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

<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> <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&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> <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> <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

Towards an evaluation framework for medical web applications

Copyright @ 2013 EMCIS.The main aim of this study is to review and analyse various evaluation frameworks used to assess the operational effectiveness of various Information Technology (IT) processes/applications and identify their strengths in order to form a new holistic framework for economic evaluation of web applications. This research aims to address the need for a new holistic evaluation framework for the purpose of the evaluation of the medical web applications. Over the last decade more and more, companies used accountancy techniques such as the frameworks analysed in this research. This new holistic framework that was developed will include also steps regarding the indirect and intangible costs and benefits identification and their incorporation in the evaluation process. Moreover the new emerging market of the medical websites and the embedded on them web applications requires also a new evaluation framework that will provide accurate results in the estimation of the efficiency of an investment on them. The paper first presents an introduction about why economic evaluation is important when evaluating the Information Technology in organizations. Various studies are reviewed, which highlight the ever increasing importance of integrating economic evaluation processes, such as Cost Benefit Analysis (CBA) and Return on Investment (ROI), into systems and processes of organizations and economic organizations, and analyse the factors that govern their role. Finally, the evaluation frameworks and methods that are found in these studies should be used as a part of a proactive systematic action plan that the organizations could use to avoid budget reduction due to incorrect planning. The next part of this study includes a comprehensive presentation and review of past frameworks used to evaluate Information Technology. The frameworks that are reviewed are the Framework for evaluation of information systems, the Information Technology Adoption Model (ITAM), the Total Evaluation and Acceptance Methodology (TEAM) framework, the ROI Process Model and HOT-fit evaluation framework for Health Information Systems

Accessing Antecedents and Outcomes of RFID Implementation in Health Care

This research first conceptualizes, develops, and validates four constructs for studying RFID in health care, including Drivers (Internal and External), Implementation Level (Clinical Focus and Administrative Focus), Barriers (Cost Issues, Lack of Understanding, Technical Issues, and Privacy and Security Concerns), and Benefits (Patient Care, Productivity, Security and Safety, Asset Management, and Communication). Data for the study were collected from 88 health care organizations and the measurement scales were validated using structural equation modeling. Second, a framework is developed to discuss the causal relationships among the above mentioned constructs. It is found that Internal Drivers are positively related to Implementation Level, which in turn is positively related to Benefits and Performance. In addition, Barriers are found to be positively related to Implementation Level, which is in contrast to the originally proposed negative relationship. The research also compares perception differences regarding RFID implementation among the non-implementers, future implementers, and current implementers of RFID. It is found that both future implementers and current implementers consider RFID barriers to be lower and benefits to be higher compared to the non-implementers. This paper ends with our research implications, limitations and future research

The rationale of e-health evaluation: The case of NHS Direct

An important area of research is that of the evaluation of e-health services. A holistic e-health evaluation framework should address the aspects that are hampering healthcare services from embracing the full potential of information and communication technologies towards successful e-health initiatives. Towards building a holistic evaluation framework for e-health services, this paper is intended to examine the rationale of e-health evaluation, as the paper argues that this aspect should be addressed first in the development of such a framework. NHS Direct which is one of the largest e-health services in the world has been chosen to discuss and validate a set of evaluation rationales and their applicability in practice

Realising benefits in primary healthcare infrastructures

Purpose: This paper focuses upon the requirements to manage change, tangible and intangible benefits in a joint approach to deliver outputs on time, to quality and cost without failing to realise the benefits of the change. The aim of the paper is to demonstrate the need for benefits driven programme/project management as well as the importance of identifying the stakeholders’ level of involvement and contribution throughout the process, and manage their expectations. Design/methodology/approach: The methodology used is based on an action research approach, combining findings from a literature review and case studies within UK’s primary healthcare sector. Findings: Findings demonstrate development of a Benefits Realisation (BeReal) approach in healthcare through looking at case studies taking place within UK’s primary and acute healthcare sector Research limitations/implications: The framework development is based upon theoretical evidence and further research is needed to test and validate its robustness. Originality/value: The application of Benefits Realisation and Management in developing and delivering primary healthcare facilities. Keywords: Benefits management, Benefits realisation, healthcare infrastructures, process and LIF

Reviewing the Drivers and Challenges in RFID Implementation in the Pharmaceutical Supply Chain

Counterfeiting is a global phenomenon that poses a serious financial threat to the pharmaceutical industry and more importantly jeopardizes public safety and security. Different measures, including new laws and regulations, have been put in place to mitigate the threat and tighten control in the pharmaceuticals supply chain. However, it appears that the most promising countermeasure is track-and-trace technology such as electronic-pedigree (E-pedigree) with Radio Frequency Identification (RFID) technology. In this study we present a framework exploring the antecedents and consequences of RFID applications in the pharmaceutical supply chain. The framework proposes that counterfeiting and E-pedigree regulation will drive the implementation of RFID in the pharmaceutical supply chain, which in turn provides strategic and operational benefits that enable competitive advantage. Meanwhile, the implementation of RFID requires overcoming many operational, technical and financial challenges. The framework provides a springboard that future study can explore using empirical data

A Methodological Approach for Measuring the Impact of HTA

There is a lack of evidence concerning the link between HTA and outcomes in terms of health improvements. This work proposes a framework for assessing the impact of HTA. This impact assessment is a necessary step in then better understanding the value for money of HTA bodies. We emphasis that this is still a work in progress. iDSI has developed a theory of change-based framework in order to evaluate the impact the iDSI has on institutional strengthening – leading to ‘better decisions’ for ‘better health’. This framework recognises that there is a complex translation process between better decisions and better health dependent on many assumptions about local factors and systems, including linkage between decisions and budgets, delivery, implementation, and data accuracy. Work has been undertaken over the last 6 months developing a methodological approach for measuring the impact of health technology assessment (HTA). Two case studies are used to illustrate the approach. At the core of impact assessment is a requirement to link causes and effects, to explain ‘how’ and ‘why’ and to identify – and thus improve or adapt – mechanisms leading to impact. Policy makers also want to know ‘to what extent’ or ‘the magnitude of impact’. The framework developed adopts an economic approach nested in theory of change as a means of both quantifying the magnitude of impact (utilising economic models) as well as explaining why and how impact happens (drawing on theory based approaches) in order to reinforce learning as to how to improve our response and optimise the use of HTA to have the greatest impact in a given context. This should also enable us to capture and explain wider impact – perhaps more intangible aspects which cannot be easily quantified. This may also possibly increase policy-makers’ ‘buy-in’

Implementing centralised IT service management: drawing lessons from the public sector

[Abstract]: The IT service management model represents a paradigm shift for IT organisations as it deemphasizes the management of IT assets and focuses on the provision of quality end-to-end IT services. This paper presents part of an in-depth study that examines the experience of a government agency, Queensland Health, in the implementation of a centralised IT service management model based on the ITIL framework. The paper sheds light on the challenges and breakthroughs, distils a set of critical success factors and offers a learning opportunity for other organisations. Outsourcing some activities and tool requirements to vendors was seen as one contributor to success although ensuring effective technology transfer to in-house staff was also necessary. Another success factor was centralisation of IT services. Commitment of senior management was also crucial as was a recognition of the need for effective change management to transform the organisational culture to a service-oriented focus

Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review

OBJECTIVE: To systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject.METHODS: MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.FINDINGS: Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (i) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii) effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation processes might be reconfigured by user-produced knowledge.CONCLUSION: The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.<br/

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