Technology Implementation Case Studies: Lincus Software as a Service

  • Adie Blanchard
  • Faye Prior
  • Laura Gilbert
  • Tom DawsonEmail author


Stakeholders have often failed to foresee, identify and address implementation barriers when introducing new technologies into health and social care settings. As a result, many technologies have not been adopted by organisations or have failed to be used to their full potential. This chapter is written from the perspective of a small-sized technology enterprise in the UK and critically discusses the experiences of deploying a novel ‘software as a service system’ in the UK health and social care sectors. The chapter will specifically discuss the barriers that have been faced throughout implementations and how they were addressed in a series of case studies. We propose that the lessons learned from these implementations will be just as relevant in the future as they were at the time of writing.


Technology Implementation Barriers Healthcare Social care Software as a service 


  1. 1.
    Anderson, J. G. (2007). Social, ethical and legal barriers to e-health. International Journal of Medical Informatics, 76(5), 480–483.Google Scholar
  2. 2.
    Anderson, G. F., Frogner, B. K., Johns, R. A., & Reinhardt, U. E. (2006). Health care spending and use of information technology in OECD countries. Health Affairs, 25(3), 819–831.CrossRefGoogle Scholar
  3. 3.
    Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling, 48(2), 177–187.CrossRefGoogle Scholar
  4. 4.
    Bayer, S., Barlow, J., & Curry, R. (2007). Assessing the impact of a care innovation: Telecare. System Dynamics Review, 23(1), 61–80.CrossRefGoogle Scholar
  5. 5.
    Beuscart-Zéphir, M. C., Anceaux, F., Crinquette, V., & Renard, J. M. (2001). Integrating users’ activity modeling in the design and assessment of hospital electronic patient records: The example of anesthesia. International Journal of Medical Informatics, 64(2), 157–171.CrossRefGoogle Scholar
  6. 6.
    Buntin, M. B., Burke, M. F., Hoaglin, M. C., & Blumenthal, D. (2011). The benefits of health information technology: A review of the recent literature shows predominantly positive results. Health Affairs, 30(3), 464–471.CrossRefGoogle Scholar
  7. 7.
    Care Quality Commission. (2015). The state of health care and adult social care in England. [Online]. Available at: Accessed November 2016.
  8. 8.
    Cashen, M. S., Dykes, P., & Gerber, B. (2004). eHealth technology and internet resources: Barriers for vulnerable populations. Journal of Cardiovascular Nursing, 19(3), 209–214.CrossRefGoogle Scholar
  9. 9.
    Chismar, W.G., & Wiley-Patton, S. (2002). Test of the technology acceptance model for the internet in pediatrics. In Proceedings of the AMIA Symposium (p. 155). American Medical Informatics Association.Google Scholar
  10. 10.
    Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service (NHS CRS): Recommendations from the literature on successful implementation and adoption. Journal of Innovation in Health Informatics, 17(3), 153–160.CrossRefGoogle Scholar
  11. 11.
    Cresswell, K., & Sheikh, A. (2013). Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review. International Journal of Medical Informatics, 82(5), e73–e86.CrossRefGoogle Scholar
  12. 12.
    Cresswell, K., Coleman, J., Slee, A., Williams, R., & Sheikh, A. (2013a). Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals: A questionnaire study. PloS One, 8(1), e53369.CrossRefGoogle Scholar
  13. 13.
    Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013b). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, 20(e1), e9–e13.CrossRefGoogle Scholar
  14. 14.
    Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 1.CrossRefGoogle Scholar
  15. 15.
    Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13, 319–340.CrossRefGoogle Scholar
  16. 16.
    Edmondson, A. C., Bohmer, R. M., & Pisano, G. P. (2001). Disrupted routines: Team learning and new technology implementation in hospitals. Administrative Science Quarterly, 46(4), 685–716.CrossRefGoogle Scholar
  17. 17.
    Forouzanfar, M. H., Alexander, L., Anderson, H. R., Bachman, V. F., Biryukov, S., Brauer, M., Burnett, R., Casey, D., Coates, M. M., Cohen, A., Delwiche, K., et al. (2015). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(10010), 2287–2323.Google Scholar
  18. 18.
    Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., Patel V., & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Medicine, 10(1), e1001362.Google Scholar
  19. 19.
    Gagnon, M. P., Duplantie, J., Fortin, J. P., & Landry, R. (2006). Implementing telehealth to support medical practice in rural/remote regions: What are the conditions for success? Implementation Science, 1(1), 1.CrossRefGoogle Scholar
  20. 20.
