Abstract: We examined how five integrated delivery systems make decisions about and implement clinical information systems. Using case study methods, we identified general themes and explored how organizational context factors and information technology characteristics affect adoption and implementation processes.
Health care delivery organizations, especially integrated delivery systems (IDSs), have significantly increased investment in information technology (IT) in recent years.1-3 However, the use of IT in key clinical functions remains low.1-3 Indeed, many health care delivery organizations (including well-known IDSs) do not have IT systems that provide clinical information or support clinical decision-making.4,5 As such, the revolutionary promise that IT holds for transforming the way that care is delivered remains illusive for much of the health care industry.
As the Institute of Medicine6 noted in Crossing the Quality Chasm, a host of technical, behavioral, financial, and public policy challenges have slowed the development and application of clinical information systems. The most formidable barriers, the report suggests, are the organizational issues that health care delivery system leaders face as they make difficult decisions about how to adopt and implement clinical information systems. Examples include the following: Should health care delivery organizations adopt comprehensive solutions from a single vendor or purchase "best of breed" applications from multiple vendors? How do health care delivery organizations maintain a long-term, enterprise view in IT decision-making and at the same time stay abreast of rapidly changing products and vendors in disparate clinical domains? What role should physicians and other clinical personnel play in adoption and implementation decisions? Should clinical information systems be phased in across care delivery sites or installed everywhere all at once? Finally, should health care delivery organizations maintain parallel data entry and retrieval systems during implementation, and if so, for how long?
The successful development, application, and diffusion of clinical information systems depend largely on how health care delivery organizations address these organizational issues. Yet, little is known about how health care delivery organizations make decisions about and implement clinical information systems. Anecdotal reports typically describe successful implementations among the handful of health care delivery organizations leading the IT revolution. While informative, such reports do not provide a broad view of how organizations across the spectrum of IT experience make decisions about and implement clinical information systems. Consequently, leaders of more "typical" health care delivery organizations have had little opportunity to systematically learn about how their peers have grappled with these issues.
Lack of systematic data about how health care delivery organizations make decisions about and implement clinical information systems poses significant challenges for public policy-makers seeking to promote more widespread use of IT in health care. Adoption and implementation processes remain a "black box" for policy-makers, hampering efforts to devise targeted, effective national initiatives to promote the development, application, and diffusion of clinical information systems.
In this study, we examine how five IDSs make decisions about and implement clinical information systems. Using case study research methods, we identify general themes and explore how organizational factors and IT characteristics affect adoption and implementation processes. We conclude with implications for future research and management practice.