantage, high complexity, low compatibility, and available organizational slack.
Halbesleben, Wakefield, Ward, Brokel, Crandall [51]	Clinical Information System (CIS). Includes an electronic health record (EHR) with computerized physician order entry (CPOE).	Large, Midwestern rural referral hospital.	Case study	Explore the impact of Super Users on the implementation of a CIS.	Super-users, and leadership support for super users are important factors in implementation of (CIS).
Hao, Padman, Telang [26]	Mobile Clinical Access Portal (MCAP) with secured wireless PDA-based solution providing access to electronic medical record system (EMR).	Community-based healthcare system in southwestern Pennsylvania.	Multivariate regression analysis	Examine empirical evidence for the contextual factors associated with physician adoption of a PDA-based electronic medical record system.	Opinion leaders have significant effects on physician adoption of PDA-based EHR systems.
Hartswood, Procter, Rouchy, Rouncefiled, Slack, Voss [29]	Improved electronic tools for management of patient records and patient care.	Toxicology ward of a large hospital.	Case study	Explore the process of participant design of health information technology.	HIT professionals must design and develop systems with users.
Hendy and Barlow [43]	Telehealth	Three health and social care organizations with experience in telehealth in England (UK).	Multiple case study	Examine the role of champions in telehealth initiatives.	Questions the positive and necessary role that champions play in HIT implementation.
Hsiao, Li, Chen, Ko [23]	Mobile nursing information system	Eighty-four Nursing Directors at Hospitals in Taiwan	Multivariate regression analysis	Examine the factors associated with adoption of MNIS	Organizations should scan environment, identify mobile nursing needs, and develop vendor relationships in order to adopt.
Leidner, Preston, Chen [28]	Hospital health information technology.	Matched pairs of CIOs and executives.	Multivariate regression analysis	Examine the hospital characteristics associated with IT innovation.	There are different types of CIO-Board dynamics that affect the role of CIO as a champion and his/her champion behaviors.
McAlearney, Schweikhart, Medow [48]	Handheld computers in clinical practice.	161 informants at seven clinical practice sites.	Multiple case study	Describe strategies that promote use of handheld computers.	Organizations will use different strategies that promote handheld computer use and remain responsive to physician needs.
Miller and Sim [46]	Electronic medical record (EMR).	EMR managers in physician champions in 30 physician organizations.	Multiple case study	Identify key barriers to physician’s use of EMRs.	Practices without physician champions are likely to struggle to achieve quality or financial benefits.
Novak, Anders, Gadd, Lorenzi [52]	Barcode medication administration (BCMA)	Multi-hospital, tertiary medical center in the US.	Case study	Examine mediators efforts to implement BCMA	Clinicians can improve the safety and effectiveness of BCMA implementation with institutional support.
Paré, Elam, Ward [38]	Patient charting system (PCS).	Burn center of a large, not-for-profit teaching hospital.	Case study	Examine the implementation of a patient charting system.	Patient charting system implementation requires key actors anticipating and proactive with challenges; key actors are associated with quality of implementation; PCS implementation is indeterminate process, and outcomes are associated with management of the process and actions after introduction of system.
Paré, Sicotte, Jaana, Girouard [41]	Clinical information system (CIS).	Participants with backgrounds in CIS project management.	Delphi study	Identifying the risks associated with the implementation of CIS.	Risk management is a key strategy throughout the implementation of CIS.
Paré, Sicotte, Poba-Nzaou, Balouzakis [61]	Mobile computing technology; Clinical information system (CIS).	Future users of mobile computing technology in home care organizations; and a large teaching hospital implementation of CIS.	Multivariate regression analysis	Examine clinicians’ early perceptions of organizational readiness for change with clinical information system projects.	Organizational readiness for change is a key factor in clinician’s initial support for implementation of CIS.
Piscotty, Tzeng [59]	Clinical information system (CIS)	Regional multi-hospital system.	Multiple case study	Explore CIS readiness activities adopted by chief nurse executives.	Chief nurse executives suggested that champions are necessary at multiple organizational levels to obtain buy in and gather support for implementation.
