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Published in: Journal of Medical Systems 5/2009

01-10-2009

Health Information System Implementation: A Qualitative Meta-analysis

Authors: Bahlol Rahimi, Vivian Vimarlund, Toomas Timpka

Published in: Journal of Medical Systems | Issue 5/2009

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Abstract

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.
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Literature
2.
go back to reference Kaplan, B., Culture counts: How institutional values affect computer use. MD Comput. 17:23–26, 2000. Kaplan, B., Culture counts: How institutional values affect computer use. MD Comput. 17:23–26, 2000.
3.
go back to reference Van Der Meijden, M. J., Tange, H. J., Troost, J., and Hasman, A., Determinants of success of inpatient clinical information systems: A literature review. J. Am. Med. Inform. Assoc. 10:235–243, 2003. doi:10.1197/jamia.M1094.CrossRef Van Der Meijden, M. J., Tange, H. J., Troost, J., and Hasman, A., Determinants of success of inpatient clinical information systems: A literature review. J. Am. Med. Inform. Assoc. 10:235–243, 2003. doi:10.​1197/​jamia.​M1094.CrossRef
4.
go back to reference Adi, A., Healthcare information systems: challenges of the new millennium. Idea Group Publishing, Hershey, PA, USA, 2000. Adi, A., Healthcare information systems: challenges of the new millennium. Idea Group Publishing, Hershey, PA, USA, 2000.
5.
go back to reference Paré, G., and Elam, J. J., Introducing information technology in the clinical setting. Int. Int. J. Technol. Assess. Health Care. 14:331–343, 1998.CrossRef Paré, G., and Elam, J. J., Introducing information technology in the clinical setting. Int. Int. J. Technol. Assess. Health Care. 14:331–343, 1998.CrossRef
6.
go back to reference Fullerton, C., Aponte, P., Hopkins, R., Bragg, D., and Ballard, D. J., Lessons learned from pilot site implementation of an ambulatory electronic health record. Proc. (Bayl. Univ. Med. Cent.). 19:303–310, 2006. Fullerton, C., Aponte, P., Hopkins, R., Bragg, D., and Ballard, D. J., Lessons learned from pilot site implementation of an ambulatory electronic health record. Proc. (Bayl. Univ. Med. Cent.). 19:303–310, 2006.
7.
go back to reference Harrison, M. I., Koppel, R., and Bar-Lev, S. H., Unintended consequences of information technologies in health care—An interactive sociotechnical analysis. J. Am. Med. Inform. Assoc. 14:542–549, 2007. doi:10.1197/jamia.M2384.CrossRef Harrison, M. I., Koppel, R., and Bar-Lev, S. H., Unintended consequences of information technologies in health care—An interactive sociotechnical analysis. J. Am. Med. Inform. Assoc. 14:542–549, 2007. doi:10.​1197/​jamia.​M2384.CrossRef
8.
go back to reference Forsythe, D. E., and Buchanan, B. G., Broadening our approach to evaluating medical information systems. Proc. Annu. Symp. Comput. Appl. Med. Care. 1991:8–12, 1991. Forsythe, D. E., and Buchanan, B. G., Broadening our approach to evaluating medical information systems. Proc. Annu. Symp. Comput. Appl. Med. Care. 1991:8–12, 1991.
9.
go back to reference Forsythe, D. E., Buchanan, B. G., Osheroff, J. A., and Miller, R. A., Expanding the concept of medical information: An observational study of physicians’ information needs. Comput. Biomed. Res. 25:181–200, 1992. doi:10.1016/0010-4809(92)90020-B.CrossRef Forsythe, D. E., Buchanan, B. G., Osheroff, J. A., and Miller, R. A., Expanding the concept of medical information: An observational study of physicians’ information needs. Comput. Biomed. Res. 25:181–200, 1992. doi:10.​1016/​0010-4809(92)90020-B.CrossRef
11.
go back to reference Finlayson, K. W., and Dixon, A., Qualitative meta-synthesis: A guide for the novice. Nurse Res. 15:59–71, 2008. Finlayson, K. W., and Dixon, A., Qualitative meta-synthesis: A guide for the novice. Nurse Res. 15:59–71, 2008.
12.
go back to reference Flemming, K., Synthesis of qualitative research and evidence-based nursing. Br. J. Nurs. 16:616–620, 2007. Flemming, K., Synthesis of qualitative research and evidence-based nursing. Br. J. Nurs. 16:616–620, 2007.
13.
go back to reference Noblit, G. W., and Hare, R. D., Meta-ethnography: synthesizing qualitative studies. Sage Publications, Newbury Park, CA, 1988. Noblit, G. W., and Hare, R. D., Meta-ethnography: synthesizing qualitative studies. Sage Publications, Newbury Park, CA, 1988.
14.
go back to reference Atkins, S., Lewin, S., Smith, H., Engel, M., Fretheim, A., and Volmink, J., Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Med. Res. Methodol. 16:8–21, 2008. Atkins, S., Lewin, S., Smith, H., Engel, M., Fretheim, A., and Volmink, J., Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Med. Res. Methodol. 16:8–21, 2008.
