Journal of Medical Systems

, 38:151 | Cite as

Prioritizing Barriers to Successful Implementation of Hospital Information Systems

  • Leila Ahmadian
  • Reza Khajouei
  • Simin Salehi Nejad
  • Maryam Ebrahimzadeh
  • Somayeh Ezhari Nikkar
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement

Abstract

Hospital information systems (HIS) are often implemented to enhance the quality of care, as well as to improve the efficiency and safety of health care services. However, there are various barriers for their successful implementation. The aim of this paper is to prioritize these barriers. This research is a cross sectional analytic-descriptive study. The study populations were hospital managers, IT department administrators, and clinical supervisors at the academic and non-academic hospitals of two cities in Iran. The data was collected by a questionnaire that its content validity was confirmed by three specialists. Its reliability was confirmed using Cronbach’s alpha (α = 0.78). Questionnaire contained five dimensions and 39 implementation barriers. The collected data was analyzed by descriptive and analytical statistics using the Kendall Rank Correlation Coefficient and Chi2 tests. The findings of the study revealed that lack of powerful information networks, error in data entry, technical problems related to system design, lack of organizational training, lack of users’ knowledge about system and working with it, and negative attitudes of providers and patients toward systems are the most important barriers of HIS implementation. Prioritizing of these barriers helps policy makers to decide what to do when planning for HIS utilization.

Keywords

Hospital information systems Health information systems Hospitals Barriers Medical informatics Implementation 

Notes

Acknowledgments

We would like to acknowledge managers, IT department administrators and clinical supervisors who participated in this study. We would also like to thank experts who provided inputs for the revision of the questionnaire.

Conflict of Interest

None.

