Are we doing it right? We need to evaluate the current approaches for implementation of digital health systems
Ronald Dendere
A C , Monika Janda A and Clair Sullivan A B
+ Author Affiliations
- Author Affiliations
A Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Qld 4102, Australia. Email: m.janda@uq.edu.au
B Digital Metro North, Metro North Hospital and Health Service, Department of Health, Queensland Government, Qld 4029, Australia. Email: Clair.Sullivan@health.qld.gov.au
C Corresponding author. Email: r.dendere@uq.edu.au
Australian Health Review 45(6) 778-781 https://doi.org/10.1071/AH20289
Submitted: 7 October 2020 Accepted: 28 May 2021 Published: 7 September 2021
Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND
Abstract
Successful implementation of digital health programs is imperative as it is becoming increasingly clear that digital solutions will underpin modern health care. These projects are often supported by large budgets and if not implemented successfully, the quality, safety, and efficiency of patient care may be compromised. Failure rates for the implementation of large, complex healthcare software platforms in digital health programs have been persistently high. Although several factors may contribute to the failure of such projects, the majority have been reported to fail largely due to poor project management. Nevertheless, little is known about the optimal project management approaches for digital health projects, with many health services reliant on external advisory companies and contractors for advice. Although publication bias makes it difficult to reliably study and understand global trends for the failure of digital health projects, examination of media reports and published literature indicates that this is a global phenomenon affecting digital health projects in North America, Europe and Australasia. In this article, our aim is to examine the literature for evidence underpinning current project management approaches used when implementing commercial, off-the-shelf healthcare information technology solutions, including complex healthcare software in large digital health programs in hospitals or across health systems, and evaluate the suitability of current project management approaches to deliver these projects. This starts to build an important evidence base for hospitals and health services considering digital transformation projects.
Keywords: healthcare information technology, healthcare software, medical software, implementation, project management, digital health, digital transformation, health informatics, Agile project management, Traditional project management.
References
[1] Keasberry J, Scott IA, Sullivan C, Staib A, Ashby R. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. Aust Health Rev 2017; 41 646–64.| Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.Crossref | GoogleScholarGoogle Scholar | 28063462PubMed |
[2] Sullivan C, Staib A, Ayre S, Daly M, Collins R, Draheim M, et al Pioneering digital disruption: Australia’s first integrated digital tertiary hospital. Med J Aust 2016; 205 386–9.
| Pioneering digital disruption: Australia’s first integrated digital tertiary hospital.Crossref | GoogleScholarGoogle Scholar | 27809727PubMed |
[3] Abouzahra M. Causes of failure in Healthcare IT projects. 3rd International Conference on Advanced Management Science; 4–6 November 2011; Kuala Lumpur, Malaysia. Singapore: IACSIT Press; 2011. p. 46–50.
[4] Box TL, McDonell M, Helfrich CD, Jesse RL, Fihn SD, Rumsfeld JS. Strategies from a nationwide health information technology implementation: the VA CART story. J Gen Intern Med 2010; 25 72–6.
| Strategies from a nationwide health information technology implementation: the VA CART story.Crossref | GoogleScholarGoogle Scholar | 20077156PubMed |
[5] Wears RLBerg M.
[6] Heeks R. Health information systems: failure, success and improvisation. Int J Med Inform 2006; 75 125–37.
| Health information systems: failure, success and improvisation.Crossref | GoogleScholarGoogle Scholar | 16112893PubMed |
[7] Kaplan B, Harris-Salamone KD. Health IT success and failure: recommendations from literature and an AMIA workshop. J Am Med Inform Assoc 2009; 16 291–9.
| Health IT success and failure: recommendations from literature and an AMIA workshop.Crossref | GoogleScholarGoogle Scholar | 19261935PubMed |
[8] Minion L. SA Government describes EPAS as a “failure” that is impairing hospital operations. HIMSS; 2018. Available at: https://www.healthcareit.com.au/article/sa-government-describes-epas-failure-impairing-hospital-operations.
