Model Formulation: Contextual Implementation Model: A Framework for Assisting Clinical Information System Implementations

OBJECTIVE This paper presents a multiple perspectives model of clinical information system implementation, the CONTEXTual Implementation Model (CIM). Although other implementation models have been developed, few are grounded in data and others fail to take adequate account of the clinical environment and users' requirements. DESIGN The CIM arose from qualitative data collected from four clinical units in two large Australian teaching hospitals. The aim of the study was to explore physicians' test management work practices associated with the compulsory use of a hospital-wide, mandatory computerized provider order entry (CPOE) system.(1) The dataset consisted of non-participatory observations of physicians using CPOE (n=55 sessions) and interviews with health professionals (n=28) about test management work practices. Data were analyzed by two researchers independently using an iterative grounded approach. RESULTS A core underlying theme of 'contextual differences' emerged which explained physicians' use of the CPOE system in the sites. The CIM focuses attention on diversity at three contextual levels: the organizational level; the clinical or departmental level, and the individual level. Within each of these levels there are dimensions for consideration (for example, organizational culture, leadership and diverse ways of working) which affect physicians' attitudes to, and use of, CPOE. CONCLUSION The CIM provides a contextual differences perspective which can be used to facilitate the implementation of clinical information systems. Developing a clinical information system implementation model serves as a framework to guide future implementations to ensure their safe and efficient use and also improve the likelihood of uptake by physicians.

[1]  Dale Goodhue,et al.  Task-Technology Fit and Individual Performance , 1995, MIS Q..

[2]  Harold A. Linstone,et al.  Multiple Perspectives for Decision Making: Bridging the Gap between Analysis and Action , 1984 .

[3]  Chris Sauer,et al.  Research Paper: Information Technology in Complex Health Services: Organizational Impediments to Successful Technology Transfer and Diffusion , 1997, J. Am. Medical Informatics Assoc..

[4]  C. Atkinson,et al.  Transforming a hospital through growing, not building, an electronic patient record system. , 1998, Methods of information in medicine.

[5]  P. Gorman,et al.  Perceptions of physician order entry: results of a cross-site qualitative study. , 2003, Methods of information in medicine.

[6]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[7]  Edmund J. Metz Managing change toward a leading-edge information culture , 1986 .

[8]  T. Massaro Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior , 1993, Academic medicine : journal of the Association of American Medical Colleges.

[9]  Heshan Sun,et al.  The role of moderating factors in user technology acceptance , 2006, Int. J. Hum. Comput. Stud..

[10]  Guy Paré,et al.  Implementing clinical information systems: a multiple-case study within a US hospital , 2002, Health services management research.

[11]  Thomas H. Payne,et al.  A cross-site qualitative study of physician order entry. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[12]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[13]  Stephen B. Johnson,et al.  Grounding a new information technology implementation framework in behavioral science: a systematic analysis of the literature on IT use , 2003, J. Biomed. Informatics.

[14]  Deborah Compeau,et al.  Social Cognitive Theory and Individual Reactions to Computing Technology: A Longitudinal Study , 1999, MIS Q..

[15]  Marc Berg,et al.  Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context , 1998, Int. J. Medical Informatics.

[16]  E. Murphy,et al.  Evaluating medical information systems: ethnomethodological and interactionist approaches , 2001, Health services management research.

[17]  Paul N. Gorman,et al.  Computerized physician order entry in U.S. hospitals: results of a 2002 survey. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[18]  A. Bandura Social Foundations of Thought and Action , 1986 .

[19]  Gilad J. Kuperman,et al.  Synthesis of Research Paper: A Consensus Statement on Considerations for a Successful CPOE Implementation , 2003, J. Am. Medical Informatics Assoc..

[20]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[21]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[22]  Johanna I. Westbrook,et al.  Research Paper: The Effect of Physicians' Long-term Use of CPOE on Their Test Management Work Practices , 2006, J. Am. Medical Informatics Assoc..

[23]  D. R. Dixon,et al.  The behavioral side of information technology , 1999, Int. J. Medical Informatics.

[24]  Hans-Ulrich Prokosch,et al.  Visions and strategies to improve evaluation of health information systems: Reflections and lessons based on the HIS-EVAL workshop in Innsbruck , 2004, Int. J. Medical Informatics.

[25]  Joan S. Ash,et al.  Organizational factors that influence information technology diffusion in academic health sciences centers. , 1997, Journal of the American Medical Informatics Association : JAMIA.

[26]  Fred D. Davis User Acceptance of Information Technology: System Characteristics, User Perceptions and Behavioral Impacts , 1993, Int. J. Man Mach. Stud..

[27]  Bonnie Kaplan,et al.  Personal relationships with an intelligent interactive telephone health behavior advisor system: a multimethod study using surveys and ethnographic interviews , 2003, Int. J. Medical Informatics.