    Gagnon, M. P., Desmartis, M., Labrecque, M., Car, J., Pagliari, C., Pluye, P., Frémont, P., Gagnon, J., Tremblay, N., & Légaré, F. (2012). Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. Journal of Medical Systems, 36(1), 241–277.CrossRefGoogle Scholar
  21. 21.
    van Gemert-Pijnen, J. E., Nijland, N., van Limburg, M., Ossebaard, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4), e111.CrossRefGoogle Scholar
  22. 22.
    Gilbert, L., & Dawson, T. (2014). One precious life: Technology report. Rescon Internal Publication.
  23. 23.
    Gilbert, L., Blanchard, A., Barton, J., & Dawson, T. (2014). Lincus: An adaptation and pilot usability study on individuals with learning disabilities. Rescon Internal Publication.
  24. 24.
    Glied, S., & Lleras-Muney, A. (2008). Technological innovation and inequality in health. Demography, 45(3), 741–761.CrossRefGoogle Scholar
  25. 25.
    Grant, R., Adams, A. S., Trinacty, C. M., Zhang, F., Kleinman, K., Soumerai, S. B., Meigs, J. B., & Ross-Degnan, D. (2007). Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management. Diabetes Care, 30(4), 807–812.Google Scholar
  26. 26.
    Gruber, D., Cummings, G. G., Leblanc, L., & Smith, D. L. (2009). Factors influencing outcomes of clinical information systems implementation: A systematic review. CIN: Computers, Informatics, Nursing, 27(3), 151–163.Google Scholar
  27. 27.
    Hall, B.H., & Khan, B. (2003). Adoption of new technology (No. w9730). National Bureau of Economic Research.Google Scholar
  28. 28.
    Ham, C. (2010). The ten characteristics of the high-performing chronic care system. Health Economics, Policy, and Law, 5(01), 71–90.CrossRefGoogle Scholar
  29. 29.
    Hartswood, M., Procter, R., Rouncefield, M., & Sharpe, M. (2000). Being there and doing IT in the workplace: A case study of a co-development approach in healthcare. In Proceedings of the 2000 Participatory Design Conference.Google Scholar
  30. 30.
    Henderson, C., Knapp, M., Fernández, J. L., Beecham, J., Hirani, S. P., Cartwright, M., Rixon, L., Beynon, M., Rogers, A., Bower, P., Doll, H., Fitzpatrick, R., Steventon, A., Bardsley, M., Hendy, J., Newman, S. P; Whole System Demonstrator evaluation team. (2013). Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): Nested economic evaluation in a pragmatic, cluster randomised controlled trial. British Medical Journal, 346, f1035. Google Scholar
  31. 31.
    House of Commons Health Committee. (2014). Managing the care of people with long-term conditions. [Online]. Available at: Accessed November 2016.
  32. 32.
    Hu, P. J., Chau, P. Y., Sheng, O. R. L., & Tam, K. Y. (1999). Examining the technology acceptance model using physician acceptance of telemedicine technology. Journal of Management Information Systems, 16(2), 91–112.CrossRefGoogle Scholar
  33. 33.
    Ipsos MORI. (2015). GP patient survey – National summary report. [Online]. Available at: Accessed November 2016.
  34. 34.
    Jha, A. K., DesRoches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G., Shields, A., Rosenbaum, S., & Blumenthal, D. (2009). Use of electronic health records in US hospitals. New England Journal of Medicine, 360(16), 1628–1638.CrossRefGoogle Scholar
  35. 35.
    Jimison, H., Gorman, P., Woods, S., Nygren, P., Walker, M., Norris, S., & Hersh, W. (2008). Barriers and drivers of health information technology use for the elderly, chronically III, and underserved. Evidence Reports/Technology Assessments, No. 175.Google Scholar
  36. 36.
    Keller, M. C., Fredrickson, B. L., Ybarra, O., Côté, S., Johnson, K., Mikels, J., Conway, A., & Wager, T. (2005). A warm heart and a clear head the contingent effects of weather on mood and cognition. Psychological Science, 16(9), 724–731.Google Scholar
  37. 37.
    Kemper, A. R., Uren, R. L., & Clark, S. J. (2006). Adoption of electronic health records in primary care pediatric practices. Pediatrics, 118(1), e20–e24.CrossRefGoogle Scholar
  38. 38.
