Why is it difficult to implement e-health initiatives? A qualitative study

Murray, E., Burns, J., May, C., Finch, T., O'Donnell, C. , Wallace, P. and Mair, F. (2011) Why is it difficult to implement e-health initiatives? A qualitative study. Implementation Science, 6(6), pp. 1-11. (doi:10.1186/1748-5908-6-6)

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Publisher's URL: http://dx.doi.org/10.1186/1748-5908-6-6

Abstract

Background The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.

Methods We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).

Results Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.

Conclusions Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mair, Professor Frances and O'Donnell, Professor Catherine
Authors: Murray, E., Burns, J., May, C., Finch, T., O'Donnell, C., Wallace, P., and Mair, F.
Subjects:R Medicine > RA Public aspects of medicine
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:Implementation Science
Publisher:BioMed Central
ISSN:1748-5908
Published Online:19 January 2011
Copyright Holders:Copyright © 2011 The Authors
First Published:First published in Implementation Science 6(6)
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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