Barriers to the adoption of health information technology

Information Technology (IT) is successfully applied in a diverse range of fields. Though, the field of Medical Informatics is more than three decades old, it shows a very slow progress compared to many other fields in which the application of IT is growing rapidly. The spending on IT in health care is shooting up but the road to successful use of IT in health care has not been easy. This paper discusses about the barriers to the successful adoption of information technology in clinical environments and outlines the different approaches used by various countries and organisations to tackle the issues successfully. Investing financial and other resources to overcome the barriers for successful adoption of HIT is highly important to realise the dream of a future healthcare system with each customer having secure, private Electronic Health Record (EHR) that is available whenever and wherever needed, enabling the highest degree of coordinated medical care based on the latest medical knowledge and evidence. Arguably, the paper reviews barriers to HIT from organisations’ alignment in respect to the leadership; with their stated values when accepting or willingness to consider the HIT as a determinant factor on their decision-making processes. However, the review concludes that there are many aspects of the organisational accountability and readiness to agree to the technology implementation

The driving force of government in promoting BIM implementation

The adoption of Building Information Modelling (BIM) is one of the greatest technological innovations in the construction industry to date. However, the implementation of BIM lags far behind its potential due to the existence of various barriers. Strong government support is critical for the successful development and deployment of complex technology systems. BIM could seek government support to drive its implementation process and overcome the barriers. Through a survey, this paper aims to discover stakeholders’ expectations of the government role in BIM implementation and explores specific ways for governments to promote BIM implementation. The research findings are expected to assist related departments to accelerate BIM implementation

Achieving Excellence in Lean Implementation at Construction Companies - A Case Study from Brazil

Lean Construction has become a popular concept to improve performance and reduce costs in construction projects. Assessment tools and implementation strategies that focus on lean practices such as the Last Planner® System, the use of Kanbans, the routine of Kaizens and, recently, the integration with information technology are also common. However, barriers to the wide adoption of lean principles remain and implementation challenges continue to intrigue scholars. Previous studies suggest that barriers to the successful implementation can be either political, economical, social and/or technical, with the focus on lack of knowledge about lean concepts, resistance to the required organisational culture change, and lack of support from top management. Few studies present the lean implementation process from the practitioners' perspective. Using the narrative enquiry methodology, the authors aim to describe how a construction company from Brazil matured from the implementation of lean operational tools to achieve excellence in the lean culture and mindset. Key themes that emerge from this study for a successful lean construction journey are; effort to stabilise the environment, knowledge creation and management, transparency in the process to enable simplicity and shared understanding, and building trust for further growth

ISM analysis of CPFR implementation barriers

Collaborative Planning, Forecasting and Replenishment (CPFR) as an interconnection scheme between organizations has been shown to have significant benefits. Since its inception in the 1990s, its uptake has been lower than originally predicted. This paper identifies the major barriers and their interrelationships in CPFR implementations with a focus on high-tech industries. Interpretive Structural Modeling (ISM) is used with a group of CPFR experts from industry/academia and Matrice d’Impacts Croisés Multiplication Appliquée àun Classement (MICMAC) analysis to identify the driving and dependence powers. The paper identified 45 CPFR barriers and classifies them into four categories based on expert opinion, with only 13 of these determined to be significant. The results indicate that in terms of categories, managerial barriers are a significant root cause for both process and cultural barriers and CPFR implementation difficulties. It also indicates that although the importance of information technology to launch collaborative schemes has been addressed by many scholars, technology alone is not the complete solution for successful CPFR implementation. The paper has significant practical implications for organizations as it identifies the main CPFR barriers and their causal relationships. This will help firms in the process of CPFR strategy development particularly for mitigation strategies for dominant barriers

General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease:implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

