Health Information System Implementation: A Qualitative Meta-analysis

Abstract

Abstract:Healthcare information systems (HISs) are often implemented to enhance the quality and patient-centeredness of care, as well as to improve the efficiency and safety of the services. However, the outcomes of HISs implementations in both primary care and hospital settings have not met expectations. Research reports indicate that there is a need to study HISs implementation process and its organizational consequences.The aim of this paper has been to organize the knowledge gained in qualitative studies performed in association to HIS implementations and to use this knowledge to outline an updated structure for implementation planning. We found that the main action implication that could be drawn from the meta-analysis was that merely implementing a HIS will not automatically increase the organizational efficiency. We used a multi-disciplinary team for the analyses in order to cover as many aspects of the primary studies as possible. Nevertheless, our results should be interpreted as a high-order scheme, and not a predictive theory and the action recommendation need to be investigated in prospective studies.The results obtained shown that when implementing HISs in hospital and primary care environments, at a minimum, strategic, tactical, and operational actions have to be taken into consideration, through management involvement, integration in healthcare workflow and specially user involvement, education and training and through establishing compatibility between software and hardware. The results show also that many of the most important failures seem still to emerge from the absence of feedback from end-users to developers during the development process. What it is needed is the use of an implementation methodology that minimizes the information asymmetry in the implementation process, and that allows the accumulation of the knowledge capital needed to prevent rejection of the final system Keywords: health information system, implementation, failure IntroductionHealthcare information systems (HISs), such as computerized physician order entry (CPOE) and computer-based patient records (CPRs) have been implemented to enhance the quality and patient-centeredness of care, as well as to improve the efficiency and safety of the services (1). However, the outcomes of HIS implementations in both primary care and hospital settings have not met expectations. A number of research reports indicate undesired consequences (2, 3, 4, 5), also pointing out that implementation failures affect negatively the return of investments (6). In consequence, hospital managers have today realized that they may overlook interplays between the HIS and organizational performance, and in particular individual users' needs, problems, and demands, if they uncritically trust the promises made by vendors (7). This situation implies that there is an urgent need to make the best possible use of the scientific knowledge available about HIS implementation processes and their organizational consequences. Starting with a number of groundbreaking s...

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