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Understanding Critical Barriers to Implementing a Clinical Information System in a Nursing Home Through the Lens of a Socio-Technical Perspective

  • Systems-Level Quality Improvement
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Abstract

This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n = 12) and semi-structured individual interviews (n = 18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve as a guide for future implementation strategies and policies in CIS initiatives.

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Acknowledgments

This work was supported by the Department of Industrial and Manufacturing Systems Engineering at the University of Hong Kong. We thank the Chief Executive and the manager of the nursing home for their support of this study. We are grateful to all the interviewees for their time. We also thank Jing Xu and Henry Wong for their effort in data collection and initially preparing this paper.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Industrial & Manufacturing Systems Engineering, The University of Hong Kong, Room 8-7, 8/f., Haking Wong Building, Pokfulam, Hong Kong

    Calvin Or

  2. DeGroote School of Business, McMaster University, Hamilton, ON, Canada

    Michael Dohan & Joseph Tan

  3. Faculty of Business Administration, Lakehead University, Thunder Bay, ON, Canada

    Michael Dohan

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  1. Calvin Or
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Correspondence to Calvin Or.

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Or, C., Dohan, M. & Tan, J. Understanding Critical Barriers to Implementing a Clinical Information System in a Nursing Home Through the Lens of a Socio-Technical Perspective. J Med Syst 38, 99 (2014). https://doi.org/10.1007/s10916-014-0099-9

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