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The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network.

  • Alami, Hassane1, 2
  • Fortin, Jean-Paul1, 3
  • Gagnon, Marie-Pierre1, 2, 4
  • Pollender, Hugo1
  • Têtu, Bernard2, 3
  • Tanguay, France5
  • 1 Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care of Laval University (CERSSPL-UL), CIUSSS-Capitale Nationale, Quebec City, QC, Canada. , (Canada)
  • 2 University Hospital Center of Quebec-Laval University Research Center, Quebec City, QC, Canada. , (Canada)
  • 3 Faculty of Medicine, Laval University, Quebec City, QC, Canada. , (Canada)
  • 4 Faculty of Nursing, Laval University, Quebec City, QC, Canada. , (Canada)
  • 5 Integrated Health and Social Services Centre of Chaudière-Appalaches Hôtel-Dieu de Lévis, Lévis City, QC, Canada. , (Canada)
Published Article
International journal of health policy and management
Publication Date
May 01, 2018
DOI: 10.15171/ijhpm.2017.106
PMID: 29764106


The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological considerations. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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