Hassane Alami - 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
Jean-Paul Fortin - 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
Marie-Pierre Gagnon - 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
Hugo Pollender - 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
Bernard Têtu - University Hospital Center of Quebec-Laval University Research Center, Quebec City, QC, Canada
France Tanguay - Integrated Health and Social Services Centre of Chaudière-Appalaches Hôtel-Dieu de Lévis, Lévis City, QC, Canada

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 ۲۲ hospitals and serves a population of ۱.۷ 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: (۱) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (۲) participation in meetings of the committee in charge of telehealth programs and the project; and (۳) 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 integrativeand 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.

Telepathology Network, Telehealth Implementation, Evaluation, Sustainability, Healthcare Services