Why is it difficult to implement e-health initiatives? A qualitative study.
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.
e-Health Unit, Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2 PF, UK. elizabeth.murray@ucl.ac.uk
Elizabeth
E
Murray
Joanne
J
Burns
Carl
C
May
Tracy
T
Finch
Catherine
C
O'Donnell
Paul
P
Wallace
Frances
F
Mair
D001292:Attitude to Computers; D002755:Choice Behavior; D003152:Community Health Nursing / Q000458:organization & administration; D003625:Data Collection; D004059:Diffusion of Innovation; D006801:Humans; D007407:Interviews as Topic; D008491:Medical Informatics Applications; D008962:Models, Theoretical; D019982:Organizational Case Studies; D011320:Primary Health Care; D036301:Qualitative Research; D011873:Radiology Information Systems / Q000458:organization & administration; D012017:Referral and Consultation; D006113:United Kingdom
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