title: Sustained User Engagement in Health Information Technology: The Long Road from Implementation to System Optimization of Computerized Physician Order Entry and Clinical Decision Support Systems for Prescribing in Hospitals in England.
abstract: To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing.
  
  
  
  Six hospitals in England, United Kingdom.
  
  
  
  Qualitative case study.
  
  
  
  We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals. Thematic analysis was initially undertaken within individual cases, followed by cross-case comparisons.
  
  
  
  We conducted 173 interviews, conducted 24 observations, and collected 17 documents between 2011 and 2015. We found that perceived individual and safety benefits among different user groups tended to facilitate engagement in some, while other less engaged groups developed resistance and unsanctioned workarounds if systems were perceived to be inadequate. We identified both the opportunity and need for sustained engagement across user groups around system enhancement (e.g., through customizing software) and the development of user competencies and effective use.
  
  
  
  There is an urgent need to move away from an episodic view of engagement focused on the preimplementation phase, to more continuous holistic attempts to engage with and respond to end-users.
authors.affiliation: Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Kathrin M
authors.initials: KM
authors.lastname: Cresswell
authors.affiliation: Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lee
authors.affiliation: Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Hajar
authors.initials: H
authors.lastname: Mozaffar
authors.affiliation: Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Williams
authors.affiliation: Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003258:Consumer Behavior; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D004739:England; D006739:Hospital Administration; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D014584:User-Computer Interface
keywords: Health information technology; adoption; engagement; implementation