J Med Syst - Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective.

Tópicos

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Resumo

This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n=12) and semi-structured individual interviews (n=18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve as a guide for future implementation strategies and policies in CIS initiatives.

Resumo Limpo

paper address key barrier implement clinic inform system cis hong kong nurs home set healthcar specif sociotechn perspect data collect field observ n semistructur individu interview n cis stakehold hong kong nurs home analyz use immersioncrystal approach complex interact relev case contextu interpret within perspect sittigsingh healthcar sociotechn framework hstf three broad cluster implement barrier eight hstf dimens identifi infrastructurebas barrier relat conflict govern regul system function need user lack financi support inconsist workflow work polici procedur inadequaci hardwaresoftwar infrastructur technic support b processbas barrier relat mismatch technolog exist work practic workflow communic low system speed access stabil defici comput literaci experi health care profess clinic content inadequaci unavail well poor system use user interfac design c outcomebas barrier relat lack measur monitor system effect two addit dimens underlin import abil cis chang propos extend sittigsingh hstf first advocaci promot articul influenc chang system subsequ outcom cis stakehold second adapt ensur abil system adjust emerg need broad set discov implement shortcom expand prior research cis can fail nurs home set moreov investig offer knowledg base recommend can serv guid futur implement strategi polici cis initi

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