A case study of an EMR system at a large hospital in India: Challenges and strategies for successful adoption

This paper presents an ethnographically inspired interpretive case study of the Electronic Medical Record (EMR) system at Sankara Nethralaya hospital in India. It presents challenges related to the adoption of the system and methods and strategies that were utilized in order to overcome these challenges and help the system be adopted successfully. One of the more notable challenges at the hospital was a user base that included skeptical users, those lacking computing skills, and that had a history of rejecting designs. Despite these barriers the hospital was able to adopt the EMR system successfully. Notable issues related to the success of the system include the design strategy that was eventually used, and critical technical and social features of the system intended to support skeptical users and those lacking IT skills. The study contributes to overall understanding of the environment at large hospitals in developing countries as it relates to the adoption of EMR systems, and helps inform on methods that can be used to improve the adoption of EMR systems in similar contexts in both developed and developing countries.

[1]  William L. Anderson,et al.  Engineering practice and codevelopment of codevelopment of product prototypes , 1993, CACM.

[2]  Per Hasvold,et al.  A Framework for Mobile Services Supporting Mobile Non-office Workers , 2007, HCI.

[3]  Mark Rouncefield,et al.  Fieldwork for Design - Theory and Practice , 2007, Computer Supported Cooperative Work.

[4]  Don E Detmer,et al.  Research challenges for electronic health records. , 2007, American journal of preventive medicine.

[5]  John Doucette,et al.  Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries , 2009, Int. J. Medical Informatics.

[6]  Thomas G Rundall,et al.  Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study , 2005, BMJ : British Medical Journal.

[7]  Wanda J. Orlikowski,et al.  ICT and Organizational Change , 2006 .

[8]  Andrew Georgiou,et al.  Model Formulation: Multimethod Evaluation of Information and Communication Technologies in Health in the Context of Wicked Problems and Sociotechnical Theory , 2007, J. Am. Medical Informatics Assoc..

[9]  Rolf E. Nikula,et al.  Why Implementing EPR's Does Not Bring about Organizational Changes - A Qualitative Approach , 2001, MedInfo.

[10]  E. Coiera Four rules for the reinvention of health care , 2004, BMJ : British Medical Journal.

[11]  Enrico Coiera,et al.  Health Information Management: Integrating Information and Communication Technology in Health Care Work , 2003 .

[12]  J. Jacko,et al.  The human-computer interaction handbook: fundamentals, evolving technologies and emerging applications , 2002 .

[13]  Diana E. Forsythe,et al.  “It's Just a Matter of Common Sense”: Ethnography as Invisible Work , 1999, Computer Supported Cooperative Work (CSCW).

[14]  Madhu C. Reddy,et al.  Incorporating ideas from computer-supported cooperative work , 2004, J. Biomed. Informatics.

[15]  Diane M. Strong,et al.  Extending the technology acceptance model with task-technology fit constructs , 1999, Inf. Manag..

[16]  Mark Rouncefield,et al.  Fieldwork for Design: Theory and Practice (Computer Supported Cooperative Work) , 2007 .

[17]  Jonathan Grudin,et al.  Groupware and social dynamics: eight challenges for developers , 1994, CACM.

[18]  Elena Maceviciute,et al.  Review of: Oates, Briony J. Researching information systems and computing. London: Sage Publications, 2006 , 2006, Inf. Res..

[19]  Marc Berg,et al.  Implementing information systems in health care organizations: myths and challenges , 2001, Int. J. Medical Informatics.

[20]  Ian England,et al.  Health: IT leader or laggard? A comparative assessment of IT maturity. , 2003, Australian health review : a publication of the Australian Hospital Association.

[21]  J. Øvretveit,et al.  Improving quality through effective implementation of information technology in healthcare. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[22]  C. Aydin,et al.  Evaluating the organizational impact of healthcare information systems , 2005 .

[23]  Eric A. Brewer,et al.  Deploying a Rural Wireless Telemedicine System: Experiences in Sustainability , 2008, Computer.

[24]  Christian Heath,et al.  Documents and professional practice: “bad” organisational reasons for “good” clinical records , 1996, CSCW '96.

[25]  Karim Keshavjee,et al.  Best Practices in EMR Implementation: A Systematic Review , 2006, AMIA.

[26]  J Mildon,et al.  Drivers in the electronic medical records market. , 2001, Health management technology.

[27]  Marc Berg,et al.  Patient care information systems and health care work: a sociotechnical approach , 1999, Int. J. Medical Informatics.

[28]  Michael J. Muller,et al.  Participatory design: the third space in HCI , 2002 .

[29]  William L. Anderson,et al.  Engineering practice and codevelopment of product prototypes , 1993 .

[30]  Francisco del Pozo,et al.  Analysis of information and communication needs in rural primary health care in developing countries , 2005, IEEE Transactions on Information Technology in Biomedicine.

[31]  B. J. Oates,et al.  Researching Information Systems and Computing , 2005 .

[32]  K. Eisenhardt Building theories from case study research , 1989, STUDI ORGANIZZATIVI.

[33]  Kaj Grønbæk,et al.  Design in Action: From Prototyping by Demonstration to Cooperative Prototyping , 1992 .

[34]  Jesper Simonsen,et al.  A Regional PD Strategy for EPR Systems: Evidence-Based IT Development , 2006 .

[35]  Ole Hanseth,et al.  Implementing Open Network Technologies in Complex Work Practices: A Case from Telemedicine , 2000, Organizational and Social Perspectives on IT.

[36]  Monika Alise Johansen,et al.  "Garbage in, garbage out": extracting disease surveillance data from epr systems in primary care , 2008, CSCW.

[37]  Morten Kyng,et al.  Design at Work , 1992 .

[38]  Qi Li,et al.  Using qualitative studies to improve the usability of an EMR , 2005, J. Biomed. Informatics.

[39]  Sharon S. Choi,et al.  Implementing electronic medical record systems in developing countries. , 2005, Informatics in primary care.

[40]  Enrico W. Coiera,et al.  Putting the technical back into socio-technical systems research , 2007, Int. J. Medical Informatics.