Clinical information systems: understanding and preventing their premature demise.

ElectronicHealthcare Vol.3 No.4>2005 What hospital would not want a clinical information system (IS) where all information, orders and prescriptions for an individual patient are available in one place and accessible as needed? Many hospitals introduce these systems to much enthusiasm. Yet, a few months later, this positive attitude often deteriorates into frustration and even organized resistance. Sometimes, faced with outright rebellion, management is forced to withdraw the system or its most disrupting features, reverting to former practices. Indeed, many hospitals interrupt such projects after investing millions in software acquisition and implementation (Anderson 1997; Doolin 1999; Greene 2003). Such failures are not exclusive to the healthcare domain. Studies have shown that IS project failure is an enduring problem in all sectors of the economy (Wallace et al. 2004). Yet characteristics of hospital settings are distinctive enough to warrant studying their particular IS implementations (Fogel 1989). In an attempt to understand and prevent such failures, we conducted three in-depth case studies at hospitals that had implemented clinical IS. We followed their story from project inception to project termination (see box for a description of the research methodology; see Lapointe and Rivard 2004 for a complete account of the study). We analyzed each case using three models, each one aiming at explaining implementation outcomes at a different level: 1. the individual; 2. the group; 3. the organization. We chose this multilevel approach to obtain a thorough understanding of the phenomenon (Coghlan 1998). We found that each level has to be addressed if these systems are to thrive in a hospital environment. Clinical Information Systems: Understanding and Preventing Their Premature Demise