Poe, Abbott, Pronovost [55]	Electronic health records (EHR)	Clinical units at an academic medical center (n = 9).	Structured program evaluation	Evaluate the effectiveness of peer coaches impact on increasing learner satisfaction and confidence in EHR use.	Peer coaches had a positive effect on satisfaction and confidence.
Postema, Peeters, Friele [44]	Telehealth	Care organizations in the Netherlands (n = 3).	Multiple case study	Examine the key factors that improve implementation of video communication.	Technical stability and the alignment of the external environment with organizational goals and implementation strategy are key factors.
Shachak, Montgomery Dow, Barnsley, Tu, Jadad, Lemieux-Charles [74]	Electronic medical records (EMR)	Four family health teams, one family health organization (Canada).	Multiple case study	Investigate user expectations and needs for end-user support for EMR.	Highlights importance of on-site support and super-users in liaison roles, local development of support practices, and gaps in understanding of other organizational members’ work processes.
Sharkey, Hudak, Horn, Barrett, Spector, Limcangco [60]	Clinical decision support tools for pressure ulcer prevention.	Nursing homes in Washington, D.C. (USA) (n = 14).	Multivariate regression analysis	Examine nursing home factors associated with implementation of clinical decision support tools for pressure ulcer prevention.	High involvement of nurse managers, in-house dietitian, high participation from staff educator and QI personnel, internal champions, and openness to redesign were associated with implementation.
Shaw, Howard, West, Crabtree, Nease, Tutt, Nutting [39]	EPIC quality improvement intervention.	Primary care practices in Colorado (USA) (n = 14)	Multiple case study	What are the roles of champions in the implementation of organizational innovations.	Two types of champions are key – specific project champions, and organizational change champions.
Sloane, Wroth, Halladay, Bray, Spragens, Stearns, Zimmerman [40]	Quality monitoring and reporting initiative.	Primary care practices in North Carolina (USA)	Multiple case study	Examine the factors that impact initiation and maintenance of a quality monitoring and reporting process.	Complex sets of factors are required to implement and sustain quality-reporting interventions.
Verhoeven, Steehouder, Hendrix, van Gemert-Pijnen [27]	Website with infection control guidelines.	Health care workers at 5 occupational groups in 4 hospitals in the Netherlands and Germany (n = 20).	Multiple case study	Identify factors impacting health care workers use of a website for communicating infection control guidelines.	Organizational factors play the key role in implementation, and inclusion of the health care workers is essential in the design process.
Wright, Ash, Erickson, Wasserman, Bunce, Stanescu, St Hilaire, Panzenhagen, Gebhardt, McMullen, Sittig [53]	Clinical decision support (CDS)	Two community hospitals; an academic medical center and outpatient clinic; Veterans Administration hospital outpatient clinics; community outpatient independent physician association; and academic outpatient clinic.	Multiple case study	Examine activities in the implementation of CDS.	Implementation of CDS requires a variety of skills and activities.
Yuan, Bradley, Nembhard [30]	Electronic health records (EHR)	Two medical units of a large academic hospital	Mixed methods case study	Investigate behaviors of EHR super-users.	Super-users may support or hinder implementation.
Yusof [64]	Critical care information system	Intensive care unit of tertiary referral center (Malayasia)	Case study	Examine factors associated with adoption of a critical care information system	Champions may be important, but other organizational factors may promote or hinder implementation.
Zandieh, Yoon-Flannery, Kuperman, Langsam, Hyman, Kaushal [62]	Electronic health records (EHR)	Practice managers (n = 11) and medical directors (n = 12) from ambulatory care network of large teaching hospital in New York City (USA).	Case study	Examine the different approaches to EHR implementation between organizations from paper-based vs. legacy EHRs.	Physician information technology champions was a priority for organizations with paper-based records implementing EHRs, but not a priority for those moving from a legacy EHR to a more sophisticated EHR.