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Health Information System Implementation: A Qualitative Meta-analysis
Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.ORCID iD: 0000-0001-6049-5402
2009 (English)In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 33, no 5, 359-368 p.Article in journal (Refereed) Published
Abstract [en]

Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.

Place, publisher, year, edition, pages
Springer Netherlands , 2009. Vol. 33, no 5, 359-368 p.
Keyword [en]
Health information system, Implementation, Qualitative methods, Meta-analysis
National Category
Biomedical Laboratory Science/Technology
Identifiers
URN: urn:nbn:se:liu:diva-15673DOI: 10.1007/s10916-008-9198-9OAI: oai:DiVA.org:liu-15673DiVA: diva2:126917
Note
The original publication is available at www.springerlink.com: Bahlol Rahimi, Vivian Vimarlund and Toomas Timpka, Health Information System Implementation: A Qualitative Meta-analysis, 2009, Journal of medical systems, (33), 5, 359-368. http://dx.doi.org/10.1007/s10916-008-9198-9 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Implementation of Health Information Systems
Open this publication in new window or tab >>Implementation of Health Information Systems
2008 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare organizations now consider increased efficiency, reduced costs, improved patient care and quality of services, and safety when they are planning to implement new information and communication technology (ICT) based applications. However, in spite of enormous investment in health information systems (HIS), no convincing evidence of the overall benefits of HISs yet exists. The publishing of studies that capture the effects of the implementation and use of ICT-based applications in healthcare may contribute to the emergence of an evidence-based health informatics which can be used as a platform for decisions made by policy makers, executives, and clinicians. Health informatics needs further studies identifying the factors affecting successful HIS implementation and capturing the effects of HIS implementation. The purpose of the work presented in this thesis is to increase the available knowledge about the impact of the implementation and use of HISs in healthcare organizations. All the studies included in this thesis used qualitative research methods. A case study design and literature review were performed to collect data.

This thesis’s results highlight an increasing need to share knowledge, find methods to evaluate the impact of investments, and formulate indicators for success. It makes suggestions for developing or extending evaluation methods that can be applied to this area with a multi-actor perspective in order to understand the effects, consequences, and prerequisites that have to be achieved for the successful implementation and use of IT in healthcare. The results also propose that HIS, particularly integrated computer-based patient records (ICPR), be introduced to fulfill a high number of organizational, individualbased, and socio-technical goals at different levels. It is therefore necessary to link the goals that HIS systems are to fulfill in relation to short-term, middle-term, and long-term strategic goals. Another suggestion is that implementers and vendors should direct more attention to what has been published in the area to avoid future failures.

This thesis’s findings outline an updated structure for implementation planning. When implementing HISs in hospital and primary-care environments, this thesis suggests that such strategic actions as management involvement and resource allocation, such tactical action as integrating HIS with healthcare workflow, and such operational actions as user involvement, establishing compatibility between software and hardware, and education and training should be taken into consideration.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 17 p.
Series
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1387
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:liu:diva-15677 (URN)LiU-Tek-Lic-2008:45 (Local ID)978-91-7393-745-0 (ISBN)LiU-Tek-Lic-2008:45 (Archive number)LiU-Tek-Lic-2008:45 (OAI)
Presentation
2008-12-15, Alan Turing, hus E, Campus Valla, Linköpings universitet, Linköping, 10:15 (English)
Opponent
Supervisors
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2013-09-05Bibliographically approved
2. Supporting Collaborative Work through ICT: How End-users Think of and Adopt Integrated HealthInformation Systems
Open this publication in new window or tab >>Supporting Collaborative Work through ICT: How End-users Think of and Adopt Integrated HealthInformation Systems
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Health Information Systems (HISs) are implemented to support individuals,organizations, and society, making work processes integrated andcontributing to increase service quality and patient safety. However, theoutcomes of many HIS implementations in both primary care and hospitalsettings have either not met yet all the expectations decision-makersidentified or have failed in their implementation. There is, therefore, agrowing interest in increasing knowledge about prerequisites to be fulfilledin order to make the implementation and adoption of HIS more effective andto improve collaboration between healthcare providers.

The general purpose of the work presented in this thesis is to explore issuesrelated to the implementation, use, and adoption of HISs and its contributionfor improving inter- and intra-organizational collaboration in a healthcarecontext. The studies included have, however, different research objectivesand consequently used different research methods such as case study,literature review, meta-analysis, and surveys. The selection of the researchmethodology has thus depended on the aim of the studies and their expectedresults.

In the first study performed we showed that there is no standard frameworkto evaluate effects and outputs of implementation and use of ICT-basedapplications in the healthcare setting, which makes the comparison ofinternational results not possible yet.

Critical issues, such as techniques employed to teach the staff when usingintegrated system, involvement of the users in the implementation process,and the efficiency of the human computer interface were particularlyreported in the second study included in this thesis. The results of this studyalso indicated that the development of evidence-based implementation processes should be considered in order to diminish unexpected outputs thataffect users, patients and stakeholders.

We learned in the third study, that merely implementing of a HIS will notautomatically increase organizational efficiency. Strategic, tactical, andoperational actions have to be taken into consideration, includingmanagement involvement, integration in healthcare workflow, establishingcompatibility between software and hardware, user involvement, andeducation and training.

When using an Integrated Electronic Prescribing System (IEPS), pharmaciesstaff declared expedited the processing of prescriptions, increased patientsafety, and reduced the risk for prescription errors, as well as the handingover of erroneous medications to patients. However, they stated also that thesystem does not avoid all mistakes or errors and medication errors stilloccur. We documented, however, in general, positive opinions about theIEPS system in the fifth article. The results in this article indicated thatsafety of the system compared to a paper-based one has increased. Theresults showed also an impact on customer relations with the pharmacy; andprevention of errors. However, besides finding an adoption of the IEPS, weidentified a series of undesired and non planned outputs that affect theefficiency and efficacy of use of the system.

Finally, we captured in the sixth study indications for non-optimality in thecomputer provider entry system. This is because; the system was not adaptedto the three-quarters of physicians and one-half of nurses’ specificprofessional practice. Respondents pointed out also human-computerinteraction constrains when using the system. They indicated also the factthat the system could lead to adverse drug events in some circumstances.

The work presented in this thesis contributes to increase knowledge in thearea of health informatics on how ICT supports inter- and intraorganizationalcollaborative work in a healthcare context and to identifyfactors and prerequisites needed to be taken into consideration whenimplementing new generations of HIS.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 61 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1268
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-20572 (URN)978-91-7393-550-0 (ISBN)
Public defence
2009-10-09, Planck, Fysikhuset, Campus Valla, Linköpings universitet, Linköping, 10:15 (English)
Opponent
Supervisors
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2013-09-05Bibliographically approved

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Rahimi, BahlolVimarlund, VivianTimpka, Toomas

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