Albert Boonstra

Implementing electronic health records in hospitals: a systematic literature review

BackgroundThe literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers.MethodsA systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles were also analyzed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: (1) written in English, (2) full text available online, (3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) satisfying established quality criteria.ResultsOf the 364 initially identified articles, this study analyzes the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a framework consisting of the following three interacting dimensions: (1) EHR context, (2) EHR content, and (3) EHR implementation process.ConclusionsAlthough EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity and presents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementers in developing effective EHR implementation strategies for hospitals.

Stakeholder management in IOS projects: analysis of an attempt to implement an electronic patient file

Implementing an inter-organizational system (IOS) requires significant organizational as well as technical changes. These will affect stakeholders (upon whom promoters depend) with varying degrees of power and with varying degrees of interest in the system. Identifying stakeholders and understanding the sources of their attitudes will enable promoters to meet their expectations more fully, and hence encourage acceptance. We examine these issues through a theoretically based study of an attempt to introduce an Electronic Patient File system in The Netherlands. All saw that the system would benefit patients, yet powerful players resisted its implementation, fearing it would affect their interests. This paper develops and tests a model of stakeholder management, showing that those with high interest in the system lacked the power to implement it, while those with low interest had the power to block it. These negative attitudes were shaped by concerns not about the system itself, but about the likely effects on working routines, power, culture and finance. This paper implies that those promoting an IOS (in any sector) should, from the outset of a project, identify their power sources and seek to reconcile stakeholder interests.

Towards Integrating Acceptance and Resistance Research: Evidence from a Telecare Case Study

There is wide agreement that acceptance and resistance are crucial factors in information system (IS) adoption. Research has yielded many theories that have focused on either acceptance or resistance, often implicitly assuming that these are opposites. This paper proposes a two-factor view on acceptance and resistance, and shows how this idea may advance our knowledge of IS adoption. In developing a user reactions framework, we take a first step towards integrating the IS literature on acceptance and on resistance. This framework distinguishes between two behavioural dimensions, namely, acceptance, ranging from high use to non-use, and a dimension that ranges from enthusiastic support to aggressive resistance. Combining the two dimensions leads to four categories of user reactions. We show the frameworks usefulness by analysing data from a telecare implementation project. The findings identify ambivalent reactions. Many clients are identified as supporting but non-using, while we also find telenurses and care coordinators that show themselves to be resisting but using. These findings support the view that non-acceptance and resistance are conceptually non-equivalent. Our data suggest voluntariness as one determinant of the variation in behavioural reactions encountered. We argue that the concepts are also functionally different: IS implementers will have to adapt their strategies to the different reactions described.

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

BackgroundAn ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?MethodsWe conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.ResultsOf the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.ConclusionsRural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

Risk management affecting IS/IT project success through communicative action

Project risk management is defined in the literature as being instrumental action based on rational problem solving. Research indicates limited positive effects of an exclusive focus of instrumental action on project success. This article proposes to extend this instrumental view through communicative action. This theoretical broadening was explored by interviewing project stakeholders about project success and risk management application. Analysis demonstrates stakeholders deliberately use risk management to convey messages to others, with the aim of influencing their behavior, synchronizing their perception, and making them aware of the context and their responsibilities. Stakeholders perceive these effects as contributing to project success.

Understanding ERP System Implementation in a Hospital by Analysing Stakeholders

Implementing enterprise resource planning (ERP) systems requires significant organisational, as well as technical, changes. These will affect stakeholders with varying perspectives and interests in the system. This is particularly the case in health care, as a feature of this sector is that responsibility of services is shared between many autonomous units. In these and similar settings, it is essential to analyse stakeholders and to understand their expectations and attitudes towards the system. Such an understanding will help implementers to address stakeholder interests and to encourage acceptance. Therefore, the purpose of this paper is to develop a theoretically based model to analyse how stakeholder attitudes and behaviours in a hospital setting affect the outcome of ERP implementation. This model is applied in an empirical study of a project to introduce an ERP system in medium-sized hospital in The Netherlands. The study shows how the ERP implementation impacts the interests of stakeholders such as physicians and administrators, which caused tensions. The paper examines the reasons of these tensions. In doing so, it contributes to our understanding of ERP implementation in health care and any other similar sectors from a stakeholder perspective, and it may help implementers to manage this more effectively.

Essential competencies for technochange management: Towards an assessment model

The term technochange refers to technology-driven organizational changes and covers the broad spectrum of aspects that are related to and have an impact on changes within organizations. Technochange processes are usually managed by change managers, who are responsible for successfully accomplishing the IT-related tasks in their projects, as well as every other structural and organizational dimension related to the implementation of technochanges. This paper discusses what competencies managers should have to carry out these processes effectively. On the basis of the existing literature, interviews with experts and case study research, we identify and test a set of IT- and non-IT-related competencies that are essential for managing technochange processes within and among organizations. Further, this paper presents a model for assessing and allocating project managers to IT technochange projects that match their competencies and skills. This model could also serve as a tool for developing technochange management competencies via targeted training programmes. A case study demonstrates how the assessment model can be used in practice. Finally, we make some suggestions for future research in the fields of change management and IT.

Social media use in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals.

BackgroundSince the emergence of social media in 2004, a growing percentage of patients use this technology for health related reasons. To reflect on the alleged beneficial and potentially harmful effects of social media use by patients, the aim of this paper is to provide an overview of the extant literature on the effects of social media use for health related reasons on patients and their relationship with healthcare professionals.MethodsWe conducted a systematic literature review on empirical research regarding the effects of social media use by patients for health related reasons. The papers we included met the following selection criteria: (1) published in a peer-reviewed journal, (2) written in English, (3) full text available to the researcher, (4) contain primary empirical data, (5) the users of social media are patients, (6) the effects of patients using social media are clearly stated, (7) satisfy established quality criteria.ResultsInitially, a total of 1,743 articles were identified from which 22 were included in the study. From these articles six categories of patients’ use of social media were identified, namely: emotional, information, esteem, network support, social comparison and emotional expression. The types of use were found to lead to seven identified types of effects on patients, namely improved self-management and control, enhanced psychological well-being, and enhanced subjective well-being, diminished subjective well-being, addiction to social media, loss of privacy, and being targeted for promotion. Social media use by patients was found to affect the healthcare professional and patient relationship, by leading to more equal communication between the patient and healthcare professional, increased switching of doctors, harmonious relationships, and suboptimal interaction between the patient and healthcare professional.ConclusionsOur review provides insights into the emerging utilization of social media in healthcare. In particular, it identifies types of use by patients as well as the effects of such use, which may differ between patients and doctors. Accordingly, our results framework and propositions can serve to guide future research, and they also have practical implications for healthcare providers and policy makers.

Managing IS adoption in ambivalent groups

Insightful implementers refocus user ambivalence and resistance toward trust and acceptance of new systems.

The influence of ERP implementation on the division of power at the production‐sales interface

Purpose – The purpose of this paper is to develop and validate a model that demonstrates the influence of enterprise resource planning (ERP) implementation on the power and interests of actors at the production‐sales interface, and vice versa.Design/methodology/approach – An empirical in‐depth longitudinal case study examines how a medium‐sized company in the graphics industry implemented an ERP system and how this has affected the interests and power distribution between the manufacturing and sales departments.Findings – The case study reveals that the power division among key players at the production‐sales interface has been affected by the ERP implementation. These changes influence their attitudes and behaviours as well as the usage of the ERP system.Research limitations/implications – Limitations are associated with the inherent weaknesses of any research based on a single‐case study: theoretical, but not statistical, generalisations are possible.Practical implications – The findings imply that thos...