<strong>Objective</strong> The Scottish Care Information - Diabetes Collaboration (SCI-DC) developed a computer- based information system to create a shared electronic record for use by all involved in the care of patients with diabetes mellitus. The objectives of this study were to understand primary care practitioners' views towards screening for diabetic foot disease and their experience of the SCI-DC system. <strong>Method</strong> We conducted an exploratory study using qualitativemethods. Semi-structured interviews were audiotape-recorded, transcribed and subjected to thematic analysis. Seven practice nurses and six general practitioners (GPs) with special responsibility for diabetes care inNHS Lothian participated. <strong>Results</strong> Primary care clinicians reported good systems in place to screen for diabetes-related complications and to refer their patients to specialist care. Foot ulceration was rarely observed; other diabetesrelated conditions were seen as a higher priority. Most had heard of the SCI-DC foot assessment tool, but its failure to integrate with other primary care information technology (IT) systems meant it was not used in these general practices. <strong>Conclusions</strong> Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption

What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review

Background Technological support may be crucial in optimizing healthcare professional practice and improving patient outcomes. A focus on electronic health records has left other technological supports relatively neglected. Additionally, there has been no comparison between different types of technology-based interventions, and the importance of delivery setting on the implementation of technology-based interventions to change professional practice. Consequently, there is a need to synthesise and examine intervention characteristics using a methodology suited to identifying important features of effective interventions, and the barriers and facilitators to implementation. Three aims were addressed: to identify interventions with a technological component that are successful at changing professional practice, to determine if and how such interventions are theory-based, and to examine barriers and facilitators to successful implementation. Methods A literature review informed by realist review methods was conducted involving a systematic search of studies reporting either: (1) behavior change interventions that included technology to support professional practice change; or (2) barriers and facilitators to implementation of technological interventions. Extracted data was quantitative and qualitative, and included setting, target professionals, and use of Behaviour Change Techniques (BCTs). The primary outcome was a change in professional practice. A thematic analysis was conducted on studies reporting barriers and facilitators of implementation. Results Sixty-nine studies met the inclusion criteria; 48 (27 randomized controlled trials) reported behavior change interventions and 21 reported practicalities of implementation. The most successful technological intervention was decision support providing healthcare professionals with knowledge and/or person-specific information to assist with patient management. Successful technologies were more likely to operationalise BCTs, particularly “instruction on how to perform the behavior”. Facilitators of implementation included aligning studies with organisational initiatives, ensuring senior peer endorsement, and integration into clinical workload. Barriers included organisational challenges, and design, content and technical issues of technology-based interventions. Conclusions Technological interventions must focus on providing decision support for clinical practice using recognized behavior change techniques. Interventions must consider organizational context, clinical workload, and have clearly defined benefits for improving practice and patient outcomes

Bronchial thermoplasty: implementing best practice in the era of cost containment.

Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine. Bronchial thermoplasty (BT), a US Food and Drug Administration approved bronchoscopy procedure in difficult-to-control persistent asthma, is a prime example of a new technology facing cost and implementation challenges. We discuss the specific indications and contraindications for BT and review recent real-world experiences that can provide the foundation for building a comprehensive asthma program that provides BT for difficult-to-control asthma patients who fail national guideline treatment recommendations after an adequate clinical trial of one. We also offer insight into the barriers to implementing a successful BT program and strategies for overcoming them

Investigating Ruptures in Shared Understanding as Recursive Cycles of Mutual Adaptation During Implementation

Shared understanding between diverse technology stakeholders is a key driver of IT-Business alignment, also underpinning successful adaptive, IS development activities. Lack of shared understanding creates representational gaps, innovation blindness and different technology frames which create barriers to development and implementation of technology. Applying a socio-material perspective to Leonard-Barton’s model of mutual adaptation between technology and organization, as well as research on shared capabilities between IS and business stakeholders, we examine the process by which shared understanding emerges during the design, development and implementation of IT systems. We followed key multi-disciplinary stakeholder groups over a two-year period during the development and implementation of a health information system. We report on events during the project that we call ruptures – highly charged incidents which reveal a lack shared understanding between stakeholders. We argue that ruptures occur during the mutual adaptation of organizational and technological elements necessitated by the implementation process and are precipitated by the constitutive entanglement of social and technological elements. They reveal serious misalignments among stakeholders and in relation to the technology as its material properties become more concrete. We investigate the emergence of ruptures and the mechanisms by which they influence stakeholders, the implementation process and its outcomes

