Understanding Implementation: The Case of a Computerized Physician Order Entry System in a Large Dutch University Medical Center

Abstract

Most studies of the impact of information systems in organizations tend to see the implementation process as a "rollout" of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing information systems is determined by organizational factors. However, it is less clear what these factors are. The authors propose to characterize the introduction of an information system as a process of mutual shaping. As a result, both the technology and the practice supported by the technology are transformed, and specific technical and social outcomes gradually emerge. The authors suggest that insights from social studies of science and technology can help to understand an implementation process. Focusing on three theoretical aspects, the authors argue first that the implementation process should be understood as a thoroughly social process in which both technology and practice are transformed. Second, following Orlikowski's concept of "emergent change," they suggest that implementing a system is, by its very nature, unpredictable. Third, they argue that success and failure are not dichotomous and static categories, but socially negotiated judgments. Using these insights, the authors have analyzed the implementation of a computerized physician order entry (CPOE) system in a large Dutch university medical center. During the course of this study, the full implementation of CPOE was halted, but the aborted implementation exposed issues on which the authors did not initially focus.

User Perceptions and Expectations of the Personally Controlled Electronic Health Record (PCEHR): A Case Study of Australias e-health Solution

“…Different concerns have been raised in the system model and its supporting framework by stakeholders and e-health experts as indicated in the analysis. The results of this study support the argument of using theoretically rich and informed analysis techniques presented by Aarts et al, (2004);Cresswell et al, (2010); Wickramasinghe et al, (2009);Yusof et al, (2008).…”

“…The results were presented on the basis of user group perceptions and expectations from the MyHealth Record collected through survey questionnaires. The results have identified critical factors for the implementation and adoption of MyHealth Record through the lens of socio-technical system perspective (Aarts et al, 2004;Wickramasinghe et al, 2009;Yusof et al, 2008).…”

“…One approach identified in the literature used to correctly and accurately capture the complexities and levels of interactions in healthcare operations is to use a SocioTechnical System (STS) perspective (Aarts et al, 2004;Wickramasinghe et al, 2009;Yusof et al, 2008). A Socio-Technical system is described as a system where technical and social dimensions of a system are interrelated (Cresswell et al, 2010).…”

Organisational influences on nurses’ use of clinical decision support systems

“…While organisational factors are generally agreed to play an important role in the successful implementation of new technologies within healthcare, a lack of studies exploring this means there is uncertainty as to what these factors are [14]. Because of the complexity of healthcare organisations and the unpredictability of implementation, there is no simple formula for success [14;15].…”

Physician satisfaction with transition from CPOE to paper-based prescription

“…Despite calls for other hospitals to share experience on suboptimal implementation [14] [15], only a few cases of failure have been described in the literature [16] [17]. All of these reported failures, whether partial or total, have allowed the identification of factors associated with successful implementation of CPOE, which are now well described in the literature [18] [19].…”