The influence of context and process when implementing e-health

Abstract

BackgroundInvesting in computer-based information systems is notoriously risky, since many systems fail to become routinely used as part of everyday working practices, yet there is clear evidence about the management practices which improve the acceptance and integration of such systems. Our aim in this study was to identify to what extent these generic management practices are evident in e-health projects, and to use that knowledge to develop a theoretical model of e-health implementation. This will support the implementation of appropriate e-health systems.MethodsThis study consisted of qualitative semi-structured interviews with managers and health professionals in Scotland, UK. We contacted the Scottish Ethics Committee, who advised that formal application to that body was not necessary for this study. The interview guide aimed to identify the issues which respondents believed had affected the successful implementation of e-health projects. We drew on our research into information systems in other sectors to identify likely themes and questions, which we piloted and revised. Eighteen respondents with experience of e-health projects agreed to be interviewed. These were recorded, transcribed, coded, and then analysed with 'Nvivo' data analysis software.ResultsRespondents identified factors in the context of e-health projects which had affected implementation, including clarity of the strategy; supportive structures and cultures; effects on working processes; and how staff perceived the change. The results also identified useful implementation practices such as balancing planning with adaptability; managing participation; and using power effectively.ConclusionThe interviews confirmed that the contextual factors that affect implementation of information systems in general also affect implementation of e-health projects. As expected, these take place in an evolving context of strategies, structures, cultures, working processes and people. Respondents also confirmed that those managing such projects seek to change these contexts through observable implementation processes of planning, adaptation, participation and using power. This study confirms that research to support the delivery of appropriate e-health projects can usefully draw on the experience of information systems in other sectors.

A systematic review of medical and non-medical practitioners’ views of the impact of ehealth on shared care

“…Of the 12 articles reviewed, five gave an explicit or implicit definition of ehealth similar to WHO14 and ECIS,15 22 28 55–57 one provided a list of functionality and resource requirements58 while six defined a specific ehealth application but not ehealth itself 26 30 59–62. Although shared care is the basis for inclusion, only one paper included a definition: ‘establishing coherent treatment of the patient through close coordination and cooperation across care sector boundaries’60 while Melby et al 61 offered ‘integrated’ or ‘seamless’ care as alternative terms.…”

“…Three ehealth research themes were identified with a shared care focus: Telemedicine57 58 Generalised ehealth implementation22 56 59 Electronic health records26 28 30 55 60–62 …”

“…Some feature coauthors with a long tradition, and continuing interest, in ehealth research (Pagliari et al 59—Morrison, Sullivan; Boddy et al 22—Mair; Robertson et al 30—Barber).…”

Strategies and Solutions in eHealth: A Literature Review

“…As a consequence, in these cases even excellent eHealth-based customer care initiatives are likely not to be accepted by health care providers, unless other, more civilized barriers against patient (and expenditure) overload are provided to replace "good old" bureaucratic bothers and uncomfortable access! In other words, when we study health care strategies and eHealth solutions from the point of view of different stakeholders, it becomes apparent that innovation processes, to be successfully put in practice, must be founded on a sound awareness of the many, complex and contrasting interests hidden in the health care system they are faced with (Boddy et al 2009 ) .…”

Understanding Innovation Deployment and Evaluation in Healthcare: The Triality Framework

“…The introduction of technology in healthcare system introduce a number of changes to overall healthcare delivery, including the context where care is delivered and the way in which it is delivered (Boddy et al, 2009). This can result in factors contributing to conflict among its users and contradiction in overall goals ( May, 1993 However, to apply this approach appropriately, IS innovation based services such as telehealth and electronic records have to be seen as an extension of a healthcare social system that spans across time and space.…”