[9] National Audit Office. Review of the final benefits statement for programmes previously managed under the National Programme for IT in the NHS. London: National Audit Office; 2013. Available at: https://www.nao.org.uk/report/review-of-the-final-benefits-statement-for-programmes-previously-managed-under-the-national-programme-for-it-in-the-nhs/.
[10] Silverstein SM. Contemporary issues in medical informatics: Good health IT, Bad health IT, and Common examples of healthcare IT difficulties. Drexel University, College of Information Science & Technology; 2015. Available at: http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases
[11] Justinia T. The UK’s National Programme for IT: Why was it dismantled? Health Serv Manage Res 2017; 30 2–9.
| The UK’s National Programme for IT: Why was it dismantled?Crossref | GoogleScholarGoogle Scholar | 28166675PubMed |
[12] Allen A. Lost in translation: Epic goes to Denmark. Politico; 2019. Available at: https://www.politico.com/story/2019/06/06/epic-denmark-health-1510223 [verified 3 February 2021].
[13] Zieger A. Denmark’s Health System Suffering Familiar EMR Woes. Healthcare IT Today; 2017. Available at: https://www.healthcareittoday.com/2017/02/21/denmarks-health-system-suffering-familiar-emr-woes/ [verified 3 February 2021].
[14] Sicotte C, Denis JL, Lehoux P. The computer based patient record: a strategic issue in process innovation. J Med Syst 1998; 22 431–43.
| The computer based patient record: a strategic issue in process innovation.Crossref | GoogleScholarGoogle Scholar | 9871877PubMed |
[15] Poitras JNB. Electronic medical records system rollout botched, says auditor general. Canada: CBC; 2021. Available at: https://www.cbc.ca/news/canada/new-brunswick/electronic-medical-record-system-1.5924178#:~:text=0-,The%20New%20Brunswick%20government%20botched%20the%20rollout%20of%20an%20electronic,Auditor%20General%20Kim%20Adair-MacPherson [verified 7 March 2021].
[16] Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study. BMJ 2005; 331 1313–6.
| Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 16269467PubMed |
[17] Costello D. Head of Kaiser’s digital project quits. United States: Los Angeles Times; 2006. Available at: https://www.latimes.com/archives/la-xpm-2006-nov-08-fi-kaiser8-story.html [verified 7 March 2021].
[18] Beynon-Davies P, Lloyd-Williams M. When health information systems fail. Top Health Inf Manage 1999; 20 66–79.
| 10539424PubMed |
[19] Southon FCG, Sauer C, Dampney CNG. Information technology in complex health services: organizational impediments to successful technology transfer and diffusion. J Am Med Inform Assoc 1997; 4 112–24.
| Information technology in complex health services: organizational impediments to successful technology transfer and diffusion.Crossref | GoogleScholarGoogle Scholar |
[20] Aarts J, Doorewaard H, Berg M. Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center. J Am Med Inform Assoc 2004; 11 207–16.
| Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center.Crossref | GoogleScholarGoogle Scholar | 14764612PubMed |
[21] Granja C, Janssen W, Johansen MA. Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. J Med Internet Res 2018; 20 e10235
| Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature.Crossref | GoogleScholarGoogle Scholar | 29716883PubMed |
[22] McLoughlin IP, Garrety K, Wilson R, Yu P, Dalley A. The Troubled History of Implementing EHRs. The Digitalization of Healthcare: Electronic Records and the Disruption of Moral Orders. Oxford Scholarship Online; 2017.
