Skip to main content
Article thumbnail
Location of Repository

Why is it difficult to implement e-health initiatives? A qualitative study

By E. Murray, J. Burns, C. May, T. Finch, C. O'Donnell, P. Wallace and F. Mair

Abstract

<b>Background</b> The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.<p></p>\ud \ud <b>Methods</b> We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&#38;B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).<p></p>\ud \ud <b>Results</b> Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.<p></p>\ud \ud <b>Conclusions</b> Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning

Topics: RA
Publisher: BioMed Central
Year: 2011
OAI identifier: oai:eprints.gla.ac.uk:47538
Provided by: Enlighten

Suggested articles

Citations

  1. (1999). A hospital-wide picture archiving and communication system (PACS): the views of users and providers of the radiology service at Hammersmith Hospital. Eur J Radiol doi
  2. (2009). A PACS maturity model: A systematic meta-analytic review on maturation and evolvability of PACS in the hospital enterprise. doi
  3. (2006). A rational model for assessing and evaluating complex interventions in health care.
  4. (2009). Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. doi
  5. (2009). al: An implementation research agenda. Implementation Science doi
  6. (2009). al: Understanding the implementation and integration of e-Health Services. Report for the NHS Service and Delivery R and D Organisation (NCCSDO).
  7. (2006). Case study: a bridge across the paradigms. Nurs Inq doi
  8. (2005). Choose and book. By the book. Health Serv J
  9. (2009). Clinical Effectiveness Research Agenda Group: An Implementation Research Agenda. A report prepared for the High Level Group on Clinical Effectiveness. London: Department of Health;
  10. (2003). Collerette P: Why do people use information technology? A critical review of the technology acceptance model. Information and Management doi
  11. (2007). Computer says yes–and no. BMJ doi
  12. CR: Teledermatology in the UK: lessons in service innovation.
  13. (2007). Determinants of implementation effectiveness: adapting a framework for complex innovations. Med Care Res Rev doi
  14. (2008). DW: The use of health information technology in seven nations. doi
  15. (2006). E: Costs and Benefits of Health Information Technology. Rockville: Agency for Healthcare Research and Quality;
  16. (1999). Enhancing the quality of case studies in health services research. Health Serv Res.
  17. (2006). et al: Assessing the level of healthcare information technology adoption in the United States: a snapshot. BMC Med Inform Decis Mak
  18. (2009). et al: Development of a theory of implementation and integration: Normalization Process Theory. Implement Sci doi
  19. (2006). et al: Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med doi
  20. (2010). et al: The role of academic health science systems in the transformation of medicine. Lancet doi
  21. (2007). et al: Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res doi
  22. (2003). From best evidence to best practice: effective implementation of change in patients’ care. Lancet doi
  23. (2003). Gask L: Integrating service development with evaluation in telehealthcare: an ethnographic study. BMJ doi
  24. (2007). Health, technology and society: a sociological critique. doi
  25. (2009). Hospital boss hits out at new computer system. The Independent
  26. (2010). How the Performance of the U.S. Health Care System Compares Internationally. New York: Commonwealth Fund;
  27. (2009). Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology doi
  28. (2009). Information and communications technology in U.S. health care: why is adoption so slow and is slower better? J Health Polit Policy Law doi
  29. (2006). L: A balanced evaluation perspective: picture archiving and communication system impacts on hospital workflow. doi
  30. (2006). Lacity MC: A review of the predictors, linkages, and biases in IT innovation adoption research. doi
  31. (2002). Lowe A: To reveal is to critique: actor-network theory and critical information systems research. doi
  32. (2009). NHS Connecting for Health: The cost of the National Programme for IT is spiralling.
  33. (2006). Office: The National Programme for IT in the NHS. London: The Stationery Office; doi
  34. (1999). Patient care information systems and health care work: a sociotechnical approach. doi
  35. (2007). PCTs still only half way to choose and book target. Health Serv J
  36. (2008). Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clin Radiol doi
  37. (2008). Priedane E: Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study. BMJ doi
  38. (2009). Qualitative case study methodology in nursing research: an integrative review. doi
  39. (1994). Qualitative data for applied policy research. In Analysing Qualitative Data. Edited by: Bryman doi
  40. (2000). S: Practical considerations in case study research: the relationship between methodology and process. doi
  41. (2008). SC: Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease. Chronic Illn doi
  42. (2007). TB: Technology acceptance among physicians: a new take on TAM. Med Care Res Rev doi
  43. (2008). Telemedicine in interdisciplinary work practices: on an IT system that met the criteria for success set out by its sponsors, yet failed to become part of every-day clinical routines. BMC Med Inform Decis Mak doi
  44. (2008). The meaning of translational research and why it matters. JAMA doi
  45. (1999). The World Health Report 1999: Making a Difference. Geneva: The World Health Organisation; doi
  46. (2010). Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory. Soc Sci Med doi
  47. (2007). TL: Process evaluation for complex interventions in primary care: understanding trials using the normalization process model. BMC Fam Pract doi
  48. (1999). Using reflexivity to optimize teamwork in qualitative research. Qual Health Res doi
  49. (2010). What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model. Implement Sci doi
  50. (2006). Will Connecting for Health deliver its promises? BMJ doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.