[28]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[29]  Deborah Compeau,et al.  Application of Social Cognitive Theory to Training for Computer Skills , 1995, Inf. Syst. Res..

[30]  David M. Schuster,et al.  Implementation Brief: Involving Users in the Implementation of an Imaging Order Entry System , 2003, J. Am. Medical Informatics Assoc..

[31]  A D Kaluzny,et al.  A Life Cycle Model of Continuous Clinical Process Innovation , 2000, Journal of healthcare management / American College of Healthcare Executives.

[32]  Bonnie Kaplan,et al.  Evaluating informatics applications - some alternative approaches: theory, social interactionism, and call for methodological pluralism , 2001, Int. J. Medical Informatics.

[33]  M Berg,et al.  Integrating Quantitative and Qualitative Methods in Patient Care Information System Evaluation , 2003, Methods of Information in Medicine.

[34]  Jos Aarts,et al.  Organizational issues in health informatics: a model approach , 1998, Int. J. Medical Informatics.

[35]  Jeffrey Braithwaite,et al.  Cultures in hospitals and their influence on attitudes to, and satisfaction with, the use of clinical information systems. , 2007, Social science & medicine.

[36]  Joan S. Ash,et al.  Principles for a Successful Computerized Physician Order Entry Implementation , 2003, AMIA.

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

[38]  Paul N. Gorman,et al.  Multiple perspectives on physician order entry , 2000, AMIA.

[39]  Nerida Creswick,et al.  What Do Doctors, Senior Managers and IT Professionals Perceive to Be the Key Factors in the Use of Clinical Information Systems? , 2002 .

[40]  Joan S. Ash,et al.  Implementing computerized physician order entry: the importance of special people , 2003, Int. J. Medical Informatics.

[41]  Gordon B. Davis,et al.  User Acceptance of Information Technology: Toward a Unified View , 2003, MIS Q..

[42]  T. Massaro Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior. , 1993 .

[43]  M. Miles,et al.  Data management and analysis methods. , 1994 .

[44]  A. Adam Whatever happened to information systems ethics? Caught between the devil and the deep blue sea , 2004 .

[45]  C. Marano,et al.  To err is human. Building a safer health system , 2005 .

[46]  E. Rogers Diffusion of Innovations , 1962 .

[47]  Fred D. Davis Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[48]  Larry N. Killough,et al.  Testing the Interaction Effects of Task Complexity in Computer Training Using the Social Cognitive Model , 2001, Decis. Sci..

[49]  Chris Sauer,et al.  Lessons from a failed information systems initiative: issues for complex organisations , 1999, Int. J. Medical Informatics.

[50]  Joan S. Ash,et al.  A diffusion of innovations model of physician order entry , 2001, AMIA.

[51]  Peter A. Todd,et al.  Assessing IT usage: the role of prior experience , 1995 .

[52]  L Narine,et al.  Gaining and maintaining commitment to large-scale change in healthcare organizations , 2003, Health services management research.

[53]  Joan S. Ash,et al.  Exploring the Unintended Consequences of Computerized Physician Order Entry , 2007, MedInfo.

[54]  Elske Ammenwerth,et al.  Evaluation of health information systems - problems and challenges , 2003, Int. J. Medical Informatics.

[55]  R. Wears,et al.  Computer technology and clinical work: still waiting for Godot. , 2005, JAMA.

[56]  James D. Carpenter,et al.  Adding Insight: A Qualitative Cross-Site Study of Physician Order Entry , 2004, MedInfo.

[57]  Marc Berg,et al.  Case Report: Understanding Implementation: The Case of a Computerized Physician Order Entry System in a Large Dutch University Medical Center , 2004, J. Am. Medical Informatics Assoc..

[58]  Nancy M. Lorenzi,et al.  The Success Factor ProrIle© for Clinical Computer Innovation , 2004, MedInfo.

[59]  Jos Aarts,et al.  Using a descriptive model of change when implementing large scale clinical information systems to identify priorities for further research , 1999, Int. J. Medical Informatics.

[60]  P. Lucas,et al.  Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin Lymphoma , 1998, Methods of Information in Medicine.

[61]  R D Zielstorff,et al.  Managing change: analysis of a hypothetical case. , 2000, Journal of the American Medical Informatics Association : JAMIA.

[62]  David W. Bates,et al.  Case Report: The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites , 2003, J. Am. Medical Informatics Assoc..

[63]  James D. Carpenter,et al.  Categorizing the unintended sociotechnical consequences of computerized provider order entry , 2007, Int. J. Medical Informatics.

[64]  Marc Berg,et al.  The contextual nature of medical information , 1999, Int. J. Medical Informatics.

[65]  R. T. Riley,et al.  Managing change: an overview. , 2000, Journal of the American Medical Informatics Association : JAMIA.