Abstract
BackgroundImplementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays.MethodsWe undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U.K. We used a combination of semi-structured interviews from six case study sites and two whole day expert roundtable discussions to collect data. Interviews were carried out with users, implementers and suppliers of CPOE/CDS systems. We used thematic analysis to examine the results, drawing on perspectives surrounding the biography of artefacts.ResultsWe identified 15 major factors contributing to delays in implementation of CPOE and CDS systems. These were then categorized in a two-by-two delay classification matrix: one axis distinguishing tactical versus unintended causes of delay, and the second axis illustrating internal i.e., (the adopting hospital) versus external (i.e., suppliers, other hospitals, policymakers) related causes.ConclusionsOur taxonomy of delays in HIT implementation should enable system developers, implementers and policymakers to better plan and manage future implementations. More detailed planning at the outset, considering long-term strategies, sustained user engagement, and phased implementation approaches appeared to reduce the risks of delays. It should however be noted that whilst some delays are likely to be preventable, other delays cannot be easily avoided and taking steps to minimize these may negatively affect the longer-term use of the system.
Highlights
Implementation delays are common in health information technology (HIT) projects
Development of other applications Our findings show that implementations could be delayed as computerized physician order entry (CPOE)/clinical decision support (CDS) became dependent on the implementation of other applications
To understand and classify these delays, we have sought to develop a taxonomy of delays in relation to CPOE and CDS systems that go beyond a single organization and capture longer-term dynamics between different stakeholders
Summary
Implementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays. Policymakers in many countries consider health information technologies (HITs), such as computerized physician order entry (CPOE) and computer decision support (CDS) systems, to be critical attempts to achieve safer, higher quality, and more efficient health care [1,2,3,4,5,6]. Ross and Vitale [16] describe an extreme case, in which an implementation overran timelines so much that no one wanted the system by the time it went live In this case, interfacing a large number of disparate systems in the course of implementing an enterprise system led to unexpected integration testing times, which in turn contributed to the eventual nonacceptance of the system [16]
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