A Smart Contract Architecture Framework for Successful Industrial Symbiosis Applications Using Blockchain Technology

Funding Information: Author acknowledges Fundação para a Ciência e a Tecnologia (FCT-MCTES) for its financial support via the project UIDB/00667/2020 (UNIDEMI). Publisher Copyright: © 2023 by the authors.Industrial Symbiosis (IS) involves a network of organizations that exchange energy, materials, and by-products to lower production costs, reduce environmental impact, and conserve natural resources. Despite over two decades of extensive research into IS, its benefits are well known, but implementation remains challenging. This paper proposes utilizing blockchain technology (BCT) to digitize IS, making it more secure and transparent. First, drivers and barriers of BCT implementation in IS are identified. A smart contract architecture framework using Hyperledger Fabric is then proposed using the constructed theoretical background and abductive method. Finally, the paper discusses how this framework supports the implementation of BCT in IS by addressing its drivers and attempting to overcome its barriers. It is a resource for those seeking a comprehensive grasp of the foundational elements necessary for constructing a successful IS blockchain design, which is adaptable to all types of IS network configurations.publishersversionpublishe

The Causes Affecting Attrition Among Industrial Technology Students And A Proposed Program To Increase Retention At Monroe County Community College

The purpose of this Major Applied Research Project was to (1) conduct an investigation of students majoring in the industrial technology division to determine the forces which influence attrition and persistence; (2) design a retention program to counter Pie attrition problem; and (3) suggest an implementation plan to increase technology retention at Monroe County Community College. With an increasing attrition problem, decision makers at MCCC supported this study with the hope that a program could be developed to increase technology retention. Six basic research questions were examined: 1. What factors are associated with at-risk industrial technology students at MCCC? 2. What institutional barriers to retention or sources of assistance currently exist at MCCC for potential dropouts? 3. How can the retention of industrial technology students at MCCC be increased and attrition be decreased? 4. What role can MCCC faculty and graduates of the industrial technology division play in assisting potential dropouts. 5. What successful retention strategies exist elsewhere? 6. What retention strategies would seem to be most appropriate for implementation at MCCC? A case study research methodology was used in this study. In this process. (1) an extensive literature review was conducted to gather information on factors associated with at-risk technical students. (2) an In-depth identification of the present sources at MCCC that either assist or are barriers to retention was outlined, (3) surveys to technology dropouts, faculty members and current students were administered to provide information which may have been unique to technology programs, students or staff at MCCC. (4) enrollment data were collected to report withdrawal patterns in technology courses and a follow-up investigation was conducted to determine each student\u27s academic standing one year later. (5) results of the industrial technology student survey were used to report reasons for initial enrollment as a technology major. (6) survey and interviews with Michigan community college technology administrators were used to obtain information on successful retention efforts, and (7) on-site visits were made to four selected colleges to observe specific retention strategies in action. A number of conclusions were reached as a result of this investigation. First, it was impossible to isolate a single cause for college departure. Secondly, the positive effects of technology student departure may be closely related to employment availability for minimally skilled workers. A third conclusion was that the primary persistence factor may be the student’s identification with those at the college. It was also concluded that no simple solutions exist for high attrition, however. improvement is possible through systematic, targeted approaches. One feature which was concluded to be present in nearly all successful programs was some form of special counseling. Further, it was concluded that successful retention programs were conducted without the need for large financial increases in operating expenses. The final conclusion supported the need for a retention program to facilitate the academic success of Monroe County Community College’s technology students. Suggested recommendations were the following (1) that the proposed retention program be adopted and implemented; (2) that the approach of retention be preventive rather than predictive: (3) that the goal be on education rather than merely retaining students; (4) that the present barriers to potential dropouts be addressed; (5) that the program be a holistic, collaborative venture which is visible at all levels of the institution: (6) that ongoing research and evaluation of the program be instituted: and (7) that the program becomes a catalyst for ethers to increase their retention efforts. The final product of this developmental case study was the design of Operation Facilitating Academic Success in Technology (FAST). Specific goals. objectives, components, responsibilities. and costs are included. In addition, an implementation plan and evaluation system are identified