Crossing the Implementation Chasm: A Proposal for Bold Action

Abstract

As health care organizations dramatically increase investment in information technology (IT) and the scope of their IT projects, implementation failures become critical events. Implementation failures cause stress on clinical units, increase risk to patients, and result in massive costs that are often not recoverable. At an estimated 28% success rate, the current level of investment defies management logic. This paper asserts that there are "chasms" in IT implementations that represent risky stages in the process. Contributors to the chasms are classified into four categories: design, management, organization, and assessment. The American College of Medical Informatics symposium participants recommend bold action to better understand problems and challenges in implementation and to improve the ability of organizations to bridge these implementation chasms. The bold action includes the creation of a Team Science for Implementation strategy that allows for participation from multiple institutions to address the long standing and costly implementation issues. The outcomes of this endeavor will include a new focus on interdisciplinary research and an inter-organizational knowledge base of strategies and methods to optimize implementations and subsequent achievement of organizational objectives.

Comparative case study investigating sociotechnical processes of change in the context of a national electronic health record implementation

“…5,13 Many challenges accompanying the introduction of new technology result from the necessary changes to and transformations of established organisational processes and individual practices. 2,[14][15][16][17][18] There is therefore a real danger that systems that are not perceived as being fit-for-purpose are rejected or used in different ways to what was originally intended. In line with this, one of the key findings to emerge from the still relatively limited number of published accounts is that implementations characterised by substantial user involvement in design tend to be more "successful".…”

Electronic health record systems: A current and future-oriented view

“…These systems may meet all Meaningful Use certification criteria and yet fail to meet the specific needs of the healthcare organization and its staff. "Implementation failures cause stress on clinical units, increase risk to patients, and results in massive costs that are often not recoverable" [1]. It is recommended that the organization try a trial version of the EHR before committing to purchase, and that they engage experienced clinical and information technology professionals to provide advice and guidance in the selection process.…”

“…Sources of dissatisfaction include unmet functional needs, hard-to-use systems, complicated computer and networking infrastructure, lack of customization options, high costs, and unresponsive vendor support [1] - [4]. This paper focuses on lessons the authors learned while implementing EHR (Electronic Health Records) technology at a variety of healthcare delivery settings.…”

Electronic Health Records: Applications, Techniques and Challenges

“…This problem occurs especially in the emergency room. Thus, sufficient procedures are needed to be available to help users deal with the interruption that occur in the connectivity of the system [99].…”