[23] Hoerbst A, Schweitzer M. A Systematic Investigation on Barriers and Critical Success Factors for Clinical Information Systems in Integrated Care Settings. Yearb Med Inform 2015; 10 79–89.
| 26293853PubMed |
[24] Norris AC. Current trends and challenges in health informatics. Health Informatics J 2002; 8 205–13.
| Current trends and challenges in health informatics.Crossref | GoogleScholarGoogle Scholar |
[25] Meadows G.. Implementing clinical IT in critical care: keys to success Nurs Econ 2003; 21 89–90.
| 12739200PubMed |
[26] Bata SA, Richardson T. Value of Investment as a Key Driver for Prioritization and Implementation of Healthcare Software. Perspect Health Inf Manag 2018; 15 1g
| 29618963PubMed |
[27] Fletcher GS, Payne TH. Selection and Implementation of an Electronic Health Record. PM R 2017; 9 S4–12.
| Selection and Implementation of an Electronic Health Record.Crossref | GoogleScholarGoogle Scholar | 28527502PubMed |
[28] Špundak M. Mixed Agile/Traditional Project Management Methodology – Reality or Illusion? Procedia Soc Behav Sci 2014; 119 939–48.
| Mixed Agile/Traditional Project Management Methodology – Reality or Illusion?Crossref | GoogleScholarGoogle Scholar |
[29] Tarne B. Don’t throw the baby out with the bathwater: how to combine and use both agile and traditional project management approaches. PMI® Global Congress 2007—North America. Atlanta, USA: Newtown Square, PA: Project Management Institute; 2007.
[30] Royce WW. Managing the Development of Large Software Systems. Proceedings IEEE WESCON, 25–28 August 1970; Los Angeles: IEEE; 1970. p. 1–9.
[31] Murray A, Bennett N, Bentley C. Office of Government Commerce GB. Managing successful projects with PRINCE2, 2009 edition manual. 5th edn. London: The Stationery Office; 2009.
[32] Project Management Institute. A guide to the project management body of knowledge. 4th edn. Pennsylvania, USA: Project Management Institute, Inc.; 2008.
[33] Beedle M, van Bennekum A, Cockburn A, Cunningham W, Fowler M, Highsmith J, et al. Manifesto for Agile Software Development. Agile Manifesto; 2001. Available at: https://agilemanifesto.org/
[34] Williams T. Assessing and moving on from the dominant project management discourse in the light of project overruns. IEEE Trans Engineer Manage 2005; 52 497–508.
| Assessing and moving on from the dominant project management discourse in the light of project overruns.Crossref | GoogleScholarGoogle Scholar |
[35] Alistair C. Agile software development. Addison-Wesley Longman Publishing Co., Inc.; 2002. 278 p.
[36] Lee G, Xia W. Toward agile: an integrated analysis of quantitative and qualitative field data. MIS QUART 2010; 34 87–114.
| Toward agile: an integrated analysis of quantitative and qualitative field data.Crossref | GoogleScholarGoogle Scholar |
[37] Vrhovec SLR, ed. Agile development of a hospital information system. 2016 39th International Convention on Information and Communication Technology, Electronics and Microelectronics (MIPRO); 30 May–3 June 2016. Opatija: IEEE; 2016.
[38] Lesmana IPD, Karimah RN, Widiawan B, eds. Agile-Waterfall hybrid for prevention information system of dengue viral infections: A case study in Health Department of Jember, East Java, Indonesia. 2016 14th International Conference on ICT and Knowledge Engineering (ICT&KE); 23–25 Nov. 2016. Bangkok: IEEE; 2016.
[39] Queensland Government Enterprise Architecture. Best practice methodologies: Queensland Government; 2020. Available at: https://www.qgcio.qld.gov.au/information-on/best-practice-methodologies [verified 3 February 2021].
[40] Australian Capital Territory. Frameworks; 2020. Available at: https://health.act.gov.au/digital/frameworks [cited 3 February 2021].
[41] Eden R, Sedera D. The largest admitted IT project failure in the southern hemisphere: A teaching case. In Tan B, Karahanna E, Srinivasan A, editors. Proceedings of the 35th International Conference on Information Systems. Association for Information Systems (AIS); 2014. p. 1–15. Available at: http://aisel.aisnet.org/:
[42] TIC Team. MSH Project Management Framework. Queensland Government; 2017. Available at: https://metrosouth.health.qld.gov.au/sites/default/files/content/msh_project_management_framework_v_1.0.pdf [verified 3 February 2021].
