title: A near miss: the importance of context in a public health informatics project in a New Zealand case study.
abstract: This article describes the near failure of an information technology (IT) system designed to support a government-funded, primary care-based hepatitis B screening program in New Zealand. Qualitative methods were used to collect data and construct an explanatory model. Multiple incorrect assumptions were made about participants, primary care workflows and IT capacity, software vendor user knowledge, and the health IT infrastructure. Political factors delayed system development and it was implemented untested, almost failing. An intensive rescue strategy included system modifications, relaxation of data validity rules, close engagement with software vendors, and provision of intensive on-site user support. This case study demonstrates that consideration of the social, political, technological, and health care contexts is important for successful implementation of public health informatics projects.
authors.affiliation: Department of Health Informatics, Clinical Trials Research Unit, Faculty of Medical and Health Science, School of Population Health, University of Auckland, Auckland, New Zealand. swells@ihug.co.nz
authors.forename: Stewart
authors.initials: S
authors.lastname: Wells
authors.forename: Chris
authors.initials: C
authors.lastname: Bullen
mesh_terms: D000555:Ambulatory Care Information Systems; D006284:Health Plan Implementation; D006509:Hepatitis B / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs; D007345:Insurance Claim Review; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D008498:Medical Record Linkage; D009520:New Zealand; D019982:Organizational Case Studies; D010355:Patient Identification Systems; D040442:Public Health Informatics