    Keshavjee, K., Bosomworth, J., Copen, J., Lai, J., Kucukyazici, B., et al. (2006). Best practices in EMR implementation: A systematic review. American Medical Informatics Association Annual Symposium Proceedings, 2006, 982.Google Scholar
  39. 39.
    Kessels, R. P. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219–222.CrossRefGoogle Scholar
  40. 40.
    Ketikidis, P., Dimitrovski, T., Lazuras, L., & Bath, P. A. (2012). Acceptance of health information technology in health professionals: An application of the revised technology acceptance model. Health Informatics Journal, 18(2), 124–134.CrossRefGoogle Scholar
  41. 41.
    Kings Fund. (2008). Technology in the NHS. Transforming the patient’s experience of care. [Online]. Available at: Accessed November 2016.
  42. 42.
    Kumar, S., Nilsen, W. J., Abernethy, A., Atienza, A., Patrick, K., Pavel, M., Riley, W. T., Shar, A., Spring, B., Spruijt-Metz, D., & Hedeker, D. (2013). Mobile health technology evaluation: The mHealth evidence workshop. American Journal of Preventive Medicine, 45(2), 228–236.CrossRefGoogle Scholar
  43. 43.
    Leonard-Barton, D., & Deschamps, I. (1988). Managerial influence in the implementation of new technology. Management Science, 34(10), 1252–1265.CrossRefGoogle Scholar
  44. 44.
    Lorenzi, N. M., & Riley, R. T. (2000). Managing change. Journal of the American Medical Informatics Association, 7(2), 116–124.CrossRefGoogle Scholar
  45. 45.
    Ludwick, D. A., & Doucette, J. (2009). Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics, 78(1), 22–31.CrossRefGoogle Scholar
  46. 46.
    Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42(6), 505.CrossRefGoogle Scholar
  47. 47.
    Mair, F. S., May, C., Finch, T., Murray, E., Anderson, G., Sullivan, F., O’Donnell, C., Wallace, P., & Epstein, O. (2007). Understanding the implementation and integration of e-health services. Journal of Telemedicine and Telecare, 13(suppl 1), 36–37.CrossRefGoogle Scholar
  48. 48.
    Martin, T. (2012). Assessing mHealth: Opportunities and barriers to patient engagement. Journal of Health Care for the Poor and Underserved, 23(3), 935–941.CrossRefGoogle Scholar
  49. 49.
    McGinn, C. A., Grenier, S., Duplantie, J., Shaw, N., Sicotte, C., Mathieu, L., Leduc, Y., Légaré, F., & Gagnon, M. P. (2011). Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: A systematic review. BMC Medicine, 9(1), 1.CrossRefGoogle Scholar
  50. 50.
    Mitzner, T. L., Boron, J. B., Fausset, C. B., Adams, A. E., Charness, N., Czaja, S. J., Dijkstra, K., Fisk, A. D., Rogers, W. A., & Sharit, J. (2010). Older adults talk technology: Technology usage and attitudes. Computers in Human Behavior, 26(6), 1710–1721.CrossRefGoogle Scholar
  51. 51.
    NHS England. (2013). The NHS belongs to the people: A call to action. [Online]. Available at: Accessed November 2016.
  52. 52.
    NHS England. (2016). A and E attendances and emergency admissions. [Online]. Available at: Accessed November 2016.
  53. 53.
    NHS England Analytical Services. (2016). Referral to treatment (RTT) waiting times statistics for consultant-led elective care. [Online]. Available at: Accessed November 2016.
  54. 54.
    NICE Shared Learning Database. (2013). Lincus Trial: YMCA Liverpool pilot study for individuals with multiple and complex needs. [Online]. Available at: Accessed November 2016.
  55. 55.
    Operational Information for Commissioning. (2016). Delayed Transfers of Care Statistics for England 2015/16. [Online]. Available at: Accessed November 2016.
  56. 56.
    Or, C. K., Karsh, B. T., Severtson, D. J., Burke, L. J., Brown, R. L., & Brennan, P. F. (2011). Factors affecting home care patients’ acceptance of a web-based interactive self-management technology. Journal of the American Medical Informatics Association, 18(1), 51–59.CrossRefGoogle Scholar
  57. 57.
    Øvretveit, J., Scott, T., Rundall, T. G., Shortell, S. M., & Brommels, M. (2007). Improving quality through effective implementation of information technology in healthcare. International Journal for Quality in Health Care, 19(5), 259–266.CrossRefGoogle Scholar
  58. 58.
