Taxonomy of delays in the implementation of hospital computerized physician order entry and clinical decision support systems for prescribing:a longitudinal qualitative study

BACKGROUND: Implementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays. METHODS: We undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U.K. We used a combination of semi-structured interviews from six case study sites and two whole day expert roundtable discussions to collect data. Interviews were carried out with users, implementers and suppliers of CPOE/CDS systems. We used thematic analysis to examine the results, drawing on perspectives surrounding the biography of artefacts. RESULTS: We identified 15 major factors contributing to delays in implementation of CPOE and CDS systems. These were then categorized in a two-by-two delay classification matrix: one axis distinguishing tactical versus unintended causes of delay, and the second axis illustrating internal i.e., (the adopting hospital) versus external (i.e., suppliers, other hospitals, policymakers) related causes. CONCLUSIONS: Our taxonomy of delays in HIT implementation should enable system developers, implementers and policymakers to better plan and manage future implementations. More detailed planning at the outset, considering long-term strategies, sustained user engagement, and phased implementation approaches appeared to reduce the risks of delays. It should however be noted that whilst some delays are likely to be preventable, other delays cannot be easily avoided and taking steps to minimize these may negatively affect the longer-term use of the system

The Need for Improved Integration between PLM and KM: A PLM Services Provider Point of View

Part 1: Knowledge ManagementInternational audienceWith widespread use of digital tools in industry, an increasing amount of data and knowledge can be edited, shared and made accessible throughout the product lifecycle. As such, new technologies, that provide a formal framework for managing and organizing the intellectual assets of a business, can significantly influence the application of knowledge and the extent to which this knowledge will serve as a source of sustainable differentiation. Similarly, much suggests that the management of knowledge can positively influence and support the links between individual activities in the value stream, hence enabling the product-centered approach, which is fundamental to product lifecycle management (PLM). This paper draws on our experiences as a PLM and Knowledge Management (KM) supplier and highlights industry examples in aeronautics. It explores the potential application of a combined approach that utilizes digital support to encourage the effective use of KM throughout the product lifecycle

When the good times are over: Professionals meet new technology

Information and communication technologies play a key role in contemporary organizations. Supported by a longitudinal study of changes in purchasing practices, owing to the implementation of an e-business system at a large, global corporation, this article shows the interplay between the technology and the role of the users. We argue that the introduction of the e-business system increased the hierarchy and bureaucracy but also that the purchasers' professional identities and established work procedures were threatened by the technology being used. The results indicate how a technological artifact is by no means detached from the broader reformulating of managerial procedures and practices, instead reflecting and embodying some of the managerial virtues of predictability and hierarchy. Since technology is playing an increasingly key role in most industries and domains, it is also suggested that the intersection between technology and professions be examined in more detail