References

  1. 1.
    Lee, H. W., Ramayah, T., and Zakaria, N., External factors in hospital information system (HIS) adoption model: a case on Malaysia. Journal of medical systems 36(4):2129–2140, 2012. doi: 10.1007/s10916-011-9675-4.CrossRefGoogle Scholar
  2. 2.
    Kuhn, K. A., and Giuse, D. A., From hospital information systems to health information systems. Problems, challenges, perspectives. Methods of information in medicine 40(4):275–287, 2001.Google Scholar
  3. 3.
    Rahimi, B., Vimarlund, V., and Timpka, T., Health information system implementation: a qualitative meta-analysis. Journal of medical systems 33(5):359–368, 2009.CrossRefGoogle Scholar
  4. 4.
    Burton LC, Anderson GF, Kues IW (2004) Using electronic health records to help coordinate care. The Milbank quarterly 82 (3):457–481, table of contents. doi: 10.1111/j.0887-378X.2004.00318.x
  5. 5.
    Safran, C., msJAMA. Electronic medical records: a decade of experience. JAMA : the journal of the American Medical Association 285(13):1766, 2001.CrossRefGoogle Scholar
  6. 6.
    Salehinajad, S., Ahmaidn, L., and Khajouei, R., Affects of Health Information Systems in Iran: a Systematic Review. Journal of health information management 11(2):270–284, 2014.Google Scholar
  7. 7.
    Mandl, K. D., and Lee, T. H., Integrating medical informatics and health services research: the need for dual training at the clinical health systems and policy levels. Journal of the American Medical Informatics Association : JAMIA 9(2):127–132, 2002.CrossRefGoogle Scholar
  8. 8.
    Or, C., Dohan, M., and Tan, J., Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective. Journal of medical systems 38(9):99, 2014. doi: 10.1007/s10916-014-0099-9.CrossRefGoogle Scholar
  9. 9.
    Munson, S. A., Cavusoglu, H., Frisch, L., and Fels, S., Sociotechnical challenges and progress in using social media for health. Journal of medical Internet research 15(10):e226, 2013. doi: 10.2196/jmir.2792.CrossRefGoogle Scholar
  10. 10.
    Lai, H. M., Lin, I. C., and Tseng, L. T., High-level managers’ considerations for RFID adoption in hospitals: an empirical study in Taiwan. Journal of medical systems 38(2):3, 2014. doi: 10.1007/s10916-013-0003-z.CrossRefGoogle Scholar
  11. 11.
    Tung, F. C., Chang, S. C., and Chou, C. M., An extension of trust and TAM model with IDT in the adoption of the electronic logistics information system in HIS in the medical industry. International journal of medical informatics 77(5):324–335, 2008. doi: 10.1016/j.ijmedinf.2007.06.006.CrossRefGoogle Scholar
  12. 12.
    Wang, B. B., Wan, T. T., Burke, D. E., Bazzoli, G. J., and Lin, B. Y., Factors influencing health information system adoption in American hospitals. Health care management review 30(1):44–51, 2005.CrossRefGoogle Scholar
  13. 13.
    Anderson, J. G., Social, ethical and legal barriers to e-health. International journal of medical informatics 76(5–6):480–483, 2007. doi: 10.1016/j.ijmedinf.2006.09.016.CrossRefGoogle Scholar
  14. 14.
    Alkraiji, A., Jackson, T., and Murray, I., Barriers to the widespread adoption of health data standards: an exploratory qualitative study in tertiary healthcare organizations in Saudi Arabia. Journal of medical systems 37(2):9895, 2013. doi: 10.1007/s10916-012-9895-2.CrossRefGoogle Scholar
  15. 15.
    Legare, F., Ratte, S., Gravel, K., and Graham, I. D., Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient education and counseling 73(3):526–535, 2008. doi: 10.1016/j.pec.2008.07.018.CrossRefGoogle Scholar
  16. 16.
    Hayajneh SA, Zaghloul AA Barriers to the Adoption of Health Information Technology in Arab Countries’ Hospitals: Practitioners’ Perspective. In: Mantas J (ed) 24th International Conference of the European Federation for Medical Informatics Quality of Life through Quality of Information –MIE2012, 2012.Google Scholar
  17. 17.
    Gravel, K., Legare, F., and Graham, I. D., Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals’ perceptions. Implementation science : IS 1:16, 2006. doi: 10.1186/1748-5908-1-16.CrossRefGoogle Scholar
  18. 18.
    Guindon, G. E., Lavis, J. N., Becerra-Posada, F., Malek-Afzali, H., Shi, G., Yesudian, C. A., and Hoffman, S. J., Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 182(9):E362–372, 2010. doi: 10.1503/cmaj.081165.CrossRefGoogle Scholar
  19. 19.
    Anvar, F., and Shamim, A., Barriers in adoption of health information technology in developing societies. International Journal of Advanced Computer Science 2(8):40–45, 2011.Google Scholar
  20. 20.
    Rahimi B, Moberg A, Timpka T, Vimarlund V (2008) Implementing an integrated computerized patient record system: Towards an evidence-based information system implementation practice in healthcare. AMIA Annual Symposium proceedings / AMIA Symposium AMIA Symposium:616–620Google Scholar
  21. 21.