    Poon, E. G., Blumenthal, D., Jaggi, T., Honour, M. M., Bates, D. W., & Kaushal, R. (2004). Overcoming barriers to adopting and implementing computerized physician order entry systems in US hospitals. Health Affairs, 23(4), 184–190.CrossRefGoogle Scholar
  59. 59.
    Prior, F., & Dawson, T. (2016). Development of a holistic health economic evaluation tool leveraging patient self-report. IEEE. In Press. Google Scholar
  60. 60.
    Rogers, A., Kirk, S., Gately, C., May, C. R., & Finch, T. (2011). Established users and the making of telecare work in long term condition management: Implications for health policy. Social Science and Medicine, 72(7), 1077–1084.CrossRefGoogle Scholar
  61. 61.
    Sanders, C., Rogers, A., Bowen, R., Bower, P., Hirani, S., Cartwright, M., Fitzpatrick, R., Knapp, M., Barlow, J., Hendy, J., & Chrysanthaki, T. (2012). Exploring barriers to participation and adoption of telehealth and telecare within the whole system demonstrator trial: A qualitative study. BMC Health Services Research, 12(1), 1.CrossRefGoogle Scholar
  62. 62.
    Southon, F. C. G., Sauer, C., & Dampney, C. N. G. K. (1997). Information technology in complex health services. Journal of the American Medical Informatics Association, 4(2), 112–124.CrossRefGoogle Scholar
  63. 63.
    Steventon, A., Bardsley, M., Billings. J., Dixon. J., Doll, H., Hirani, S., Cartwright, M., Rixon, L., Knapp, M., Henderson, C., Rogers, A., Fitzpatrick, R., Hendy, J., Newman, S; Whole System Demonstrator Evaluation Team. (2012). Effect of telehealth on use of secondary care and mortality: Findings from the Whole System Demonstrator cluster randomised trial. British Medical Journal, 344, e3874.Google Scholar
  64. 64.
    Steventon, A., Bardsley, M., Billings, J., Dixon, J., Doll, H., Beynon, M., Hirani, S., Cartwright, M., Rixon, L., Knapp, M., Henderson, C., Rogers, A., Hendy, J., Fitzpatrick, R., & Newman, S. (2013). Effect of telecare on use of health and social care services: Findings from the Whole Systems Demonstrator cluster randomised trial. Age and Ageing, 42(4), 501–508.Google Scholar
  65. 65.
    Sudore, R. L., Landefeld, C. S., Pérez-Stable, E. J., Bibbins-Domingo, K., Williams, B. A., & Schillinger, D. (2009). Unraveling the relationship between literacy, language proficiency, and patient–physician communication. Patient Education and Counseling, 75(3), 398–402.CrossRefGoogle Scholar
  66. 66.
    The Kings Fund. (2016). A digital NHS? An introduction to the digital agenda and plans for implementation. [Online]. Available at: Accessed November 2016.
  67. 67.
    Thiru, K., Hassey, A., & Sullivan, F. (2003). Systematic review of scope and quality of electronic patient record data in primary care. British Medical Journal, 326(7398), 1070.CrossRefGoogle Scholar
  68. 68.
    UK Department of Health. (2011). Whole system demonstrator programme. [Online]. Available at: . Accessed November 2016.
  69. 69.
    UK Department of Health. (2012). Long term conditions compendium of information: 3rd edition. [Online]. Available at: Accessed November 2016.
  70. 70.
    UK Department of Health. (2016). Making IT work: Harnessing the power of health information technology to improve care in England. [Online]. Available at: Accessed November 2016.
  71. 71.
    Ward, R., Stevens, C., Brentnall, P., & Briddon, J. (2008). The attitudes of health care staff to information technology: A comprehensive review of the research literature. Health Information and Libraries Journal, 25(2), 81–97.CrossRefGoogle Scholar
  72. 72.
    Whittaker, R. (2012). Issues in mHealth: Findings from key informant interviews. Journal of Medical Internet Research, 14(5), e129.CrossRefGoogle Scholar
  73. 73.
    World Health Organization. (2013). Global action plan for the prevention and control of NCDs 2013–2020. [Online]. Available at: Accessed November 2016.
  74. 74.
    York Health Economics Consortium. (2009). Organisational and behavioural barriers to medical technology adoption (pp. 1–144). Coventry: York Health Economics Consortium.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Adie Blanchard
    • 1
  • Faye Prior
    • 1
  • Laura Gilbert
    • 1
  • Tom Dawson
    • 1
    Email author
  1. 1.Rescon Ltd, 2 The Kilns, Penn Croft FarmCrondallUK

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