16.
go back to reference Ruland, C. M., and Ravn, I. H., Usefulness and effects on costs and staff management of a nursing resource management information system. J. Nurs. Manag. 11:208–215, 2003. Ruland, C. M., and Ravn, I. H., Usefulness and effects on costs and staff management of a nursing resource management information system. J. Nurs. Manag. 11:208–215, 2003.
18.
go back to reference Malato, L. A., and Kim, S., End-user perceptions of a computerized medication system: Is there resistance to change? J. Health Hum. Serv. Adm. 27:34–55, 2004. Malato, L. A., and Kim, S., End-user perceptions of a computerized medication system: Is there resistance to change? J. Health Hum. Serv. Adm. 27:34–55, 2004.
19.
go back to reference Poon, E. G., Blumenthal, D., Jaggi, T., Honour, M. M., Bates, D. W., and Kaushal, R., Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff. (Millwood). 23:184–190, 2004. doi:10.1377/hlthaff.23.4.184.CrossRef Poon, E. G., Blumenthal, D., Jaggi, T., Honour, M. M., Bates, D. W., and Kaushal, R., Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff. (Millwood). 23:184–190, 2004. doi:10.​1377/​hlthaff.​23.​4.​184.CrossRef
21.
go back to reference Bryson, M., Tidy, N., Smith, M., and Levy, S., An online survey of nurses’ perceptions, knowledge and expectations of the National Health Service modernization programme. J. Telemed. Telecare. 11:S164–66, 2005. doi:10.1258/1357633054461732.CrossRef Bryson, M., Tidy, N., Smith, M., and Levy, S., An online survey of nurses’ perceptions, knowledge and expectations of the National Health Service modernization programme. J. Telemed. Telecare. 11:S164–66, 2005. doi:10.​1258/​1357633054461732​.CrossRef
22.
go back to reference Pizziferri, L., Kittler, A. F., Volk, L. A., Honour, M. M., Gupta, S., Wang, S. , et al., Primary care physician time utilization before and after implementation of an electronic health record: A time-motion study. J. Biomed. Inform. 38:176–188, 2005. doi:10.1016/j.jbi.2004.11.009.CrossRef Pizziferri, L., Kittler, A. F., Volk, L. A., Honour, M. M., Gupta, S., Wang, S. , et al., Primary care physician time utilization before and after implementation of an electronic health record: A time-motion study. J. Biomed. Inform. 38:176–188, 2005. doi:10.​1016/​j.​jbi.​2004.​11.​009.CrossRef
23.
go back to reference Kamadjeu, R. M., Tapang, E. M., and Moluh, R. N., Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: A case study from Cameroon. Inform. Prim. Care. 13:179–186, 2005. Kamadjeu, R. M., Tapang, E. M., and Moluh, R. N., Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: A case study from Cameroon. Inform. Prim. Care. 13:179–186, 2005.
26.
go back to reference Lapointe, L., and Rivard, S., Getting physicians to accept new information technology: Insights from case studies. CMAJ. 174:1573–1578, 2006. doi:10.1503/cmaj.050281. Lapointe, L., and Rivard, S., Getting physicians to accept new information technology: Insights from case studies. CMAJ. 174:1573–1578, 2006. doi:10.​1503/​cmaj.​050281.
27.
go back to reference Paré, G., Sicotte, C., and Jacques, H., The effects of creating psychological ownership on physicians’ acceptance of clinical information systems. J. Am. Med. Inform. Assoc. 13:197–205, 2006. doi:10.1197/jamia.M1930.CrossRef Paré, G., Sicotte, C., and Jacques, H., The effects of creating psychological ownership on physicians’ acceptance of clinical information systems. J. Am. Med. Inform. Assoc. 13:197–205, 2006. doi:10.​1197/​jamia.​M1930.CrossRef
28.
go back to reference Møller-Jensen, J., Lund Pedersen, I., and Simonsen, J., Measurement of the clinical usability a configurable HER. Stud. Health Technol. Inform. 124:356–361, 2006. Møller-Jensen, J., Lund Pedersen, I., and Simonsen, J., Measurement of the clinical usability a configurable HER. Stud. Health Technol. Inform. 124:356–361, 2006.
29.
go back to reference Machan, C., Ammenwerth, E., and Schabetsberger, T., Evaluation of the electronic transmission of medical findings from hospitals to practitioners by triangulation. Methods Inf. Med. 45:225–233, 2006. Machan, C., Ammenwerth, E., and Schabetsberger, T., Evaluation of the electronic transmission of medical findings from hospitals to practitioners by triangulation. Methods Inf. Med. 45:225–233, 2006.
30.
go back to reference Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K., Campbell, E., and Dykstra, R. H., The extent and importance of unintended consequences related to computerized provider order entry. J. Am. Med. Inform. Assoc. 14:415–423, 2007. doi:10.1197/jamia.M2373.CrossRef Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K., Campbell, E., and Dykstra, R. H., The extent and importance of unintended consequences related to computerized provider order entry. J. Am. Med. Inform. Assoc. 14:415–423, 2007. doi:10.​1197/​jamia.​M2373.CrossRef
