Evaluating computerised health information systems: hard lessons still to be learnt
TL;DR: In this paper, the authors describe how the project and its evaluation were set up and examine where the project went wrong and the lessons learnt are applicable to the installa- tion of all hospital information systems.
Abstract: 5 gave us the opportunity to evaluate the introduction of computerisation into a new environ- ment. We describe how the project and its evaluation were set up and examine where the project went wrong. The lessons learnt are applicable to the installa- tion of all hospital information systems.
Citations
More filters
TL;DR: It is highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized and how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses is identified.
831 citations
Book•
19 Mar 2013
TL;DR: In this paper, the authors provide a framework for change and an action plan for a systems approach to health care delivery based on a partnership between engineers, health care professionals, and health care managers.
Abstract: The report builds on a growing realization within the health care community of the critical role information/ communications technologies, systems engineering tools, and related organizational innovations must play in addressing the interrelated quality and productivity crises facing the health care system. The report provides a framework for change and an action plan for a systems approach to health care delivery based on a partnership between engineers, health care professionals, and health care managers. The goal of the plan is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers, etc.) into a high-performance "system" in which participating units recognize their interdependence and the implications and repercussions of their actions on the system as a whole. The report describes opportunities and challenges to using systems engineering, information technologies, and other tools to advance a twenty-first century system capable of delivering safe, effective, timely, patient-centered, efficient, equitable health care — a system that embodies the six "equality aims" envisioned in Crossing the Quality Chasm.
623 citations
TL;DR: The UTAUT model was validated in the field context of a developing country's healthcare system and it was demonstrated that the PLS path modeling works well in a field study and in exploratory research with a complex model.
600 citations
TL;DR: It is suggested that the scaling (i.e., spreading) of intervention is a prerequisite, not a luxury, for sustainable action research, and more generally, IS implementations that are dispersed, large-scale, and have scarce resources.
Abstract: Our paper is motivated by one simple question: Why do so many action research efforts fail to persist over time? We approach this question, the problem of sustainability, building on a perspective on action research identifying the pivotal importance of networks. More precisely, local action research interventions need to be conceptualized and approached as but one element in a larger network of action in order to ensure sustainability. A vital aspect of our perspective is that local interventions depend heavily on the support of similar action research efforts in other locations. This is essential for the necessary processes of learning and experience sharing. We suggest that the scaling (i.e., spreading) of intervention is a prerequisite, not a luxury, for sustainable action research. Empirically, we base our analysis on an ongoing, large-scale action research project within the health care sector (called HISP) in a number of developing countries. HISP provides a fruitful occasion to investigate key criteria for our approach to action research, namely sustainability, scalability, and capacity to be politically relevant to the participants. We contribute to three discourses: (1) models of action research, (2) lessons for health information systems in developing countries, and (3) more generally, IS implementations that are dispersed, large-scale, and have scarce resources.
578 citations
TL;DR: A systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise.
Abstract: Is there any evidence that e-health—using information technology to manage patient care—can have a positive impact in developing countries? Our systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise. Evaluations of personal digital assistants and mobile devices convincingly demonstrate that such devices can be very effective in improving data collection time and quality. Donors and funders should require and sponsor outside evaluations to ensure that future e-health investments are well-targeted.
512 citations
References
More filters
Book•
21 Jan 2013
TL;DR: This chapter discusses Subjectivist Approaches to Evaluation, the design and conduct of Subjectivist Studies, and Organizational Evaluation of Medical Information Resources.
Abstract: 1. The Challenge of Evaluation in Medical Informatics 2. Evaluation as a Field 3. Studying Clinical Information Resources 4. The Structure of Objectivist Studies 5. The Basics of Measurement 6. Developing Measurement Technique 7. Design, Conduct and Analysis of Demonstration Studies 8. Subjectivist Approaches to Evaluation 9. Design and conduct of Subjectivist Studies 10. Organizational Evaluation of Medical Information Resources 11. Proposing, Reporting, and Refereeing Empirical Studies, and Study Ethics
493 citations
TL;DR: This is the first attempt to carry out an RCT evaluation of a multi-site implementation of an HIS in the world and should help to stimulate an evaluation culture in the health and welfare services in the Northern Province as well as building the capacity to undertake such evaluations in the future.
Abstract: Despite enormous investment world-wide in computerized health information systems their overall benefits and costs have rarely been fully assessed. A major new initiative in South Africa provides the opportunity to evaluate the introduction of information technology from a global perspective and assess its impact on public health. The Northern Province is implementing a comprehensive integrated hospital information system (HIS) in all of its 42 hospitals. These include two mental health institutions, eight regional hospitals (two acting as a tertiary complex with teaching responsibilities) and 32 district hospitals. The overall goal of the HIS is to improve the efficiency and effectiveness of health (and welfare) services through the creation and use of information, for clinical, administrative and monitoring purposes. This multi-site implementation is being undertaken as a single project at a cost of R130 million (which represents 2.5 per cent of the health and welfare budget on an annual basis). The implementation process commenced on 1 September 1998 with the introduction of the system into Mankweng Hospital as the pilot site and is to be completed in the year 2001. An evaluation programme has been designed to maximize the likelihood of success of the implementation phase (formative evaluation) as well as providing an overall assessment of its benefits and costs (summative evaluation). The evaluation was designed as a form of health technology assessment; the system will have to prove its worth (in terms of cost-effectiveness) relative to other interventions. This is more extensive than the traditional form of technical assessment of hardware and software functionality, and moves into assessing the day-to-day utility of the system, the clinical and managerial environment in which it is situated (humanware), and ultimately its effects on the quality of patient care and public health. In keeping with new South African legislation the evaluation process sought to involve as many stakeholders as possible at the same time as creating a methodologically rigorous study that lived within realistic resource limits. The design chosen for the summative assessment was a randomized controlled trial (RCT) in which 24 district hospitals will receive the HIS either early or late. This is the first attempt to carry out an RCT evaluation of a multi-site implementation of an HIS in the world. Within this design the evaluation will utilize a range of qualitative and quantitative techniques over varying time scales, each addressing specific aims of the evaluation programme. In addition, it will attempt to provide an overview of the general impact on people and organizations of introducing high-technology solutions into a relatively unprepared environment. The study should help to stimulate an evaluation culture in the health and welfare services in the Northern Province as well as building the capacity to undertake such evaluations in the future.
42 citations
Journal Article•
TL;DR: Medical Information Systems and hospital information systems involve using computers for storing, retrieving, and transmitting information for clinical, administrative, business, and sometimes research purposes.
Abstract: Computers first were introduced into medicine in the early 1950s at about the same time that they became available for uses in business and science. In the earliest years of medical computing, patient record information was collected primarily in order to conduct research that was expected to improve medical practice. During the 1960s, applications were developed that addressed the basic divisions of institutional medicine, patient care, research, administration, and education. By the end of the 1960s, developers began to integrate separate applications into what came to be called Medical Information Systems (MIS). The move toward integration marked a shift in how computers were viewed?a shift from research to patient care. The development of Medical Information Systems was part of this shift. Medical Information Systems and hospital information systems involve using computers for storing, retrieving, and transmitting information for clinical, administrative, business, and sometimes research purposes. These systems link patient tracking, census, and billing with physicians' orders to and the responses from various ancillary services (e.g., laboratory, pharmacy, dietary) as well as with clinical care information such as nurses' notes. Development of such systems began in the 1950s, both commercially and in academic institutions. Generally, commercial hospital information systems are
29 citations