ABSTRACT

Healthcare organizations now consider increased efficiency, reduced costs, improved patient care and quality of services, and safety when they are planning to implement new information and communication technology (ICT) based applications. However, in spite of enormous investment in health information systems (HIS), no convincing evidence of the overall benefits of HISs yet exists. 

The publishing of studies that capture the effects of the implementation and use of ICT-based applications in healthcare may contribute to the emergence of an evidencebased health informatics which can be used as a platform for decisions made by policy makers, executives, and clinicians. 

Health informatics needs further studies identifying the factors affecting successful HIS implementation and capturing the effects of HIS implementation. The purpose of the work presented in this thesis is to increase the available knowledge about the impact of the implementation and use of HISs in healthcare organizations. 

All the studies included in this thesis used qualitative research methods. A case study design and literature review were performed to collect data.

This thesis’s results highlight an increasing need to share knowledge, find methods to evaluate the impact of investments, and formulate indicators for success. It makes suggestions for developing or extending evaluation methods that can be applied to this area with a multi-actor perspective in order to understand the effects, consequences, and prerequisites that have to be achieved for the successful implementation and use of IT in healthcare.

The results also propose that HIS, particularly integrated computer-based patient records (ICPR), be introduced to fulfill a high number of organizational, individualbased, and socio-technical goals at different levels. It is therefore necessary to link the goals that HIS systems are to fulfill in relation to short-term, middle-term, and long-term strategic goals. Another suggestion is that implementers and vendors should direct more attention to what has been published in the area to avoid future failures. 

This thesis’s findings outline an updated structure for implementation planning. When implementing HISs in hospital and primary-care environments, this thesis suggests that such strategic actions as management involvement and resource allocation, such tactical action as integrating HIS with healthcare workflow, and such operational actions as user involvement, establishing compatibility between software and hardware, and education and training should be taken into consideration.

Motivation 

The science and practice of health or medical informatics changed radically in the late 1970s and early 1980s when computer use began to become increasingly common in healthcare environments (Shortliffe & Blois 2006). Since then, improvements in the speed and processing power of computers, computer networks, and the Internet has led to increased accessibility and availability of information for healthcare professionals to support their decision-making processes (Vimarlund et al 2008; Rose 2005; Winkelman & Leonard 2004; Chamorro 2001). According to Hassett (2002):

“A health information system (HIS) encompasses a wide array of applications and information systems that are linked or interfaced. A HIS supports the provision of care to patients and the business aspects of the healthcare organization by communicating information.”  

It is now hard to imagine healthcare without information and communication technology (ICT) based applications for both the accumulation and interchange of clinical information (Ammenwerth et al. 2004). This is in part because ICT-based applications have been recognized as enablers. This means that they are tools that offer solutions to the problem of the increasing accumulation of patient data (Timpka et al 2007; Andersen et al. 1994; Friedman 1996). Due to their central role in enabling ubiquitous access to information, ICTbased systems ensure a more efficient use of healthcare organizations’ scarce resources (Harrison et al. 2007; Rahimi et al 2008; Pardes et al. 2006).

With the increased spread of ICT-based applications in all healthcare domains from clinical settings to home healthcare environments, the financial return on investment is expected to rise (Eisenstein et al. 2008; Rahimi & Vimarlund 2007; Westbrook et al. 2004). Increased efficiency, reduced cost, improved patient care and quality of service, and safety are the factors that healthcare organizations now consider when planning to implement new ICT-based applications (Andersen & Aydin 2005; Chismar & Thomas 2004). 

However, in spite of the enormous investment in HIS, no convincing evidence of their overall benefits has been produced (Littlejohns et al. 2003). The outcomes of many HIS implementations in both primary care and hospital settings have either not met yet all the expectations or have failed in their implementation (Rahimi et al 2009; Heeks 2006; Garde et al. 2007). Such studies as Van Der Meijden et al. (2003) and Fullerton et al. (2006) have indicated undesired consequences. Kucukyazici et al. (2008) estimated the failure rate for new HIS implementations in healthcare organizations to be approximately 50%. 

The implementation of HIS is therefore a major challenge in the healthcare setting. Acknowledgement of this has led to a need for understanding the match between HISs and existing IT infrastructure, organizational structure, and established routines. This means that the decision-making process leading to the implementation and use of ICT-based applications in healthcare has to improve generally.

Implementing HISs successfully therefore appears to be a difficult task (Doebbeling &  Pekny 2008; Pagliari 2007). The publication of studies that capture the effects of the implementation and use of ICTbased applications in healthcare may contribute to the emergence of an evidence-based health informatics which can be used as a platform for decisions by policy makers, executives, and clinicians (Ammenwerth & De Keizer 2007). As information systems are strategically intended to affect organizations, people, and society (Kucukyazici et al. 2008; Berg 2001), further studies are needed to identify the factors affecting successful HIS implementation and those implementations’ effects. 

Problem statement 

The purpose of the work presented in this thesis is to increase the available knowledge about the impact of the implementation and use of HISs in healthcare organizations. It focuses on three problem areas. These are (a) the methodological approaches employed to capture the effects of HISs’ implementation and use, (b) the challenges and problems involved with the implementation of integrated computerized patient record systems (ICPRs), and (c) the key factors which influence the implementation of HISs.