    Laerum, H., Karlsen, T. H., and Faxvaag, A., Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report. BMC medical informatics and decision making 4:18, 2004. doi: 10.1186/1472-6947-4-18.CrossRefGoogle Scholar
  22. 22.
    Simon, S. R., Kaushal, R., Cleary, P. D., Jenter, C. A., Volk, L. A., Poon, E. G., Orav, E. J., Lo, H. G., Williams, D. H., and Bates, D. W., Correlates of electronic health record adoption in office practices: a statewide survey. Journal of the American Medical Informatics Association : JAMIA 14(1):110–117, 2007. doi: 10.1197/jamia.M2187.CrossRefGoogle Scholar
  23. 23.
    McGinn, C. A., Grenier, S., Duplantie, J., Shaw, N., Sicotte, C., Mathieu, L., Leduc, Y., Legare, F., and Gagnon, M. P., Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC medicine 9:46, 2011. doi: 10.1186/1741-7015-9-46.CrossRefGoogle Scholar
  24. 24.
    Khajouei, R., and Jaspers, M. W., The impact of CPOE medication systems’ design aspects on usability, workflow and medication orders: a systematic review. Methods of information in medicine 49(1):3–19, 2010. doi: 10.3414/me0630.Google Scholar
  25. 25.
    Nabovati, E., Vakili-Arki, H., Eslami, S., and Khajouei, R., Usability evaluation of Laboratory and Radiology Information Systems integrated into a hospital information system. Journal of medical systems 38(4):35, 2014. doi: 10.1007/s10916-014-0035-z.CrossRefGoogle Scholar
  26. 26.
    Berg, M., Implementing information systems in health care organizations: myths and challenges. International journal of medical informatics 64(2–3):143–156, 2001.CrossRefGoogle Scholar
  27. 27.
    Berg, M., Patient care information systems and health care work: a sociotechnical approach. International journal of medical informatics 55(2):87–101, 1999.CrossRefGoogle Scholar
  28. 28.
    Loomis, G. A., Ries, J. S., Saywell, R. M., Jr., and Thakker, N. R., If electronic medical records are so great, why aren't family physicians using them? The Journal of family practice 51(7):636–641, 2002.Google Scholar
  29. 29.
    Walsh, S. H., The clinician's perspective on electronic health records and how they can affect patient care. BMJ (Clinical research ed) 328(7449):1184–1187, 2004. doi: 10.1136/bmj.328.7449.1184.CrossRefGoogle Scholar
  30. 30.
    Castillo, V. H., Martinez-Garcia, A. I., and Pulido, J. R., A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC medical informatics and decision making 10:60, 2010. doi: 10.1186/1472-6947-10-60.CrossRefGoogle Scholar
  31. 31.
    Boonstra, A., and Broekhuis, M., Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC health services research 10:231, 2010. doi: 10.1186/1472-6963-10-231.CrossRefGoogle Scholar
  32. 32.
    Simon, S. R., McCarthy, M. L., Kaushal, R., Jenter, C. A., Volk, L. A., Poon, E. G., Yee, K. C., Orav, E. J., Williams, D. H., and Bates, D. W., Electronic health records: which practices have them, and how are clinicians using them? Journal of evaluation in clinical practice 14(1):43–47, 2008. doi: 10.1111/j.1365-2753.2007.00787.x.CrossRefGoogle Scholar
  33. 33.
    Hsu, H. M., Hou, Y. H., Chang, I. C., and Yen, D. C., Factors influencing computer literacy of Taiwan and South Korea nurses. Journal of medical systems 33(2):133–139, 2009.CrossRefGoogle Scholar
  34. 34.
    Alasmary, M., El Metwally, A., and Househ, M., The association between computer literacy and training on clinical productivity and user satisfaction in using the electronic medical record in Saudi Arabia. Journal of medical systems 38(8):69, 2014. doi: 10.1007/s10916-014-0069-2.CrossRefGoogle Scholar
  35. 35.
    Trivedi, M. H., Daly, E. J., Kern, J. K., Grannemann, B. D., Sunderajan, P., and Claassen, C. A., Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in “real world” clinical settings. BMC medical informatics and decision making 9:6, 2009. doi: 10.1186/1472-6947-9-6.CrossRefGoogle Scholar
  36. 36.
    Urowitz, S., Wiljer, D., Apatu, E., Eysenbach, G., Delenardo, C., Harth, T., Pai, H., and Leonard, K. J., Is Canada ready for patient accessible electronic health records? A national scan. BMC medical informatics and decision making 8:33, 2008. doi: 10.1186/1472-6947-8-33.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Leila Ahmadian
    • 1
    • 5
  • Reza Khajouei
    • 2
    • 5
    • 6
  • Simin Salehi Nejad
    • 3
  • Maryam Ebrahimzadeh
    • 4
  • Somayeh Ezhari Nikkar
    • 5
  1. 1.Medical Informatics Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  2. 2.Research Center for Modeling in Health, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  3. 3.Research Center for Health Services Management, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  4. 4.BSc in Health Information Technology, Emam Reza HospitalMashhad University of Medical SciencesMashhadIran
  5. 5.Department of Management and Health Information Technology, Faculty of Management and Health Information SciencesKerman University of Medical SciencesKermanIran
  6. 6.Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran

Personalised recommendations