31.
go back to reference Samoutis, G., Soteriades, E. S., Kounalakis, D. K., Zachariadou, T., Philalithis, A., and Lionis, C., Implementation of an electronic medical record system in previously computer-naïve primary care centres: A pilot study from Cyprus. Inform. Prim. Care. 15:4207–216, 2007. Samoutis, G., Soteriades, E. S., Kounalakis, D. K., Zachariadou, T., Philalithis, A., and Lionis, C., Implementation of an electronic medical record system in previously computer-naïve primary care centres: A pilot study from Cyprus. Inform. Prim. Care. 15:4207–216, 2007.
32.
go back to reference Rahimi, B., Moberg, A., Timpka, T., and Vimarlund, V., Implementing an integrated computerized patient record system: Toward an evidence-based information system implementation practice in healthcare. AMIA Annu. Symp. Proc. (in press), 2008. Rahimi, B., Moberg, A., Timpka, T., and Vimarlund, V., Implementing an integrated computerized patient record system: Toward an evidence-based information system implementation practice in healthcare. AMIA Annu. Symp. Proc. (in press), 2008.
33.
go back to reference Silverstone, R., and Haddon, L., Design and the domestication of information and communication technologies: technical change and everyday life. In: Marshell, R., and Silverstong, R. (Eds.), Communication Design: The politics of Information and Communication TechnologyOxford University Press, Oxford, 1996. Silverstone, R., and Haddon, L., Design and the domestication of information and communication technologies: technical change and everyday life. In: Marshell, R., and Silverstong, R. (Eds.), Communication Design: The politics of Information and Communication TechnologyOxford University Press, Oxford, 1996.
34.
go back to reference Vimarlund, V., Eriksson, H., and Timpka, T., Economic motives to use a participatory design approach in the development of public-health information systems. Medinfo. 10:768–772, 2001. Vimarlund, V., Eriksson, H., and Timpka, T., Economic motives to use a participatory design approach in the development of public-health information systems. Medinfo. 10:768–772, 2001.
36.
go back to reference Paré, G., Sicotte, C., Jaana, M., and Girouard, D., Prioritizing the risk factors influencing the success of clinical information system projects. A Delphi study in Canada. Methods Inf. Med. 47:251–259, 2008. Paré, G., Sicotte, C., Jaana, M., and Girouard, D., Prioritizing the risk factors influencing the success of clinical information system projects. A Delphi study in Canada. Methods Inf. Med. 47:251–259, 2008.
37.
go back to reference Pilemalm, S., and Timpka, T., Third generation participatory design in health informatics-making user participation applicable to large-scale information system projects. J. Biomed. Inform. 41:327–339, 2007. doi:10.1016/j.jbi.2007.09.004.CrossRef Pilemalm, S., and Timpka, T., Third generation participatory design in health informatics-making user participation applicable to large-scale information system projects. J. Biomed. Inform. 41:327–339, 2007. doi:10.​1016/​j.​jbi.​2007.​09.​004.CrossRef
38.
go back to reference Sjöberg, C., and Timpka, T., Participatory design of information systems in health care. J. Am. Med. Inform. Assoc. 5:177–183, 1998. Sjöberg, C., and Timpka, T., Participatory design of information systems in health care. J. Am. Med. Inform. Assoc. 5:177–183, 1998.
39.
go back to reference Faber, M. G., Design and introduction of an electronic patient record: How to involve users? Methods Inf. Med. 42:371–375, 2003. Faber, M. G., Design and introduction of an electronic patient record: How to involve users? Methods Inf. Med. 42:371–375, 2003.
41.
go back to reference Reis, S., Hermoni, D., Van-Raalte, R., Dahan, R., and Borkan, J. M., Aggregation of qualitative studies—From theory to practice: Patient priorities and family medicine/general practice evaluations. Patient Educ. Couns. 65:214–222, 2007. doi:10.1016/j.pec.2006.07.011.CrossRef Reis, S., Hermoni, D., Van-Raalte, R., Dahan, R., and Borkan, J. M., Aggregation of qualitative studies—From theory to practice: Patient priorities and family medicine/general practice evaluations. Patient Educ. Couns. 65:214–222, 2007. doi:10.​1016/​j.​pec.​2006.​07.​011.CrossRef
Metadata
Title
Health Information System Implementation: A Qualitative Meta-analysis
Authors
Bahlol Rahimi
Vivian Vimarlund
Toomas Timpka
Publication date
01-10-2009
Publisher
Springer US
Published in
Journal of Medical Systems / Issue 5/2009
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI
https://doi.org/10.1007/s10916-008-9198-9

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