Abstract
Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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