[43] Sullivan F. Analysis of Healthcare IT Spending in Australia. 2015. Available at: https://store.frost.com/analysis-of-healthcare-it-spending-in-australia.html.
[44] Moore S. Gartner Forecasts Australian Enterprise IT Spending to Grow 3.6% in 2021. Sydney: Gartner; 2020. Available at: https://www.gartner.com/en/newsroom/press-releases/2020-10-29-gartner-forecasts-australian-enterprise-it-spending-to-grow-3-point-6-percent-in-2021 [verified 2 February 2021].
[45] Cheema A, Shahid AA, eds. Customizing Project Management Methodology. 2005 Pakistan Section Multitopic Conference; 24–25 Dec. 2005. Karachi: IEEE; 2005.
[46] Nelson KM, Ghods M, Nelson HJ, eds. Measuring the effectiveness of a structured methodology: a comparative analysis. Proceedings of the Thirty-First Hawaii International Conference on System Sciences; 9 Jan 1998. Kohala Coast, Hawaii: IEEE; 1998.
[47] Alter SL. Information systems, a management perspective. Third ed. Reading, MA: Addison-Wesley; 1999.
[48] Cresswell KM, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak 2012; 12 15
| Integration of a nationally procured electronic health record system into user work practices.Crossref | GoogleScholarGoogle Scholar | 22400978PubMed |
[49] Takian A, Sheikh A, Barber N. We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England. BMC Health Serv Res 2012; 12 484
| We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England.Crossref | GoogleScholarGoogle Scholar | 23272770PubMed |
[50] Janols R, Lind T, Göransson B, Sandblad B. Evaluation of user adoption during three module deployments of region-wide electronic patient record systems. Int J Med Inform 2014; 83 438–49.
| Evaluation of user adoption during three module deployments of region-wide electronic patient record systems.Crossref | GoogleScholarGoogle Scholar | 24630924PubMed |
[51] Roberts M.. Successful Public Health Information System Database Integration Projects: A Qualitative Study. Online J Public Health Inform 2018; 10 e207
| Successful Public Health Information System Database Integration Projects: A Qualitative Study.Crossref | GoogleScholarGoogle Scholar | 30349625PubMed |
[52] Goodison R, Borycki EM, Kushniruk AW. Use of Agile Project Methodology in Health Care IT Implementations: A Scoping Review. In Improving Usability, Safety and Patient Outcomes with Health Information Technology. Studies in health technology and informatics; [140–5]. Amsterdam: IOS Press; 2019.
[53] Kitzmiller R, Hunt E, Sproat SB. Adopting best practices: ‘Agility’ moves from software development to healthcare project management Comput Inform Nurs 2006; 24 75–82.
| Adopting best practices: ‘Agility’ moves from software development to healthcare project managementCrossref | GoogleScholarGoogle Scholar | 16554690PubMed |
[54] Aldosari B. Causes of EHR projects stalling or failing: A study of EHR projects in Saudi Arabia. Comput Biol Med 2017; 91 372–81.
| Causes of EHR projects stalling or failing: A study of EHR projects in Saudi Arabia.Crossref | GoogleScholarGoogle Scholar | 29127903PubMed |
[55] Boonstra A, Versluis A, Vos JF. Implementing electronic health records in hospitals: a systematic literature review. BMC Health Serv Res 2014; 14 370
| Implementing electronic health records in hospitals: a systematic literature review.Crossref | GoogleScholarGoogle Scholar | 25190184PubMed |
[56] Chao C-A, Goldbort J. Lessons Learned from Implementation of a Perinatal Documentation System. J Obstet Gynecol Neonatal Nurs 2012; 41 599
| Lessons Learned from Implementation of a Perinatal Documentation System.Crossref | GoogleScholarGoogle Scholar | 22690726PubMed |
