ABSTRACT
KATHRIN M. CRESSWELL, DAVID W. BATES, and AZIZ SHEIKH
2.1 INTRODUCTION
Large-scale, potentially transformative, implementations of health information technology are now being planned and undertaken in multiple countries. [1 ,2] The hope is that the very substantial financial, human, and organizational investments being made in electronic health records, electronic prescribing, whole-system telehealthcare, and related technologies will streamline individual and organizational work processes and thereby improve the quality, safety, and efficiency of care. The reality is, however, that these technologies may prove frustrating for frontline clinicians and organizations as the systems may not fit their usual workflows, and the anticipated individual and organizational benefits take time to materialize. [3 ,4] In this article, we reflect on our mapping of the literature (see box 1) and complement this with our experiences of studying a range of national evaluations of various large-scale health information technology systems in the UK and USA to provide key pointers that can help streamline implementation efforts. [4 ,52-54] In so doing, we hope to inform policy and practice development to support the more successful integration of technology into complex healthcare environments. This is particularly timely
given the US Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes a $19 billion stimulus package to promote the adoption of electronic health records and associated functionality. [55]
BOX 1: Factors associated with effective implementation identified in the literature [5-51]
Technical: usability, system performance, integration and interoperability, stability and reliability, adaptability and flexibility, cost, accessibility and adaptability of hardware
Social: attitudes and concerns, resistance and workarounds, expectations, benefits/ values and motivations, engagement and user input in design, training and support, champions, integration with existing work practices
Organizational: getting the organization ready for change, planning, leadership and management, realistic expectations, user ownership, teamwork and communication, learning and evaluation
Wider socio-political: other healthcare organizations, industry, policy, professional groups, independent bodies, the wider economic environment, international developments
This paper complements a previous publication by Bates and colleagues on ‘Ten commandments for effective clinical decision support’, [11] which focused on lessons learned in relation to clinical decision support systems. We have developed a technology lifecycle approach to highlight key considerations at four stages: establishing the need for change, selecting a system, implementation planning, and maintenance and evaluation (fi gure 1).
