Supporting Collaborative Work through ICT : How End-users Think of and Adopt Integrated HealthInformation Systems

Abstract: Health Information Systems (HISs) are implemented to support individuals,organizations, and society, making work processes integrated andcontributing to increase service quality and patient safety. However, theoutcomes of many HIS implementations in both primary care and hospitalsettings have either not met yet all the expectations decision-makersidentified or have failed in their implementation. There is, therefore, agrowing interest in increasing knowledge about prerequisites to be fulfilledin order to make the implementation and adoption of HIS more effective andto improve collaboration between healthcare providers.The general purpose of the work presented in this thesis is to explore issuesrelated to the implementation, use, and adoption of HISs and its contributionfor improving inter- and intra-organizational collaboration in a healthcarecontext. The studies included have, however, different research objectivesand consequently used different research methods such as case study,literature review, meta-analysis, and surveys. The selection of the researchmethodology has thus depended on the aim of the studies and their expectedresults.In the first study performed we showed that there is no standard frameworkto evaluate effects and outputs of implementation and use of ICT-basedapplications in the healthcare setting, which makes the comparison ofinternational results not possible yet.Critical issues, such as techniques employed to teach the staff when usingintegrated system, involvement of the users in the implementation process,and the efficiency of the human computer interface were particularlyreported in the second study included in this thesis. The results of this studyalso indicated that the development of evidence-based implementation processes should be considered in order to diminish unexpected outputs thataffect users, patients and stakeholders.We learned in the third study, that merely implementing of a HIS will notautomatically increase organizational efficiency. Strategic, tactical, andoperational actions have to be taken into consideration, includingmanagement involvement, integration in healthcare workflow, establishingcompatibility between software and hardware, user involvement, andeducation and training.When using an Integrated Electronic Prescribing System (IEPS), pharmaciesstaff declared expedited the processing of prescriptions, increased patientsafety, and reduced the risk for prescription errors, as well as the handingover of erroneous medications to patients. However, they stated also that thesystem does not avoid all mistakes or errors and medication errors stilloccur. We documented, however, in general, positive opinions about theIEPS system in the fifth article. The results in this article indicated thatsafety of the system compared to a paper-based one has increased. Theresults showed also an impact on customer relations with the pharmacy; andprevention of errors. However, besides finding an adoption of the IEPS, weidentified a series of undesired and non planned outputs that affect theefficiency and efficacy of use of the system.Finally, we captured in the sixth study indications for non-optimality in thecomputer provider entry system. This is because; the system was not adaptedto the three-quarters of physicians and one-half of nurses’ specificprofessional practice. Respondents pointed out also human-computerinteraction constrains when using the system. They indicated also the factthat the system could lead to adverse drug events in some circumstances.The work presented in this thesis contributes to increase knowledge in thearea of health informatics on how ICT supports inter- and intraorganizationalcollaborative work in a healthcare context and to identifyfactors and prerequisites needed to be taken into consideration whenimplementing new generations of HIS.